Pediatric Nursing
Pediatric Nursing
Pediatric Nursing
of mitotic divisions
FETUS FORMATION o Becomes a
How? BLASTOMERE
o Two (2) donors Blastomere
Father o Also undergoes a
XY series of mitotic
Mother divisions
XX o Becomes a MORULA
Morula becomes a
Mother Father BLASTOCYST with a cavity
(XX) (XY) The Blastocyst with a cavity
egg cell sperm cell is found in the uterus
▼▼▼ sexual ▼▼▼
▼▼▼ intercourse ▼▼▼ Blastocyst Cavity
▼▼▼ ▼▼▼ ▼▼▼▼▼▼ ▼▼▼▼▼▼
▼▼▼ ▼▼▼ Trophoblast Embryoblast
▼▼▼ ▼▼▼ ▼▼▼▼▼▼ ▼▼▼▼▼▼
▼▼▼ Chorion ▼▼▼▼▼▼
fertilization ▼▼▼▼▼▼ ▼▼▼▼▼▼
(egg and sperm cell unite) Placenta ▼▼▼▼▼▼
▼▼▼ ▼▼▼▼▼▼
Forms the zygote ▼▼▼▼▼▼
▼▼▼▼▼▼
Important Concepts! ▼▼▼▼▼▼
The father determines the sex ▼▼▼▼▼▼
of the child ▼▼▼▼▼▼
Ampulla of the Fallopian Tube ▼▼▼▼▼▼
o The process of ▼▼▼▼▼▼
fertilization occurs here Amnion
o Egg and sperm cells ▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼E
meet at this area mbryonic Umbilical Umbilical
o It takes three (3) to five Disc Cord Sac
(5) minutes before the ▼▼▼▼▼▼
sperm cell reaches the Most important
ampulla part of the
Amnion
Important Concepts! ▼▼▼▼▼▼
Zygote Becomes the
o The product of Fetus
fertilization
o It is found in the Other Important Concepts!
ampulla of the Blastocyst with a Cavity
fallopian tube o The biggest in size
o It is unicellular o This is normally found
in the uterus
1
o If the blastocyst stays Key Concepts!
in the Fallopian Tube, it Importance of Seven Cardinal
lodges in the Isthmus Movements of Labor
of the Fallopian Tube
Isthmus Responsible for squeezing the
o Narrowest portion of shoulders and chest of the
the Fallopian Tube newborn
o Is the most common
site of Ectopic Remember that the entire
Pregnancy lung of the fetus contains
amniotic fluid
Important Concepts!
In normal pregnancy The lung does not function yet
o Fetus stays for nine
(9) months in the When both chest and
womb shoulder of the baby are
o Customized in the being squeezed, seven (7) to
intrauterine forty-two (42) ml of amniotic
environment as it fluid are removed from the
stays there for nine lungs of the newborn
(9) months
This would aid in the
Intrauterine Environment (9 months) breathing of the baby
▼▼▼▼▼▼
▼▼▼▼▼▼ This would make the lung
▼▼▼▼▼▼ Second Stage of Labor functional and make the baby
▼▼▼▼▼▼ Seven (7) Cardinal take his or her first breath
▼▼▼▼▼▼ Movements in Normal
▼▼▼▼▼▼ Spontaneous Delivery Important Concepts!
▼▼▼▼▼▼ In contrast, in Caesarian
▼▼▼▼▼▼ Deliveries, the seven (7)
Newborn (Extrauterine Environment) Cardinal Movements of Labor
are not utilized
Seven (7) Cardinal Movements of
Labor There is no mechanism
Experienced during Normal whereby seven (7) to forty-two
Spontaneous Delivery (42) ml of amniotic fluid would
o Engagement be removed from the baby’s
lungs
o Fetal Descent
o Flexion
Thus, the priority nursing
o Internal Rotation diagnosis for a baby born
o Extension through Caesarian Section is
o External Rotation Ineffective Airway Clearance
o Expulsion
2
Physiologic Changes that are Oxygen and Carbon Dioxide
Responsible for making the pass through the placenta
Newborn Breathe for the First
Time Clamping of Umbilical Cord
Does not allow the passage of
Mother Oxygen from the mother to
▼▼▼▼▼ the fetus
▼▼▼▼▼Placenta Thus, when the umbilical cord
▼▼▼▼▼ is clamped
▼▼▼ o There is a decrease in
▼▼▼ Clamping of oxygenation of the
▼▼▼ Umbilical Cord newborn
▼▼▼ o There is an increase in
▼▼▼▼▼ carbon dioxide levels in
▼▼▼▼▼ the newborn
▼▼▼▼▼ o When carbon dioxide
Fetus levels increase, the
blood pH level drops
How is Clamping of the Umbilical Therefore, the following
Cord Done? CHEMICAL STIMULI:
First Step o Decreased Oxygen
o Clamp is applied at o Increased Carbon
MATERNAL SIDE Dioxide
Second Step o Decreased Blood pH
o Milk the umbilical cord Will stimulate the MEDULLA
towards the FETAL OBLONGATA for the newborn
SIDE to BREATHE FOR THE
Third Step FIRST TIME!!!
o Clamp is applied at
FETAL SIDE Important Concept!
Upon growing older, both:
Nursing Responsibility o Decrease in Oxygen
Clamp and Cut the Umbilical levels
Cord o Increase in Carbon
Dioxide levels
Important Concept! Become respiratory drives
Upon clamping and cutting of
Umbilical Cord, physiological Intrauterine Environment (9 months)
changes NOW START! This is a RELATIVELY WARMER
ENVIRONMENT
Cutting of Umbilical Cord ▼▼▼▼▼▼
Decreases oxygenation of the ▼▼▼▼▼▼
newborn ▼▼▼▼▼▼
Placenta is a structure Newborn (Extrauterine Environment)
responsible for fetal This is a RELATIVELY COOLER
respiration ENVIRONMENT
3
Important Concept! oxygen levels in the
First task of the newborn upon newborn’s blood
birth is to ADJUST TO Increased carbon dioxide
EXTRAUTERINE levels in the newborn’s blood
ENVIRONMENT Abrupt changes in the
external temperature
Important Concepts!
Abrupt changes in Difference between FETAL
temperature, like the CIRCULATION and PULMONARY
following: SYSTEMIC CIRCULATION
o Warmer intrauterine
environment Pulmonary Systemic Circulation
o Cooler extrauterine
environment Lungs
Causes ▼▼▼
stimulation of Pulmonary Vein
RECEPTORS in ▼▼▼
the SKIN Left Atrium
This would, in turn, stimulate ▼▼▼
the MEDULLA OBLONGATA Left Ventricle
and cause the BABY TO ▼▼▼
BREATHE FOR THE FIRST Aorta
TIME!!! ▼▼▼▼▼▼▼▼▼▼▼
These are called the ▼▼▼ ▼▼▼
THERMAL STIMULI!!! ▼▼▼ ▼▼▼
Upper Lower
Key Concept! Extremities Extremities
Pain is NOT NECESSARY for ▼▼▼ ▼▼▼
the newborn to breathe for the ▼▼▼ ▼▼▼
first time. Superior Inferior
Therefore, spanking the Vena Cava Vena Cava
newborn immediately upon ▼▼▼▼▼▼▼▼▼▼▼
birth is no longer practiced Right Atrium
▼▼▼
Key Concepts! Right Ventricle
Therefore, CHEMICAL and ▼▼▼
THERMAL STIMULI are Pulmonary Artery
responsible for making the ▼▼▼
baby breathe for the first time! Back to the Lungs
4
o However, they carry o A hole between right
more oxygenated blood and left atrium
Veins Ductus Arteriosus
o Carry both oxygenated o An artery that connects
and deoxygenated pulmonary artery and
blood aorta
o However, they carry
more deoxygenated
blood
Fetal Circulation (continued from
FETAL CIRCULATION left side of page)
5
o Is to bypass the lungs Key Concepts!
Rationale Upon closure of the Foramen
o Because fetal Ovale, blood in the Right
circulation already Atrium GOES TO THE RIGHT
carries oxygen VENTRICLE
6
Key Concepts!!! needed in the urinary bladder
Upon closure of the Ductus to create an URGE TO VOID
Arteriosus, blood GOES TO
THE LUNGS In adults, six hundred
Normally, the Ductus milliliters (600 ml) of urine is
Arteriosus takes about fifteen needed in the urinary bladder
(15) minutes to twelve (12) for it to contract
hours to close
Important Concepts in the
Congenital Heart Diseases Urination of the Newborn!!!
Atrial Septal Defect In the newborn, only fifteen
o Failure of the Foramen milliliters (15 ml) of urine in
Ovale to close the bladder is needed to
Patent Ductus Arteriosus create an URGE TO VOID
o Failure of the Ductus
Arteriosus to close Therefore, newborns have
more FREQUENT VOIDING
Normal Physiological Changes in relative to adults
the Newborn related to the Renal
System Normally, the newborn voids
up to twenty times (20x) in a
Important Concepts!!! day!!!
All structural organs MUST
BE PRESENT AT BIRTH in a Characteristics of Urine in the
normal newborn Newborn
Normal Newborn Urine is
These ORGANS are Colorless
IMMATURE and CANNOT Odorless
FULLY FUNCTION Sterile (applies to the first
void)
When these organs REACH
THE AGE OF ONE (1) YEAR, Important Concepts!!!
they ATTAIN MATURITY Newborns should void within
the FIRST TWENTY-FOUR
Important Concepts!!! (24) HOURS, maximum is
The function of the kidney is FORTY-EIGHT (48) HOURS
to filter the blood
If voiding does not occur
The urinary bladder is made within twenty-four (24) to
up of smooth muscle forty-eight (48) hours, the
possible problems are:
Distention of the smooth o Obstruction
muscle causes contraction o Abnormal positioning of
the urethral opening
In adults, two hundred fifty
milliliters (250 ml) of urine is
7
Normally the urethral opening Hirsprung’s
is at the tip of the glans penis Disease
Aganglionic
Conditions wherein the Urethal Megacolon
Opening is not on the tip of the Meconium becomes
Glans Penis: transitional stool if the
Epispadia newborn is fed with either
o Urethral opening is on breast milk or formula milk
the dorsal side of the
glans penis Difference in Characteristics of
Hypospadia Stool of Infants given Breast
o Urethral opening is on Milk and of Infants given
the ventral side of the Formula Milk
glans penis
Stool Breast Formula
Key Concept! Characteristic Milk Milk
Color Yellow to Pale or
Patients with epispadia and Golden Light Yellow
hypospadia CANNOT to Light
UNDERGO CIRCUMCISION Brown
Rationale: Odor Sour milk More Foul
Because prepuce or foreskin odor or
Offensive
are used in the repair of both odor
epispadia and hypospadia Consistency Pasty or Much Finer
Scrambled- appearance
Gastrointestinal System of the egg
Newborn appearance
Considered sterile at birth
Contains NO BACTERIA Important Concept!
Normal odor of stool of adults
Important Concepts! is AROMATIC!!!
Meconium Bacteria (E. coli) gives the
This is the first stool of the adult stool its foul odor
newborn
This is considered as Blood and Circulatory System of
STERILE the Newborn
Normally greenish black
Normally viscous Cyanosis
Should be present in the first Bluish discoloration of the skin
twenty-four (24) to forty-eight
(48) hours Key Concept!
o Defecation must occur MAIN REASON for the
within this period occurrence of cyanosis is
o If not, possible INCREASED LEVELS OF
problems are: UNOXYGENATED BLOOD
Imperforate and NOT THE DECREASED
anus LEVELS OF OXYGENATED
BLOOD!!!
8
Hema / Hepa Concepts in the Important Concepts!!!
Newborn In the liver, glucoronyl
Red Blood Cells of the transferase converts indirect
Newborn are IMMATURE bilirubin to direct bilirubin
Hemoglobin of the Newborn is
IMMATURE Since the liver of the newborn
The Liver of the Newborn is is immature, there are
IMMATURE decreased levels of glucoronyl
transferase
Important Concepts!!!
Normal lifespan of RBC / Hgb Thus, indirect bilirubin is NOT
is ninety (90) to one hundred CONVERTED to direct
twenty (120) days bilirubin
9
Blood Volume in the Newborn o Immunoglobulin A
Normal is 80 – 110 ml / kg BW Received
through breast-
Average blood volume in the feeding
Newborn Found in breast
300 ml milk and in the
colostrums
Important Concept
Erythrocyte levels in the Types of Immunity
newborn is INCREASED Natural Immunity
This is an effect of fetal Artificial Immunity
circulation
Types of Natural Immunity
Immune System of the Newborn Natural Active Immunity
First Line of Defense Natural Passive Immunity
o Skin
o Mucous Membrane Natural Active Immunity
Second Line of Defense Client is exposed to antigen
o Immunoglobulins or Infection or antigen is
Anti-bodies introduced into the body
o IgG Own body produces the
o Immunoglobulin G antibodies
The only
immunoglobulin Natural Passive Immunity
that CAN Client is not exposed to
CROSS THE antigen
PLACENTA (this Infection or antigen is not
occurs on the introduced into the body
ninth (9th) Body does not produce the
month) antibodies
Acquired by full- There is no infection
term babies Client receives antibodies
Pre-term babies from the mother
DO NOT Examples of Natural Passive
RECEIVE IgG, Immunity
therefore, they o Immunoglobulin A
are PRONE TO o Immunoglobulin G
INFECTION
o IgM Types of Artificial Immuity
o Immunoglobulin M Artificial Active Immunity
Synthesized by Artificial Passive Immunity
the fetus at
twenty (20) Artificial Active Immunity
weeks of No infection
gestation Client is exposed to weak
o IgA antigen
10
Examples are immunizations Usually PRESENT AT BIRTH
like OPV, BCG, etc. If Moro Reflex is ABSENT by
Body produces its own the first month of life, this is
antibodies considered ABNORMAL
o This is indicative of
Artificial Passive Immunity deafness or hearing
No infection problems
Client is NOT EXPOSED to Disappears at about three (3)
weak antigen to four (4) months
Antibodies are given through
immunization EXTRUSION REFLEX
Example is DPT Important in terms of feeding
and weaning
REFLEXES Should disappear at about
Also called Primitive three (3) to four (4) months
Movements It must disappear about one
Presence of reflexes are (1) month before introduction
considered NORMAL in of semi-solid foods
infants Therefore, the BEST TIME to
Presence of reflexes indicate INTRODUCE SEMI-SOLID
IMMATURITY OF THE FOODS is around FOUR (4)
NERVOUS SYSTEM TO FIVE (5) MONTHS
11
SUCKING REFLEX GROWTH AND DEVELOPMENT
This reflex does not disappear DURING THE FIRST YEAR OF
INFANCY BASED ON
BABINSKI REFLEX CEPHALOCAUDAL PATTERN
Positive for fanning or MONTHS GROWTH AND REMARKS
extension of toes when the DEVELOPMENT
0–2 Growth and Infant cannot lift
sole of the foot is stroked development on the head. There
Disappears at about one (1) UPPER NECK is HEAD LAG.
year of age Back muscles
Presence is indicative of are not yet
immature nervous system developed.
DO NOT
In adults, the presence of PLACE INFANT
Babinski reflex indicates a IN PRONE
NEUROLOGIC PROBLEM POSITION. This
results to
GROWTH AND DEVELOPMENT RESPIRATORY
PROBLEMS.
Should be a continuous Best position is
process SIDE LYING
Certain directions should be POSITION
followed: 4 Growth and LIFTS HEAD
o Cephalocaudal development on Infant can now
LOWER NECK be placed in
Growth and and UPPER PRONE
development BACK POSITION
starts from the 6 Growth and Infant SITS
head going to development on WITH
the lower THORACIC SUPPORT.
AREA Infant SITS
extremities WITHOUT
o Proximodistal SUPPORT
Growth and MOMENTARILY
development 8 Growth and Infant SITS
starts from the development on WITHOUT
LUMBAR AREA SUPPORT
center of the 10 Growth and Infant
body going development on CRAWLS,
outward BIG MUSCLE STANDS WITH
OF THE THIGH SUPPORT
Cephalocaudal Pattern of Growth 12 Growth and Infant STANDS
development on WITHOUT
and Development
the LOWER SUPPORT,
Starts from the head LEG WALKS WITH
Has something to do with the SUPPORT
growth of BIG MUSCLES
Has something to do with the
development of GROSS
MOTOR ACTIVITIES (i.e.
walking) Important Concept!
12
Correct Sequence of Growth Infant recognizes rough /
and Development in terms of smooth objects (simple tasks)
Cephalocaudal Development before recognizing love and
o Sit hate (emotions)
o Crawl
o Stand MODES OF HEAT TRANSFER
o Walk Newborn loses heat through the
following ways:
Proximodistal Pattern of Growth
and Development CONDUCTION
Starts from the center of the Transfer of heat from one
body going outward body surface to another WITH
Growth involves SMALL CONTACT
MUSCLES Nursing Management
Development involves FINE o Place newborn at chest
MOTOR development or FINE part of mother because
MOTOR SKILLS (i.e. hand heat is obtained by the
writing) baby through
conduction
GROWTH AND DEVELOPMENT
DURING THE FIRST YEAR OF RADIATION
INFANCY BASED ON Transfer of heat from one
PROXIMODISTAL PATTERN body surface to another
MONTH GROWTH AND REMARKS WITHOUT CONTACT
DEVELOPMENT
0 Hands are CONVECTION
CLOSED Heat transfer THROUGH AIR
3 Hands are
OPEN
CURRENTS
6 PALMAR Best time to Nursing Management
GRASP give feeding o Close windows
REFLEX bottle to o Increase temperature
PRESENT baby
(palm)
of thermostat
9 PINCER GRASP Objects are
REFLEX picked up EVAPORATION
PRESENT using the Transfer of heat through
(fingers) fingers VAPORIZATION
12 HAND FULLY Stacks Nursing Management
DEVELOPED objects
o Do not place baby in a
DIFFERENTIATION THERMOSTAT
Baby learns SIMPLE TASKS because this does not
FIRST before learning contain normal
COMPLEX TASKS temperature
Infant walks first (gross motor
activity) before learning to Important Concepts!
write with the hand (fine motor Newborns NEVER SHIVER
activity)
13
They CANNOT GENERATE Vomiting results into what
HEAT type of acid-base imbalance?
o Metabolic Acidosis?
This is a cause of o Metabolic Alkalosis?
HYPOTHERMIA Answer:
It depends on what is being
Infant generates heat through vomited
FLEXION
VOMITING
FLEXION decreases body ▼▼▼▼▼▼▼▼▼▼▼
surface area, therefore, Gastric Secretion Blood
decreases the chances of ▼▼▼ ▼▼▼
suffering from hypothermia Decreased Decreased
levels levels
Vasoconstriction is less of Hydrochloric Acid of Oxygen
developed ▼▼▼ ▼▼▼
Metabolic Anaerobic
COLD STRESS Alkalosis Respiration
This is a common ▼▼▼
complication of Increased
HYPOTHERMIA levels of
Cold constricts blood vessels Lactic Acid
▼▼▼
Metabolic
Acidosis
COLD STRESS
▼▼▼ MORPHINE SULFATE TOXICITY
Vasoconstriction Results to RESPIRATORY
▼▼▼ ACIDOSIS
Decreased Tissue Perfusion
▼▼▼ MORPHINE SULFATE TOXICITY
Decreased Tissue Oxygenation ▼▼▼
▼▼▼ Respiratory depression
Anaerobic Respiration ▼▼▼
▼▼▼ Hypoventilation
Accumulation of Lactic Acid ▼▼▼
▼▼▼ Decreased Respiratory Rate
METABOLIC ACIDOSIS (a basic ▼▼▼
complication of Cold Stress) Increased Levels of Carbon Dioxide
▼▼▼
Respiratory Acidosis
HYPOVENTILATION
VOMITING Results to RESPIRATORY
Question: ACIDOSIS
14
Important Concepts on Newborn APGAR SCORING
Respiration First Minute
Newborns are NASAL o Purpose is to check if
BREATHERS newborn can adjust to
o First order of extrauterine
respiration environment
Newborns only breathe After Five Minutes
through the mouth if there is o To check the overall
CHOANAL ATRESIA status of the newborn
15
BANDS
BODY TEMPERATURE Purpose is for identification of
ASSESSMENT infants
Expose only the body part you Important Concepts!
will assess o The newborn’s
Infant is prone to hypothermia FOOTBAND is the
Wrap head to prevent Cold most accurate way of
Stress identifying the newborn
Important Concepts in In the United States, use of
Temperature taking pictures to identify the
o Rectal temperature is newborn is being done. This
most accurate is done every eight (8) hours
o Measurement of rectal
temperature is C is for:
indicated in CORD CARE
Stable Patients
Ambulatory CORD CARE
Patients Profuse bleeding is NOT
o Rectal temperature is NORMAL
contraindicated in Triple Dye Solution
patients with o Can cause
hemorrhoids vasoconstriction of
o If patient has sinus umbilical cord to
tachycardia, use rectal prevent profuse
measurement of bleeding
temperature to produce If profuse bleeding occurs,
vagal stimulation and this indicates THE EARLIEST
reduce heart rate SIGN OF HEMOPHILIA
o For oral measurement o Check the gender first
of temperature, if hot o If male, infant is
drinks were taken by possibly positive for
patient, obtain oral Hemophilia
temperature after thirty o Only males are
(30) minutes symptomatic for
Hemophilia
BONDING
Promote mother-infant M is for:
bonding through BREAST Meconium and Voiding
FEEDING
If mother develops EYE- MECONIUM AND VOIDING
CONTACT with infant, she is Should occur within twenty-
ready for mother-infant four (24) to forty-eight (48)
bonding! hours
P is for:
POSITIONING
PRINTS
16
VITAL SIGNS
POSITIONING VITAL STATISTICS
Head of the infant should
always be lower than the VITAL SIGNS
chest Normal Vital Signs in Infants
o This is to allow PARAMETER NORMAL REMARKS
secretions to go to the VALUE
Respiratory 30 – 60
mouth and nose Rate breaths
Suction first the mouth before per
the nose minute
Never do Trendelenburg Cardiac Rate AWAKE:
position in infants 120 –
160 beats
o This may result to per
INCREASED minute;
INTRACRANIAL ASLEEP:
PRESSURE 100 beats
Modified Trendelenburg per
minute
position is best for patients CRYING:
suffering from SHOCK 180 beats
per
PRINTS minute
Get footprint Temperature 36.8°C Initial
temperature
How is this done? taking is done
o Work on the heel first rectally; This is
before working on the the most
toes accurate and
serves as a
Rationale:
check for the
o It is easier to put the presence of
heels on the stamp pad IMPERFORATE
relative to the toes ANUS
Blood 80 / 46
Pressure
IMPORTANT CONCEPT IN
ANSWERING LOCAL BOARD Important Concepts!!!
EXAMINATION QUESTIONS In obtaining the blood
If the question or situation pressure of infants, check the
asks for THE INITIAL THING blood pressure on both the
THE NURSE MUST DO or for upper and the lower
the PRIORITY THING TO DO, extremities
the correct answer is always
involves ASSESSMENT Blood pressure on LOWER
EXTREMITY is NORMALLY
HIGHER than blood pressure
2. ON-GOING ASSESSMENT on UPPER EXTREMITY (BPLE
Mnemonic is VGAP > BPUE)
A HIGHER blood pressure
V is for: reading on the UPPER
EXTREMITY relative to the
17
LOWER EXTREMITY is o Head Circumference is
ABNORMAL (BPUE > BPLE) greater than Chest
Circumference
This abnormality is a
CARDINAL SIGN of Initial sign of Increased
COARCTATION of the AORTA Intracranial Pressure
o Irritability
Important Concepts in Vital Signs
Taking in Pediatric Patient Increased Respiratory Rate is:
Do first the least invasive and o NOT INDICATIVE of
the least painful Increased Intracranial
Do Respiratory Rate and Pressure
Heart Rate first o It indicates
Do Blood Pressure and DECREASED LEVELS
Temperature last of Intracranial Pressure
If you get the Temperature
first, the newborn becomes
agitated Important Concepts on Increase in
o It would then be difficult Weight in Newborn
to obtain the other vital
signs Birth weight DOUBLES in SIX
(6) MONTHS
VITAL STATISTICS OF NEWBORN
PARAMETER NORMAL VALUE Birth weight TRIPLES in ONE
Birth Weight 2,500 – 4,000 grams
Birth Length 19 – 21 inches
(1) YEAR
Head Circumference 13 – 14 inches
Chest 12 – 13 inches Birth weight QUADRUPLES in
Circumference (One inch less than TWO and a HALF (2.5)
Head YEARS
Circumference)
Important Concepts! G is for:
It is normal in newborns to GESTATIONAL AGE
find the HEAD ASSESSMENT
CIRCUMFERENCE greater
than the CHEST GESTATIONAL AGE OF UNBORN
CIRCUMFERENCE INFANT
Full Term Baby
Head Circumference is about o Thirty-eight (38) to
one (1) inch or about two (2) Forty-two (42) weeks
centimeters larger than the Pre-term Baby
Chest Circumference o Less than thirty-eight
(38) weeks
In infants with
Post-term Baby
HYDROCEPHALUS:
o More than forty-two
o Anterior fontanelle is
(42) weeks
open
18
A is for: o Beutler Test
Administration of Certain Also done within
Medications twenty-four (24)
hours, together with
Administer the following Guthrie Test
medications: Done to check if
Vitamin K client has
Erythromycin GALACTOSEMIA
19
(48) TO SEVENTY-TWO (72)
HOURS AFTER BIRTH NORMAL CHARACTERISTICS OF
Similarly, RHOGAM is THE EYES AT BIRTH
administered to the mother Normal Color at Birth
who has undergone o GRAY
ABORTION, likewise forty-
eight (48) to seventy-two (72) Normal for SEARCHING
hours after the procedure to NYSTAGMUS
prevent formation of o Due to immaturity of
antibodies ocular muscles
20
and skull of o Preserve the evidence
bones Do not do
When Disappears Disappears in
does it in WEEKS DAYS douching
Dis- Do not take a
appear bath
21
FSH-RH LH-RH
Important Concept!!! (Follicle (Leutinizing
There is Stimulating Hormone
PSEUDOMENSTRUATION at Hormone Releasing
birth of a female infant Releasing Hormone)
This is a normal occurrence Hormone) ▼▼▼
▼▼▼ ▼▼▼
Important Concept!!! Stimulates the ANTERIOR
In menstruation: PITUITARY GLAND (APG)
Shedding of endometrium ▼▼▼ ▼▼▼
occurs due to: Release of FSH Release of LH
o Decrease in levels of (Follicle (Leutinizing
Estrogen Stimulating Hormone)
o Decrease in levels of Hormone) ▼▼▼
Progesterone ▼▼▼ ▼▼▼
This results into bleeding Maturation of Maturation of
within three (3) to five (5) days GRAAFIAN CORPUS
FOLLICLE LUTEUM
Decreased levels of ESTROGEN ▼▼▼ ▼▼▼
and PROGESTERONE Increased levels Increased levels
▼▼▼ of Estrogen; of Progesterone;
Shedding of the Endometrium PROLIFERATIVE SECRETORY
▼▼▼ PHASE PHASE
Bleeding or Menstruation occurs ▼▼▼ ▼▼▼
No bleeding No bleeding
Important Concept!!!
When the levels of Estrogen and Important Concept!!!
Progesterone drop, the Increased levels of Estrogen
HYPOTHALAMUS secretes the and Progesterone trigger a
following substances: Negative Feedback
FSH-RH o Hypothalamus no
o Follicle Stimulating longer secretes FSH-
Hormone – Releasing RH and LH-RH
Hormone o The net effect would be
LH-RH decreased levels of
o Leutenizing Hormone – Estrogen and
Releasing Hormone Progesterone
Therefore, MENSTRUATION
OCCURS
Decreased levels of ESTROGEN Note that the MENSTRUAL
AND PROGESTERONE PHASE is characterized by:
▼▼▼ o Decreased levels of
Stimulates the HYPOTHALAMUS to Estrogen
release substances o Decreased levels of
▼▼▼▼▼▼▼▼▼▼▼▼ Progesterone
22
Important Concepts in Pregnancy Chemotherapeutic drugs
Estrogen and Progesterone attack rapidly dividing cells:
are both produced by the o Cancer cells
PLACENTA o Other body cells that
o Therefore, there is no are rapidly dividing:
bleeding due to Hair cells
shedding of the Skin cells
endometrium during Mucous
pregnancy membrane cells
o Therefore, there is no Side Effects of
menstruation during Chemotherapeutic Drugs
pregnancy o Alopecia
There is AMENORRHEA Hair cells
multiply quickly
Important Concepts in Clamping o Hyperpigmentation
of the Umbilical Cord Skin cells
In clamping of the umbilical multiply quickly
cord, there is decreased o Stomatitis
levels of Estrogen and Mucous
Progesterone membrane cells
This leads to multiply quickly
PSEUDOMENSTRUATION o Nausea and Vomiting
Stomach lining
Important Concept on the TESTES cells multiply
of the Newborn quickly
The testes of the newborn is o Decreased peristalsis
NORMALLY UNDESCENDED and constipation
Descent normally occurs Small and large
AFTER SIX (6) WEEKS intestine lining
If descent does not occur after cells multiply
this period, there is quickly
CRYPTORCHIDISM o Anemia
Nursing Responsibility
Bone marrow
o Check for
suppression
undescended testes results into
Warm hands decreased
Palpate testes levels of RBC
o Avoid stimulating the o Infection
cremasteric reflex Bone marrow
Presence of cold temperature suppression
will prevent the descent of the results into
testes and will make it ascend decreased
to the pelvic area levels of WBC
o Bleeding
Important Concepts in Use of
Bone marrow
Chemotherapeutic Drugs
suppression
23
results into DPT
Diphtheria
I.M. or
Intramuscular
Three
Doses:
decreased Pertussis 1st Dose 0.5 ml Vastus
levels of Tetanus (at
weeks)
6 lateralis
platelets or
thrombocytes 2nd Dose
(at 10
0.5 ml Vastus
lateralis
weeks)
Important Concepts on 3rd Dose 0.5 ml Vastus
Administration of Immunization in (at 14 lateralis
Infants undergoing Chemotherapy weeks)
OPV P.O. or per Three
Administer DPT Oral Polio orem Doses:
o This is an Artificially Vaccine 1st Dose 2 – 3 Mouth
(at 6 drops
Acquired Passive form weeks)
of Immunity 2nd Dose 2 – 3 Mouth
o Antibodies are received (at 10 drops
weeks)
by the patient
Do NOT ADMINISTER OPV 3rd Dose 2 – 3 Mouth
(at 14 drops
o This is an Artificially weeks)
Acquired Active form of
Hepatitis i.M. or Three
Immunity B vaccine Intramuscular Doses:
o This can cause 1st Dose 0.5 ml Vastus
(at 6 lateralis
possible infection of the weeks)
siblings as the virus is
2nd Dose 0.5 ml Vastus
eliminated through the (at 10 lateralis
stool. weeks)
24
vaccine and will render thing to check for is THE
them ineffective ABILITY TO CHEW
25
ALLOW STAGE hunger when he cries, the
pleasure principle is achieved
Important Concepts: and he DEVELOPS TRUST
Use pacifier when the patient On the other hand, when food
is on NPO is not given to the baby to
According to Freud, the mouth satisfy his hunger when he
is the most important part of cries, the unpleasurable
the body during the Oral principle persists and he
Stage CEASES TO CRY because he
has DEVELOPED MISTRUST
N is for: Key Concept!!!
NO CHOKING HAZARD o The most important
person in the INFANCY
Important Concepts! STAGE is the
Take precautions so that MOTHER
infant does not choke from
small objects placed in the S is for:
mouth SOLITARY PLAY
Palmar and pincer grasp
reflexes are present Important Concept
Pleasure principle at the Solitary play is the type of
ORAL STAGE is to put play that mostly occurs during
objects in the MOUTH. the infancy period
T is for: TODDLERS
Trust versus Mistrust Mnemonic is TODDLER
26
Example:
In a procedure like cardiac Client is placed on a HIGH
catheterization, the nurse talks to the ALLERGIC REACTION
toddler in simple terms: PRECAUTION
WHAT TO EXPLANATION EXPLANATION
EXPLAIN TO AN TO A
ADULT TODDLER
Keep the following nearby:
Skin Betadine will be A special brown o Epinephrine
preparation used to clean solution will be o Corticosteroid
your skin used to clean
your skin
Anesthetic Anesthesia will A special O is for:
administration be administered solution will put OFFER CHOICES
to your skin your skin to
sleep
Catheter A catheter will A special tube Situation:
insertion be inserted will be inserted In giving medications to a
and you will
experience a toddler, expect a “NO” answer
pulsating from the toddler.
sensation
Contrast A contrast A special
Medium medium would colored solution Sample Board Question:
be used would be used When the toddler says “No” when
and you will you are about to give him his
experience a
flushing medication, what will you do?
sensation a) Leave the room
X-ray A series of x- Lights will be b) Insist that the medication be
rays would be turned off and a
conducted series of picture
given
taking will occur c) Inform the physician
Model of the Needed in Not needed as d) Give the medication to the
Heart explaining this is not
necessity of the comprehended
mother for her to administer
procedure to by the toddler
the patient Answer:
Letter A!
Important Concepts!
In explaining any procedure
that would be done on a
toddler, IT IS ALWAYS BEST Sample Board Question:
TO INCLUDE THE PARENTS If after an hour, the toddler still
Parents are important people says “No” to the medication, what
to toddlers!!! will you do?
a) Leave the room
Key Concepts in Cardiac b) Insist that the medication be
Catheterization given
Check the patient for allergies c) Inform the physician
to seafoods d) Give the medication to the
mother
If patient is allergic to
seafoods, continue with the Answer:
procedure Still Letter A!!!
27
Important Concepts!
Important Concept!!! The anal part is most
Therefore, GIVE THE important at this stage of
TODDLER A CHOICE for him development
not to answer “No” The best time for toilet
Example: training:
o “Do you want to drink o When child is around
your medication with eighteen months old
water or with juice?” o When child is
physically ready – can
D is for: sit without support
DOUBT and SHAME versus o When child is
AUTONOMY psychologically ready –
with urge to defecate
Important Concept! When done improperly and at
Toddlers want to establish the wrong time, toilet training
SELF CONTROL may lead to an OBSESSIVE-
COMPULSIVE BEHAVIOR
D is for: Best management for
DO NOT LEAVE THE Obsessive-Compulsive
TODDLER UNATTENDED IN behavior
THE SWIMMING POOL OR o Allow client to do the
IN THE BATH TUB rituals in order to
decrease levels of
Important Concept! anxiety
Drowning is the most common o If hand is swollen
cause of death in toddlers Do not stop the
performance of
L is for: the rituals
LEARNING ABOUT THE This is still
CONCEPT OF DEATH needed to
reduce the
Important Concepts! client’s anxiety
Learning about the concept of levels
death o Provide gloves to the
Usually starts at the age of client to keep skin
three (3) integrity and allow him
The toddler’s concept of death to continue on with the
o It is reversible rituals
E is for: R is for:
ELIMINATION RITUALS and ROUTINES
Important Concept!
Read bedtime stories to
toddlers to put them to sleep
28
Toddler tries to establish
autonomy through rituals and Mother brings the toddler to the mall
routines ▼▼▼
Always PRAISE a toddler If the object (i.e. a G.I. Joe toy) the
whatever he does to establish toddler wants is not bought
autonomy ▼▼▼
o Except when he is Temper Tantrums now extended for
having TEMPER ten minutes; Autonomy established
TANTRUMS in ten minutes
o The best way to handle ▼▼▼
temper tantrums is to Mother buys the G.I. Joe toy
IGNORE IT but
PROVIDE SAFETY IMPORTANT CONCEPT!
Autistic children Another mnemonic for
o Do not talk toddlers is PRAISE
o Like inanimate objects
o Do head banging! P is for:
Therefore, put a PARALLEL PLAY
helmet on their
head Important Concepts!
Ways of Ignoring Toddler’s In parallel play:
Temper Tantrums to Decrease o Two toddlers are
Anxiety playing
o Allow the toddler to o They are playing WITH
FACE THE WALL or THE SAME TYPE OF
SIT ON A CHAIR TOY but WITH TWO
o TIME OUT DIFFERENT TOYS.
The best way o Each toddler has his
Temper own toy, which is
Tantrums occur exactly the same as
because of the the one the other
parents toddler is playing with
Toddlers forget the concept of
Sharing
Example: Key Concept!
Mother brings the toddler to the mall o Most IMPORTANT TOY
▼▼▼ FOR TODDLERS
If the object (i.e. a TOY GUN) the Push-Pull Toys
toddler wants is not bought o Rationale:
▼▼▼ Pincer grasp
Temper Tantrums occur for five has already
minutes; Builds autonomy been developed
▼▼▼ and they are
Mother buys the toy gun able to walk
29
ROUTINES E is for:
EXPLAIN THE PROCEDURE
A is for: TO THE CLIENT
AUTONOMY versus SHAME
and DOUBT S is for
SCHOOLMATES
I is for:
INVOLVE PARENTS ALWAYS Important Concept:
Most important person to a
S is for: Pre-schooler:
SEPARATION ANXIETY o Same age group
Therefore, give
Important Concept! room
This is the most common assignments to
cause of FEAR in a toddler pre-schoolers
using the same
E is for: age group
ELIMINATION Key Concept!
o In choosing a patient or
Important Key POINTS TO patients a pre-schooler
REMEMBER! would share a room or
Toddlers always say “NO” ward with in the
Preschoolers always ask hospital, choose the
“WHY” least infective
companion (i.e. a post-
PRE-SCHOOLERS operative pre-schooler
Mnemonic is PRESCHOOL or a pre-schooler with
impetigo)
P is for:
PLAY
Important Concepts!!! C is for:
Play is associative or CURIOSITY
cooperative
Involve pre-schoolers in any Important Concept!
group play Pre-schoolers always ask
To elicit cooperation, utilize “WHY”
“Simon says…” game
H is for:
R is for: HIGHLY IMAGINATIVE
REGRESSION
Important Concept!
Important Concept! Pre-schoolers have
Regression is common during IMAGINARY PLAYMATES
hospitalization This is NORMAL in pre-
This is a NORMAL behavior schoolers
30
O is for: A is for:
OBSERVE FOR INITIATIVE Same AGE GROUP
versus GUILT
G is for:
O is for: GUILT
OFF LIMITS TO THE
KITCHEN I is for:
INITIATIVE
Important Concept!
The most common causes of C is for:
accidents in pre-schoolers CURIOSITY
are:
o Poisoning POISONING
o Burns Occurs mostly in the house
31
o Give ten milliliters (10
ml) of Ipecac 4. Decrease the absorption of the
o Ideally, victim will vomit poison
within twenty (20) to Give activated charcoal
thirty (30) minutes Give one gram (1 g) per
o If victim does not vomit, kilogram body weight
DO NOT REPEAT THE
DOSAGE 5. Bring victim to pediatric
If victim is one (1) to twelve hospital together with:
(12) years old Vomitus
o Give fifteen milliliters Container of poison
(15 ml) of Ipecac Urine of victim (if available)
o Ideally, victim will vomit
within twenty (20) to Important Concepts!!!
thirty (30) minutes Usual cause of poisoning is
o If victim does not vomit, ASPIRIN TOXICITY
o This damages the
repeat the same dose
If victim is twelve (12) years eighth (8th) cranial
old and above nerve leading to
o Give thirty milliliters (30 TINNITUS or problems
in terms of BALANCE
ml) of Ipecac
- a major function of
o Ideally, victim will vomit
the vestibulocochlear
within twenty (20) to
nerve
thirty (30) minutes
Antidote for Aspirin
o If victim does not vomit,
o N-acetylcysteine
repeat the same dose
Other antidotes:
o For Acetaminophen
Key Concepts!!!
N-acetylcysteine
Never induce vomiting in the
o For Bleeding
following situations:
o Unconscious patient Vitamin K
o For Acidity effect
o Comatose patient
Sodium
o Patient prone to
Bicarbonate
seizures
(NaHCO3)
o When poison is
corrosive Key Concept!!!
Strong acids Most common type of poisoning in
Strong alkali school age children is LEAD
Causes POISONING or PLUMBISM
double
injury Important Concepts in PLUMBISM
o When poison is a or LEAD POISONING
hydrocarbon In the assessment for lead
Kerosene poisoning, ask the following
Gasoline questions:
32
o Is your house build o Do CHELATION
during the 1960s or THERAPY
during the 1970s? o Remove lead inside the
o Are you living in old body
Hispanic houses? o Drug of Choice
Rationale: EDTA
o These houses utilized Calcium
paint containing lead Disodium
Edetate
Three (3) Effects of LEAD
POISONING or PLUMBISM SCHOOL AGE CHILDREN
Hematologic Effect Mnemonics are:
Renal Effect SCHOOLER
Nervous System Effect DIMPLE
33
OBSERVE for INDUSTRY I is for:
versus INFERIORITY INDUSTRY versus
INFERIORITY
O is for:
OFF LIMITS TO VEHICLES Important Concept!
Part of the psychological
Important Concepts! tasks of the school age child
Most common cause of is a SENSE OF
accident in school age COLLECTION OF OBJECTS
children is VEHICULAR
ACCIDENTS M is for:
Best topic for safety and MODESTY
accident prevention for school
age children is USE OF Important Concept!
SEATBELTS Provide privacy in the
following situations:
L is for: o Grieving
LOSS OF CONTROL o Crying
o Times of emotional
Important Concept! upset
Loss of control is the most
common cause of fear in P is for:
school age children PEERS
34
Important Concepts!!!
The most important people to Important Concepts!!!
adolescents are their PEERS What is the role of the
Peer pressure starts here adolescent in the society?
Adolescent does not want to To pursue education
be different from other To pursue career
adolescents
Cases of adolescent abuse R is for:
(i.e. of alcohol) can be treated ROLE CONFUSION
by group therapy – Stop
drinking alcohol. Important Concepts!!!
If there are problems in
A is for: identity, ROLE CONFUSION
ALTERATION OF BODY arises
IMAGE If role identity is not
established, the adolescent
Important Concepts!!! develops ISOLATION
Alteration of body image is the
most common NURSING S is for:
DIAGNOSIS in adolescents SEPARATION FROM FEARS
In scoliotic patients, nursing
management is to provide a Important Concept!
MILWAUKEE BRACE This is the most common
In a colostomy patient, there cause of adolescent fear
is no bowel control.
o Nursing Management:
Provide a
colostomy bag
Control odor in
colostomy bag
Decrease odor RESPIRATORY SYSTEM
by ABC DISORDERS IN PEDIATRIC
A – A NURSING
greeny
dark CHOANAL ATRESIA
vegetable
B – Key Concept!
Bismuth Atresia
powder o Always pertains to the
C – presence of an
Charcoal obstruction
(put in
stoma) Choanal Atresia
Is a congenital disorder
I is for: involving an obstruction at the
IDENTITY
35
POSTERIOR the obstruction at the level of
NASOPHARYNX the nasopharynx
This obstruction is in the form Therefore, there is
of: DECREASED
o A membrane OXYGENATION – an
o A bony growth unpleasurable principle
36
o Edema
Three (3) Cardinal Signs of Dolor
Choanal Atresia o Presence of pain
Mouth-breathers Functiolaesa
Patient does not suck o Loss of function
Sleep apnea or inability to
sleep Signs and Symptoms of Tonsillitis
If Palatine tonsillitis
How to Check for Presence of o Difficulty of swallowing
Choanal Atresia or Dysphagia
Use of NGT If Adenoid tonsillitis
o Positive (+) for o Problems of breathing
resistance when NGT If Lingual tonsillitis
is inserted o Problems with speech
Try to close mouth of newborn If Tubal tonsillitis
and close one nostril at a time o Problems with hearing
o If patient suffers from
air hunger, patient Common Causative Organism in
possibly has choanal Tonsillitis
atresia GABHS
o If you press the left Group A Beta-hemolytic
nostril and there is air Streptococcus
hunger, the choanal o A streptococcal
atresia or the infection!!!
obstruction is at the
RIGHT SIDE. Pharmacological Management of
Tonsillitis
Management for Choanal Atresia Drug of Choice
Perform local piercing o Penicillin
If client is allergic to Penicillin
o Never give Amoxicillin
TONSILLITIS
o Patient will also be
Different Types of Tonsils allergic to Amoxicillin
Palatine tonsils Drug of Choice in the
Adenoids presence of allergies to
Lingual tonsils Penicillin is ERYTHROMYCIN
Tubal tonsils Administer antibiotics for
o Located in the ears seven (7) to ten (10) days
Surgical Management
Cardinal Signs of Inflammation
If antibiotics cannot cure
Rubor
tonsillitis, a
o Redness
TONSILLECTOMY is
Calor
performed
o Heat
When is the best time for a
Tumor tonsillectomy?
37
o If there is recurrent Post-operative Phase
tonsillitis for five (5) to 1. Positioning immediately after
six (6) times a year Tonsillectomy
with cardiac and Priority is to prevent aspiration
respiratory involvement of secretions
o Prone position or on
Nursing Responsibilities in his abdomen
Tonsillectomy o Side-lying position
If pediatric is fully awake
Pre-operative Phase o Position him or her on
1. Test for the bleeding time any comfortable
The most common position
complication of tonsillectomy 2. Diet of a post-tonsillectomy patient
is bleeding must satisfy all three (3) criteria:
2. Ask the patient to visit a dentist Clear
The most important person for Cold
the patient at this time is the Non-irritating
dentist o Only APPLE JUICE
The dentist needs to check if and CLEAR WATER
the patient has any loose satisfies the
teeth abovementioned three
If loose teeth are present, (3) criteria
tonsillectomy may be delayed 3. Assess for signs and symptoms of
or rescheduled bleeding
Loose teeth may dislodge and Bleeding is present if
cause airway obstruction o There is frequent
3. Provide the patient and the swallowing
parents a pediatric operating room o There is frequent
tour clearing of the throat
o There is frequent
Intra-operative Phase
tossing of the pediatric
Anesthesia of Choice
o Drooling of bright red
o Ketalar
secretions
o Ketamine
When an
Basic Nursing Responsibility incision is
o No premature present
awakening of the There is pain
patient Blood
o If this happens, this accumulates
could cause the in the airway
following: Drooling
Auditory occurs
hallucinations When does bleeding occur in
Visual post-tonsillectomy patients?
hallucinations o Bleeding normally
occurs:
38
Within twenty- Brassy spasmodic
four (24) hours hoarseness of the voice
after the Stridor is the abnormal breath
procedure and; sound hears
Five (5) to seven Important Concepts on
(7) days post-op Abnormal Breath Sounds
o Therefore, patient o Crackles
could only engage in Indicates the
non-contact sports presence of fluids in
the airway
Important Post-tonsillectomy Heard in
Concepts!!! Congestive Heart
Speaking and talking are NOT Failure patients
CONTRAINDICATED post- o Wheezes
tonsillectomy Indicates narrowing
Patient is not advised to of the airway
watch a championship ball Heard in Asthma
game post-tonsillectomy o Stridor
o Rationale: Indicates
Patient has laryngeal
breathing obstruction
problems and Heard in
should avoid Laryngotracheo
crowded areas, bronchitis
wherein he Laryngospasm
would be prone o May cause total
to infections obstruction
Aspirin is
CONTRAINDICATED as it Sample Board Question
would cause bleeding If a client with
Valsalva maneuver is also laryngotracheobronchitis
CONTRAINDICATED as develops laryngospams, what
severe tension at the suture should the nurse do?
line causes bleeding a) give steroids
b) bring the patient to the
CROUP hospital
Also called c) bring the patient to the
Laryngotracheobronchitis or bathroom
LTB d) insert a tracheostomy tube
Caused by viral infection Answer
If caused by a bacteria (H. o Letter C
influenzae) it is known as o Bring the patient to the
EPIGLOTITIS bathroom, close the
door, and open the hot
Signs and Symptoms of shower.
Laryngotracheobronchitis Rationale
39
o Hot shower relieves Important Concepts!
laryngospasm Decreased RBC
Other choices: o Predisposes patient to
o Steroids need a long anemia
time to take effect Decreased WBC
o Patient may die before o Predisposes patient to
reaching the hospital infections
o Inserting a Decreased platelets or
tracheostomy tube is thrombocytes
normally not done o Predisposes patient to
bleeding
Management of
Laryngotracheobronchitis I is for:
1. Administer steroids INCREASED
Purpose of Steroids GASTROINTESTINAL
For anti-inflammatory effect TRACT UPSET
Important Concepts!!!
Steroids provide Important Concepts!
Death to inflammation Take steroids with meals
Birth to side effects Take steroids after meals to
Sample Board Question prevent gastric irritation and
In a client receiving steroids, which GI bleeding
food should be omitted from the
diet? R is for:
a) toast RENAL PROBLEMS
b) jam
c) egg T is for:
d) coffee TINNITUS
Answer:
Letter C H is for:
Rationale: HEPATOTOXIC MEDICATION
o Steroids cause Bone
Marrow Depression (BMD) 2.Administer RACEMIC
o This predisposes the EPINEPHRINE
patient to infection To relax smooth muscles
o Egg may cause infection if
it contains Salmonella 3. Place on MIST TENT or
CROUPETTE
Side Effects of Steroids Nursing Responsibilities
Mnemonic is BIRTH o Frequently change the
linen, beddings, and
B is for: clothing of the pediatric
BONE MARROW because they are
DEPRESSION always wet
o Ideally feeding is done
outside the croupette
40
o If respiratory distress Check for
occurs viral
Stop feeding infection
Bring pediatric Check for
back inside the ingestion of
croupette aspirin
Acute
Important Concepts on the Use of Encephalitis
a Croupette! Can cause
Mobile Toys mental
o Could not be placed retardation
inside the croupette There is no cure for this
o This would cause disease
combustion of oxygen
inside the croupette, EPIGLOTTITIS
leading to an explosion Bacterial Croup
o Therefore, DO NOT
USE MOBILE TOYS or Important Concepts
OTHER TOYS THAT Esophagus is posterior to the
CAUSE FRICTION trachea
If there is a fire Epiglottis is a leaf-like
o The first thing to do is structure above the airway
to TURN OFF THE o It closes when
VALVE OF THE swallowing
OXYGEN TANK TO o It closes when food
SHUT IT OFF enters the GI tract
Second step is to BRING OUT
THE PEDIATRIC Epiglottitis
Third step is to ACTIVATE Inflammation of the epiglottis
THE FIRE ALARM Cherry red epiglottis
Key Concept during a Fire!
o Never attempt to Signs and Symptoms of
control the fire Epiglottitis
o You are a nurse! Not a Difficulty of Breathing
fireman! Tripod Position or Sniffing
Position
Other Important Concepts on o Sitting in a leaning
Laryngotracheobronchitis forward position
Fever is common in o Sign of epiglottitis
laryngotracheobronchitis patients Exhibiting universal sign of
If aspirin is ordered for an LTB choking
patient, VERIFY THE ORDER
Never give aspirin to clients Three (3) Ds: The three (3)
with VIRAL INFECTION Classical Signs of Epiglottitis
o This may cause Drooling
Reye’s Disease Dysphonia (ngongo)
41
Dysphagia Place pediatric in a croupette
No ET tube is utilized in an
Nursing Alert epiglottitis patient
Always place patient with Prepare tracheostomy set at
epiglottitis on NPO bedside for an epiglottitis
Closure of epiglottis causes patient
total airway obstruction Endotracheal tube can be
utilized in a
Pharmacological Management of laryngotracheobronchitis
Epiglottitis patient
Drug of Choice
o Chloramphenicol Important Concept!
Never given per If a client who is at home
orem develops total airway
Given per I.V. obstruction
Antibiotics o Do not do CPR
Do culture and sensitivity o Do not bring to the
before administering hospital
antibiotics o Cut throat and do a
tracheostomy
Sample Board Question: Put a straw
If the doctor orders a throat swab in This acts as a
a patient with epiglottitis, what will temporary
the nurse initially do? tracheostomy
a) Explain the procedure to the BRONCHIOLITIS
patient Most common etiologic agent
b) Gather the materials needed is RSV
c) Wear mask Signs and Symptoms of
d) None of the above Bronchiolitis
Answer: Starts as a simple Upper
Letter D Respiratory Tract Infection
o None of the above Progresses to:
Rationale: o Hypoxia
Nurse has to verify the Decreased
doctor’s order because this levels of
procedure causes total oral oxygenation
obstruction o Hypercapnia
o Therefore, do culture and Increased levels
sensitivity test using of carbon
BLOOD as specimen dioxide
o Never use a tongue Acidosis
depressor on an Wheezing
Epiglottitis patient
Pharmacologic Management of
Management of Epiglottitis Bronchiolitis
Same as with LTB Drug of Choice
42
o Rivabirin Medications
Only Pollen
administered in Food Dust
an OXYGEN
HOOD or a Extrinsic Factors
MIST TENT ▼▼▼
In the United Stimulates Beta lymphocytes
States, an ▼▼▼
oxygen hood nor Release of IgE
a mist tent is no ▼▼▼
longer used. Attach to Mast Cell and together with
What is utilized Basophils
is a SMALL ▼▼▼
PARTICLE Release of Chemical Mediators
AEROSOL (Histamine, Prostaglandin,
GENERATOR or Bradykinin)
SPAG ▼▼▼
Rivabirin is TERATOGENIC Causes bronchospasm
o Can affect the pregnant ▼▼▼
nurse Narrowing of Airway (wheezes can
o It can be absorbed be heard with a stethoscope
through the mucous ▼▼▼
membrane Increased airway resistance
Conjunctiva
Nose
Mouth INTRINSIC ASTHMA
o Therefore, a pregnant Non-allergic asthma
nurse cannot Common in adults
administer Rivabirin
When administering Rivabirin, Intrinsic Factors
always wear ▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼P
o Mask arasympathetic Sympathetic
o Goggles Nervous Nervous
Response Response
Hold your breath when you
▼▼▼▼▼ ▼▼▼▼▼
are administering Rivabirin
Release of Release of
Acetylcholine Basophils and
ASTHMA
▼▼▼▼▼ Mast Cells
Two (2) types:
▼▼▼▼▼ ▼▼▼▼▼
o Extrinsic Asthma
Bronchoconstriction Release of
o Intrinsic Asthma
▼▼▼▼▼ Chemical
▼▼▼▼▼ Mediators
EXTRINSIC ASTHMA ▼▼▼▼▼ ▼▼▼▼▼
Allergic asthma ▼▼▼▼▼ Bronchospasm
Common in pediatrics ▼▼▼▼▼ ▼▼▼▼▼
EXTRINSIC FACTORS
43
Narrowing of Airway (Wheezes can Most common cause of death
be heard through the stethoscope) in clients with cystic fibrosis is
▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ RESPIRATORY FAILURE
Increased airway resistance
Important Concepts!
Important Concepts in Asthma! The exocrine function of the
Absence of wheezes pancreas is to secrete the
o A bad sign following enzymes:
o Indicates absence of o Pancreatic amylase
breathing To break down
Best pet for an asthmatic carbohydrates
patient o Pancreatic lipase
o A fish! To break down
fats
Management of Asthma o Trypsin
Give steroids To break down
o Purpose is anti- proteins
inflammatory These enzymes normally
Generally, if the patient has enter the duodenum for
respiratory problems digestive purposes
o Decrease oxygen
demand by: Important Concepts in Cystic
Providing Fibrosis
periods of rest There is over secretion of
Small frequent feedings digestive enzymes by the
pancreas
CYSTIC FIBROSIS There is an increase in the
An autosomal recessive levels of the various
disorder pancreatic enzymes
Other autosomal recessive
disorders are: Signs and Symptoms of Cystic
o Phenylketonuria Fibrosis
o Sickle Cell anemia 1. Malnutrition
Only a 25% chance of a Increased levels of pancreatic
patient developing this enzymes
disease or 1:4 ratio in each ▼▼▼
pregnancy May cause obstruction in the
Both bad traits coming from pancreatic duct
parents ▼▼▼
It is an EXOCRINE Digestive enzymes could not reach
DISORDER of the pancreas the duodenum
o There is oversecretion ▼▼▼
of exocrine products of Food cannot be digested
the pancreas ▼▼▼
Leads to MALNUTRITION
44
2. Steatorrhea
Presence of bulky, greasy and Management of Cystic Fibrosis
foul smelling stool Drug of Choice:
o Cotazym
Increased levels of pancreatic An artificial
enzymes pancreatic
▼▼▼ enzyme
May cause obstruction in the Give medication BEFORE
pancreatic duct MEALS so that pancreatic
▼▼▼ enzymes would be present
Lipase could not reach the o Could also be given
duodenum WITH MEALS
▼▼▼ o NEVER GIVEN AFTER
Fat cannot be digested MEALS
▼▼▼ Do not administer Vitamin
Gives rise to steatorrhea ADEK supplementation
o Rather give water
3. Deficiency in Fat-soluble miscible form of
vitamins – ADEK Vitamins A,D,E and K
Give calcium supplementation
Increased levels of pancreatic All these measures do not
enzymes have any effect on the blood
▼▼▼ sugar level of the patient
May cause obstruction in the
pancreatic duct
▼▼▼ Signs and Symptoms of Exocrine
Lipase could not reach the Involvement
duodenum 1. Salty Sweat
▼▼▼ Overproduction of sweat by
Fat cannot be digested sweat glands
▼▼▼ o Leads to imbalance in
No fat-soluble vitamins could be sodium and chloride
absorbed levels
▼▼▼ Due to the excretion of salty
Deficiency in Fat-soluble vitamins – sweat (normally as verbalized
ADEK by the mother of the pediatric
4. Hypocalcemia Sweat Chloride Test
Calcium always binds with Test for Cystic Fibrosis
undigested fat How is it done?
Since undigested fat is o Place sterile gauze on
eliminated in the stool,
skin
calcium is also eliminated via
o Give Pilocarpine
the stool
A cholinergic
Net effect is decreased serum
drug
levels of calcium
45
A o The most common
Parasympathetic cause of death is
drug Cystic Fibrosis
Will stimulate This is due to accumulation of
the sweat fluid in the lungs or
glands emphysema secondary to
Sweat will Cystic Fibrosis
accumulate at o Patient develops a
the gauze barrel chest
o Use forceps in picking
up the gauze to Surgical Management for Cystic
prevent mixture of Fibrosis
sweat Do multiple lung transplant if
o The range to be there is fluid accumulation
observed is between Drain secretions
Forty (40) and Sixty Do Chest Physiotherapy
(60) milliequivalents (CPT)
per liter o Do this before meals
If value obtained o Never do CPT after
is less than meals
Forty (<40 Postural Drainage
meqs/liter) o Done using the
milliequivalents principle of gravity
per liter, then o Oral care is done after
this is NORMAL postural drainage
If value obtained
is more than Key Concept!
Sixty (>60 If pediatric patient with Cystic
meqs/liter) Fibrosis cannot void
milliequivalents o Ask him to milk or strip
per liter, then the penis
there is Sodium o There is obstruction
and Chloride
o Masturbation is also
imbalance
advised
Nursing Management
Removal of sperm to remove
o During hot weather
obstruction
Increase fluid
intake
Effects of Sympathetic and
Increase sodium
Parasympathetic Nervous Systems
intake
on Various Organs and Body
o Client can go to the
Systems
beach Sympathetic Parasympathetic
Nervous Nervous
System System
Important Concept!
Respiratory Failure
46
Pupils Dilate Constrict 2. Right Side of the heart
Bronchioles Bronchodilation Bronchoconstriction
Cardiac Rate Increase Decrease receives blood from the
Blood Increase Decrease organs
Pressure
Blood Vessels Constrict Dilate
Smooth Relax Contract 3. Right Side of the heart
Muscles
Uterus Relax Contract
gives blood going to the
Bladder Relax Contract; Lungs
Decreased urine Increased urine
output output
Small Intestine Decreased Increased 4. Left Side of the heart
and Large peristalsis peristalsis receives blood from the Lungs
Intestine Constipation Diarrhea
Salivary Decreased Increased activity and gives blood to the organs
Glands activity Increased salivation
Dry mouth
Sweat Glands Decreased Increased 5. The LEFT VENTRICLE has
Skeletal Increased Decreased the HIGHEST PRESSURE
Muscle
Strength among the four (4) chambers
of the heart
Important Concepts!
Atropine sulfate 6. The LEFT SIDE of the heart
Anti-cholinergic Drug has A HIGHER PRESSURE
Characteristic Effects relative to the RIGHT SIDE of
o Cannot see the heart.
o Cannot pee
o Cannot speak 7. AORTA has a HIGHER
o Cannot shit PRESSURE relative to the
PULMONARY ARTERY
Cholinergic Drugs
Pilocarpine
8. Left Side of the heart has
Tensilon
GREATER OXYGENATED
Mestinon
BLOOD LEVELS relative to
Right Side of the heart.
CIRCULATORY SYSTEM
Acyanotic Congenital Heart
DISORDERS IN PEDIATRIC
Diseases
NURSING
Characterized by the
ABSENCE of CYANOSIS AT
CONGENITAL HEART DISEASES
BIRTH
Two (2) Classifications
Cyanotic
Cyanotic Congenital Heart
Acyanotic
Diseases
Characterized by the
Important BASIC CONCEPTS!!!
PRESENCE of CYANOSIS AT
1. Reason for Cyanosis
BIRTH
o Due to INCREASED
LEVELS of
ACYANOTIC CONGENITAL HEART
UNOXYGENATED
DISEASES
BLOOD
Atrial Septal Defect
Ventricular Septal Defect
47
Patent Ductus Arteriosus BLOOD at the Left Atrium,
Coarctation of the Aorta less oxygenated and
unoxygenated blood goes to
1. ATRIAL SEPTAL DEFECT (ASD) the Left Ventricle and the
Characterized by: Aorta
Presence of a HOLE between o THERE IS LESS
the Right Atrium and the Left TISSUE PERFUSION
Atrium (by both oxygenated
There is a COMMUNICATION and unoxygenated
between the Right Atrium and blood)
the Left Atrium
Failure of the FORAMEN THEREFORE, ATRIAL
OVALE to CLOSE AFTER SEPTAL DEFECT IS
BIRTH CONSIDERED AS
ACYANOTIC AT BIRTH due
Important Concepts!!! to DECREASED LEVELS OF
If there is a HOLE in the LEFT UNOXYGENATED BLOOD
ATRIUM: GOING TO THE TISSUES
48
Therefore, this gives rise to LEVELS OF
PULMONARY CONGESTION UNOXYGENATED BLOOD
GOING TO THE TISSUES
2. VENTRICULAR SEPTAL
DEFECT (VSD) Right Ventricle receives blood
Characterized by: BOTH FROM THE RIGHT
The presence of a HOLE ATRIUM and THE LEFT
between the Right Ventricle VENTRICLE
and the Left Ventricle
There is a COMMUNICATION Therefore, there is MORE
between the Right Ventricle blood in the RIGHT
and the Left Ventricle VENTRICLE (normally, it only
receives blood from the Right
Important Concepts in VSD: Atrium, but in Ventricular
If there is a hole in the LEFT Septal Defect, it ALSO
VENTRICLE: RECEIVES BLOOD FROM
THE LEFT VENTRICLE
Shunting of blood is from the
LEFT VENTRICLE to the In effect, PULMONARY
RIGHT VENTRICLE ARTERY RECEIVES MORE
BLOOD THAN IT USUALLY
Due to the PRESENCE OF DOES
GREATER PRESSURE on
the LEFT SIDE of the heart This leads to INCREASED
RELATIVE TO THE RIGHT PULMONARY ARTERY
SIDE PRESSURE
49
Due to HIGHER PRESSURE This leads to INCREASED
on the AORTA RELATIVE TO PULMONARY ARTERY
THE PULMONARY ARTERY PRESSURE
50
There is ACCUMULATION OF
BLOOD at the AORTA In PATENT DUCTUS
ARTERIOSUS,
There is CONGESTION OF The MURMUR is
BLOOD at the LEFT MACHINERY-LIKE
VENTRICLE
In COARCTATION OF THE AORTA,
The NET EFFECT is The Blood Pressure on the
CONGESTION OF BLOOD UPPER EXTREMITY is
toward the LUNGS GREATER RELATIVE TO the
Blood Pressure on the
Therefore, this gives rise to LOWER EXTREMITY
PULMONARY CONGESTION Signs and Symptoms include:
Epistaxis
KEY CONCEPTS!!! Gum bleeding
In the four (4) most common Most common cause of death
types of ACYANOTIC in Coarctation of the Aorta is
Congenital Heart Diseases, INTRACRANIAL
the SINGLE PROBLEM is HEMORRHAGE due to
PULMONARY CONGESTION increased blood pressure in
the aorta
Signs and Symptoms of Acyanotic
Congenital Heart Disease
Dyspnea
o Difficulty of Breathing
Wheezes
Crackles
Management of Acyanotic
Nursing Responsibilities in Congenital Heart Diseases
Acyanotic Congenital Heart
Disease In ATRIAL SEPTAL DEFECT and
Decrease Oxygen demand VENTRICULAR SEPTAL DEFECT:
o Provide adequate rest If the HOLE is compatible with
periods life or it DOES NOT
o Provide small frequent INTERFERE with activities of
feedings daily living, then SURGERY
IS NOT NEEDED
IMPORTANT KEY CONCEPTS!!! If the HOLE is NOT
compatible with life or it
In ATRIAL SEPTAL DEFECT and DOES INTERFERE with
VENTRICULAR SEPTAL DEFECT activities of daily living, then
Signs and Symptoms include: SURGERY IS NEEDED
PRESENCE OF MURMURS o Put a DACRON PATCH
The LARGER THE HOLE in o OPEN HEART
the patient with ASD or VSD, SURGERY is
the LOUDER THE MURMUR performed for ATRIAL
51
SEPTAL DEFECT and CATHETER to INCREASE the
VENTRICULAR DIAMETER of the LUMEN of
SEPTAL DEFECT the AORTA
o This is usually done
In PATENT DUCTUS with CARDIAC
ARTERIOSUS: CATHETERIZATION
Physician waits for fifteen (15) If this measure is not effective,
minutes to twelve (12) hours surgery is done to LIGATE the
(this is the normal time it portion of the aorta with the
takes for the Ductus coarctation and then END-TO-
Arteriosus to CLOSE) END ANASTOMOSIS is
If the Ductus Arteriosus FAILS performed
TO CLOSE after twelve (12)
hours, there is NO SURGERY POST-OPERATIVE NURSING
YET. RESPONSIBILITIES FOR
Physician gives ACYANOTIC CONGENITAL HEART
INDOMETHACIN DISEASES
o A prostaglandin Same as other cardiac post-
inhibitor operative nursing
Indomethacin responsibilities
can cause
VASOSPASM of
the Ductus
Arteriosus
This will bring CYANOTIC CONGENITAL HEART
about the DISEASES
CLOSURE of Tetralogy of Fallot
the Ductus Transposition of the Great
Arteriosus Vessels
o A gastric irritant
Causes gastric TETRALOGY OF FALLOT
bleeding Consists of four problems:
Surgery is done if Ductus TWO (2) MAJOR
Arteriosus remains patent PROBLEMS:
after administration of o Pulmonary Stenosis
Indomethacin o Ventricular Septal
o Purpose of surgery is Defect
to dilate the Ductus TWO (2) MINOR
Arteriosus PROBLEMS:
o This is procedure o Right Ventricular
involves a CLOSED Hypertrophy
HEART SURGERY Secondary to
Pulmonary
In COARCTATION OF THE AORTA, Stenosis
Physician inserts a o Overriding of the Aorta
BALLOON-TIPPED
52
Secondary to This is secondary to
Ventricular Ventricular Septal Defect
Septal Defect
Signs and Symptoms of Tetralogy
of Fallot
PULMONARY STENOSIS Hypoxia and Increase in
Characterized by: Unoxygenated Blood to the tissues
The presence of resistance results into:
Blood cannot enter the Clubbing of the fingers
Pulmonary Artery Polycythemia
Right Ventricle compensates
by pumping more pressure Hypoxia and Increase in
Right Ventricle INCREASES Unoxygenated Blood to the Tissues
IN SIZE ▼▼▼ ▼▼▼
This results into RIGHT Clubbing of the Decreased tissue
VENTRICULAR Fingers Perfusion to the
HYPERTROPHY Kidneys
o (this is secondary to ▼▼▼
Pulmonary Stenosis) Release of
There is greater pressure at Erythropoietin
the Right Ventricle ▼▼▼
Thus, shunting of blood is Bone Marrow
from the right side of the heart ▼▼▼
to the left side of the heart Increased levels
Therefore, there is increase in of RBC
both oxygenated and ▼▼▼
unoxygenated blood going to Polycythemia
the left side of the heart and
eventually to the tissues. Important Concepts!
Organs receive an increased In Tetralogy of Fallot:
amount of UNOXYGENATED Clubbing of fingers is
BLOOD o Due to prolonged
THEREFORE, PULMONARY hypoxia
STENOSIS IS CONSIDERED o A permanent deformity
AS CYANOTIC AT BIRTH o Secondary to hypoxia
due to INCREASED LEVELS o Hypoxia is left-sided
OF UNOXYGENATED Polycythemia
BLOOD GOING TO THE o Is left sided because it
TISSUES is also secondary to
hypoxia
VENTRICULAR SEPTAL DEFECT
Aorta slips to VSD Important Concepts!
Therefore, there is Tetralogy of Fallot Spells
OVERRIDING OF THE o Due to decreased
AORTA cerebral tissue
perfusion
53
Patient goes to SQUATTING Low sodium diet is also given
POSITION with Tetralogy of to prevent Congestive Heart
Fallot Spells Failure
o Rationale:
Squatting Key Concepts on Digoxin
compresses Digoxin has:
veins in the A positive (+) INOTROPIC
lower extremity. EFFECT
o Purpose is to: o It INCREASES the
Decrease STRENGTH of
venous return MYOCARDIAL
Decrease levels CONTRACTIONS
of unoxygenated A negative (-)
blood to the CHRONOTROPIC EFFECT
tissues o It DECREASES the
Thus, Tetralogy of Fallot spells CARDIAC RATE
are RELIEVED by the Antidote of Digoxin
SQUATTING POSITION. o DIGIBIND
Knee-Chest position may also Earliest signs of Digoxin or
be considered for relieving Digitalis Toxicity
Tetralogy of Fallot Spells (if o Gastrointestinal
squatting position is not Problems
included in the list of choices) Nausea
Vomiting
Important Concepts!!! Diarrhea
In Tetralogy of Fallot, the
following medications are Nursing Responsibilities with the
given in order to prevent Use of Diuretics
CONGESTIVE HEART Mnemonic is DIURETIC
FAILURE:
o Digoxin D is for:
A cardiac DIET
glycoside
Be sure to check Important Concepts!!!
Cardiac Rate Diet must be high in
prior to its potassium
administration Except for Aldactone
If Cardiac Rate o A potassium-sparing
is below sixty diuretic
(60) beats per
minute, do not I is for:
administer Monitor INPUT and OUTPUT
Digoxin
Administer Diuretics
54
Important Concept! TAKE DIURETICS WITH
Expected outcome with FOOD
diuretic use is increased urine
output Important Concept!
The best time to take a
U is for: diuretic is in the morning
UNDESIRABLE SIDE
EFFECTS I is for:
INCREASED TENDENCY TO
Important Concepts!!! DEVELOP OTHROSTATIC
Electrolyte imbalances HYPOTENSION
leading to weakness may
occur. C is for:
These electrolyte imbalances CANCEL ALCOHOL
are:
o Hypokalemia Important Concept!
o Hyperkalemia Alcohol also has a diuretic
effect
R is for:
RECORD Important Concepts on Diet for
Tetralogy of Fallot Patients
Important Concepts!!! For low sodium diet
Record the following Avoid processed foods
information: o Hotdogs
o Blood Pressure o Pickles
Patient is prone
to Medical Management of Tetralogy
ORTHOSTATIC of Fallot
HYPOTENSION Phlebotomy for Polycythemia
o Weight of Client
Decrease in Surgical Management for
weight reflects Tetralogy of Fallot
the therapeutic Blalock Taussig Surgery
effect of o Creates a connection
diuretics between the
Pulmonary Artery and
E is for: the Aorta
ELDERLY o Creates a DUCTUS
ARTERIOSUS
Important Concepts!!!
Take special precaution when TRANSPOSITION OF THE GREAT
using diuretics in the elderly VESSELS
Elderly tends to lose more Also known as TOGV
water than ordinary adults
T is for:
55
Important Concepts!!! FORAMEN OVALE MUST
In the NORMAL ANATOMY of REMAIN OPEN
the HEART, Thus, Physician orders
o The Aorta is connected PROSTAGLANDIN to
to the Left Ventricle MAINTAIN the PATENCY of
o The Pulmonary Artery the DUCTUS ARTERIOSUS
is connected to the (Remember! – Indomethacin
Right Ventricle is anti-prostaglandin)
Physician inserts a
In Transposition of Great Vessels BALLOON-TIPPED
The Aorta is connected to the CATHETER to maintain the
Right Ventricle patency of the FORAMEN
The Pulmonary Artery is OVALE
connected to the Left Ventricle
Signs and Symptoms of
Important Concepts on Transposition of Great Vessels
Transposition of Great Vessels Same as that of Tetralogy of
TOGV is NOT compatible with Fallot
life Cyanosis
Client with TOGV experiences Clubbing of the Fingers
CYANOSIS Polycythemia
Since the Aorta is connected
to the Right Ventricle, Nursing Management for Patients
UNOXYGENATED BLOOD with Transposition of Great
from the Right Ventricle goes Vessels
to the Aorta – THIS IS THE Same as that of Tetralogy of
MAIN PROBLEM Fallot
Physician does NOT do Surgical Management for
surgery RIGHT AWAY!!! Transposition of the Great Vessels
Maintain Tissue Perfusion first ARTERIAL SWITCHING
Physician will NOT give
INDOMETHACIN
Since Pulmonary Artery is
connected to the Left RHEUMATIC FEVER
Ventricle, there is Always secondary to GABHS
INCREASED PRESSURE in or Group A Beta-hemolytic
the PULMONARY ARTERY Streptococcus
Blood must flow from the
PULMONARY ARTERY Important Concept!!!
through the DUCTUS In the assessment phase, the
ARTERIOSUS to the AORTA nurse should ask the patient if
so that the tissues would he has any of these:
receive OXYGENATED o Tonsillitis
BLOOD o Sore Throat
Therefore, the DUCTUS o Impetigo
ARTERIOSUS and
56
Key Concept! Ask the client to
A client with previous tonsillitis count from one
is prone to Rheumatic Fever (1) to twenty
(20) in a very
Sample Board Question: rapid manner
Which of the following would If, (in the
predispose a person to Rheumatic vernacular)
Fever? bulol, then he
a) Swimming has this sign.
b) Profuse Bleeding o This is temporary in
c) Bull’s eye lesion nature
d) Forgot a baseball cap Erythema Marginatum
Answer:
Letter D MINOR JONES CRITERIA
Rationale: Elevated White Blood Cell
If you borrow a baseball cap Count
(to play a game) from a Elevated C Reactive Protein
person with impetigo, that Elevated ASO Titer
would predispose you to Elevated Platelets
Rheumatic Fever. Prolonged PR interval
Other options are not related o Reflected at the ECG
to Rheumatic Fever. Bull’s History of Streptococcal
eye lesion is characteristic of infection
Lyme’s Disease
Diagnosis of Rheumatic Heart
Rheumatic Fever Secondary to Disease
Group A Beta-Hemolytic If you have:
Streptococcus o At least two (2) MAJOR
▼▼▼ JONES CRITERIA
Damages valves of the heart then you are
▼▼▼ POSITIVE (+)
Rheumatic Heart Disease for Rheumatic
▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ Heart Disease
▼▼▼ ▼▼▼ If you have:
Major Jones Minor Jones o One (1) MAJOR
Criteria Criteria JONES CRITERIA
o Two (2) MINOR
MAJOR JONES CRITERIA JONES CRITERIA
Carditis o History of
Polyarthritis
Streptococcal Infection
Subcutaneous nodules
Then you are
o How are they
POSITIVE (+)
assessed? for Rheumatic
Palpate the skin Heart Disease
Chorea of St. Vitus Dance
o How is this assessed? Management of Rheumatic Fever
57
Antibiotics o A platelet receptor
Drug of Choice inhibitor
o Penicillin (never o Inhibits the occurrence
Amoxicillin) of Myocardial Infarction
Give Phenobarbital to treat Steroids
Chorea o Also for anti-
inflammatory effect
KAWASAKI’S DISEASE N-gamma globulin
o To decease immune
Kawasaki’s Disease response
▼▼▼
Presence of Fever (which is BLOOD DISORDERS IN
unresponsive to ANTIPYRETIC PEDIATRIC NURSING
medication)
▼▼▼ SICKLE CELL ANEMIA
Vasculitis (A life-threatening An AUTOSOMAL
condition) RECESSIVE DISORDER
▼▼▼ Major Problem
Aneurysm o Body produces
(Asymptomatic bursting of a blood ABNORMAL
vessel) HEMOGLOBIN
or
Myocardial Infarction
58
Signs and Symptoms of Sickle Administer oxygen via nasal
Cell Anemia cannula
Mnemonic is SHIP
Next thing to do:
S is for: Increase the FLOW RATE of
SEVERE PAIN the I.V.
H is for:
HEMATURIA Diagnostic Tests for Sickle Cell
Anemia
Important Concept!
This is due to decreased SICKLE DEX TEST
tissue perfusion Used to determine and
identify the trait of the sickle
I is for: cell anemia
IRRITABILITY
Hemoglobin Electrophoresis Test
P is for: To determine the disease
PALE IN COLOR
THALASSEMIA
Management of Sickle Cell Anemia Also called:
Mnemonic is HOP o Cooley’s Anemia
Provide the following in a o Mediterranean Anemia
sequential manner: Major Problem
o Hydration o Produces an
o Oxygen Therapy ABNORMALLY
o Pain Medication FRAGILE hemoglobin
with a SHORT LIFE
Important Concepts!!! SPAN
First thing to do:
Abnormal Hemoglobin (very fragile
Assess or check the patency and with short life span)
of the I.V. tubing ▼▼▼
Increased rate of hemolysis
59
▼▼▼ Remove iron by CHELATION
Gives rise to the various signs and THERAPY
symptoms of the disease o Drug of Choice
Desferol
Signs and Symptoms of Remove Spleen by
Thalassemia SPLENECTOMY
Hemosiderosis o Patient
o Increased rate of Teaching
hemolysis of RBC Client should
leads to increased always receive
amounts of iron in the prophylaxis for
body life
o This tends to deposits Steroids
in the tissues causing o To decrease activity of
Hemosiderosis the bone marrow
Jaundice o For
o Increased rate of immunosuppression
hemolysis of RBC
leads to increased
levels of indirect Blood Transfusion
bilirubin o Patient’s packed RBC
o This leads to Jaundice is changed
Splenomegaly o If there is any reaction
o Increased rate of to Blood Transfusion:
hemolysis of RBC Stop
overworks the spleen Open the main
and gives rise to I.V. line (normal
increased levels of saline solution)
dead RBC o Call the doctor
o This leads to
Splenomegaly HEMOPHILIA
Aesthetic Problems A sex-linked disorder
o RBC leads to Only MALES are
decreased levels of SYMPTOMATIC
RBC Major Problem
o The body compensates o Deficiency in clotting
by increasing the factors
activity of the bone Makes the patient prone to
marrow bleeding
o This produces
hypertrophy of the
bone marrow leading to Signs and Symptoms of
Aesthetic Problems Hemophilia
60
o Clients are usually
hospitalized due to Injured Tissue
hemarthrosis ▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼
o This is also the usual Releases Bleeding
cause of pain in Thromboplastin ▼▼▼
hemophiliacs ▼▼▼ Vasoconstriction
Thromboplastin of blood vessels
Epistaxis and Gum bleeding converts to stop bleeding
Prothrombin (apply cold)
Intracranial Hemorrhage to Thrombin ▼▼▼
o This is the most ▼▼▼ Vasodilation
common cause of Thrombin converts for wound
death Fibrinogen to healing
Fibrin (blood clot) (apply hot)
Important Concepts!!!
Earliest sign of hemophilia Important Concept!!
In Hemophilia, there are NO
First choice: CLOTTING FACTORS
o Profuse bleeding in the
umbilical cord Types of Hemophilia
Normal Value
o Eleven (11) to Sixteen
Nursing Responsibilities in
(16) seconds
Hemophiliac Patients
If this is elevated
1. If client is bleeding due to
o This signifies bleeding
hemophilia, the first thing to do is to
apply the RICE technique
If this is decreased
o This signifies clotting
61
R is for: This results to its major
REST problem, which is ORGAN
INFILTRATION
Important Concept!
Immobilize the affected area Signs and Symptoms of Leukemia
1. Pain
I is for: Increase in number of
ICE immature WBCs makes the
body compensate by
Important Concept! increasing the activity of the
Vasoconstriction of blood Bone Marrow
vessels to stop bleeding This leads to Bone Marrow
Hypertrophy
C is for: Bone Marrow Hypertrophy is
COMPRESS the common cause of Pain in
Leukemia patients
Important Concept!
Put pressure to stop bleeding 2. Infection
Increase in the number of
E is for: immature WBCs makes the
ELEVATION body compensate by
increasing the activity of the
Important Concept! Bone Marrow
Elevate affected part This leads to further
production of immature
2. Blood transfusion is needed WBCs, which makes the
Provide CRYOPRECIPITATE Leukemic patient predisposed
to infection
3. Drug of Choice to prevent further
bleeding is VASOPRESSIN 3. Anemia
This is given NASALLY Increase in the number of
Patent is placed in a SUPINE immature WBCs makes the
POSITION body compensate by
o Head is hanging on the increasing the activity of the
edge of the bed Bone Marrow to produce
o Tilted down more WBCs (which are also
Vasopressin is then immature)
administered This leads to decreased levels
of Red Blood Cells, which
makes the Leukemic patient
LEUKEMIA prone to Anemia
Characterized by increase in
the number of immature White 4. Bleeding
Blood Cells Increase in the number of
immature WBCs makes the
body compensate by
62
increasing the activity of the Nursing Responsibility in the
Bone Marrow to produce Maintenance Therapy Phase
more WBCs (which are also o Advice client to
immature) undergo COMPLETE
This leads to decreased levels BLOOD COUNT
of platelets, which o This is to check if the
predisposes the Leukemic client is responding to
patient to bleeding the therapy
63
o The best restraint to The most important people for
use for a post- a cleft lip or a cleft palate
cheiloplasty patient is patient are the following:
an ELBOW o Audiologist
RESTRAINT o Speech Therapist
o If patient has already o Dentist
rolled-over, the best In pre-cheiloplasty cleft lip
restraint to use for a patient or in a pre-uranoplasty
post-cheiloplasty cleft palate patient, the person
patient is a JACKET who is MORE ANXIOUS is
RESTRAINT the MOTHER OF THE
PATIENT (rather than the
CLEFT PALATE patient)
This is a NOT AN OBVIOUS Sample Board Question:
congenital deformity at birth The best way to relieve the
o This requires thorough anxiety of the mother is to:
mouth inspection a) let the father see the
o Usually remains operation
undiagnosed despite b) show pictures of cleft
thorough mouth palate and cleft lip before
inspection and after surgery
Surgery c) breast feeding
o Uranoplasty d) family support
o Delayed until one (1) to Answer
two (2) years of age o Letter B
o Rationale for the delay: Nursing priority before
To allow the corrective surgery (either
growth of the cheiloplasty or uranoplasty) is
hard palate PROPER NUTRITION
Before speech o Therefore, use
would develop ALTERNATIVE
Best Post-operative Position FEEDING
o Prone position or lying TECHNIQUES
on abdomen
Best feeding material How does the Nurse Retain
o Feeding Cup Feeding in a Pre-operative Cleft
Lip of Cleft Palate Patient?
IMPORTANT CONCEPTS FOR Burping or Bubbling (Frequent
BOTH CLEFT LIP AND CLEFT Burping)
PALATE!!! Small Frequent Feedings
The best teaching for a pre- o Increase the size of the
cheiloplasty patient or a pre- nipple of the bottle by
uranoplasty patient is what cutting the nipple of the
the patient will have to do bottle
after the procedure
64
Important Post-Cheiloplasty or through the esophagus may
Post-Uranoplasty enter the trachea and the air
Nursing Responsibilities passing through the trachea
Post-operative priority is to may enter the esophagus
prevent infection
For both procedures Nursing Priority in
o Clean suture line Transesophageal Fistula:
before and after Airway
feeding TEF patient is more prone to
Never give a straw to post- infection
operative patient o Pneumonitis
Due to the
ESOPHAGEAL ATRESIA possible
There is an obstruction in the presence of food
esophagus in the lungs
The esophagus is not
continuous
65
you do the bed o Liver produces bile and
bath stores it in the gall
If the patient is normal. bladder
o Feet are the dirtiest o If fat is present in the
area of the body duodenum, the
Therefore, clean duodenum releases
this last when Cholecystokinin
you do the bed Pancreozymin (CCK) –
bath a substance that
causes the gall bladder
PYLORIC STENOSIS to contract and release
This disease is characterized bile
by the affectation of the o Gall bladder releases
pyloric sphincter bile through the cystic
The pyloric sphincter is the duct to the common
structure at the distal end of bile duct and through
the stomach, which prevents the ampulla of vater
the backflow of food from the going to the duodenum
duodenum to the stomach o Since bile is reaches
In Pyloric Stenosis, there is the food in the
hypertrophy of the pyloric duodenum, the vomitus
sphincter in pyloric stenosis does
This may cause obstruction not have bile
66
APPEARANCE o Secondary function of
characteristic of pyloric this test is therapeutic
stenosis in purpose
Due to the
Treatment for Pyloric Stenosis pressure
Fredet Ramstedt Procedure exerted in
o This is the surgery for barium enema,
pyloric stenosis the small
o Also called intestine is
PYLOROMYOTOMY stretched
The stretching of
INTUSSUSCEPTION the small
Major Problem intestine causes
There is a telescoping of the a reduction in
small intestine the
Part of the small intestine intussusception
enters into itself
Food accumulates into the Medical Management for
part where the intestine enters Intussusception
into itself Surgery involves cutting the
part with the invagination
Signs and Symptoms of followed by end-to-end
Intussusception: anastomosis
67
enlargement of the Treatment of Imperforate Anus
colon – a phenomenon Local Piercing
known as a
MEGACOLON METABOLIC GASTROINTESTINAL
SYSTEM PROBLEMS in
Signs and Symptoms of PEDIATRIC PATIENTS
Hirschsprung’s Disease Phenylketonuria
Galactosemia
In the newborn Coeliac Disease
Absence of meconium for the
first twenty-four (24) to forty- PHENYLKETONURIA
eight (48) hours An autosomal recessive
disorder
In the infant Major Problem
Presence of explosive o Inability to metabolize
diarrhea Phenylalanine
o Characterized by the
In the child absence of the enzyme
Presence of ribbon-like stool PHENYLALANINE
HYDROXYLASE
Management of Hirschsprung’s Phenylalanine hydroxylase
Disease converts phenylalanine to
Surgeon ligates the portion tyrosine
with Hirschsprung’s Disease
and then does end-to-end NORMAL METABOLISM OF
anastomosis PHENYLALANINE
68
▼▼▼ Absence of Phenylalanine
▼▼▼ hydroxylase does not convert Also, in Phenylketonuria
▼▼▼ Phenylalanine to tyrosine
▼▼▼ Phenylalanine
No tyrosine produced ▼▼▼
▼▼▼ ▼▼▼ Absence of Phenylalanine
No new melanin produced ▼▼▼ hydroxylase does not convert
Decreased levels of melanin ▼▼▼ Phenylalanine to tyrosine
▼▼▼ ▼▼▼
Leads to Fair Skin There is accumulation of
(Normal at Birth); Phenylalanine leading to
Leads to Blonde Hair increased levels of phenylalanine
(Normal at Birth); ▼▼▼
Leads to Blue Eyes CENTRAL NERVOUS SYSTEM
(Abnormal at Birth) DAMAGE
▼▼▼ (continued on next page)
Important Concept! Mental Retardation
At birth a pediatric normally There is no treatment for this!!!
has GRAY EYES
In phenylketonuria, the Important Concepts!
pediatric abnormally has In phenylketonuria, increased
BLUE EYES at birth levels of phenylalanine cause
CNS damage that leads to
Important Concept! Mental Retardation
At birth a pediatric normally Prevention of Mental
has odorless urine Retardation is done by
In phenylketonuria, the providing a MODIFIED DIET
pediatric has a MUSTY composed of PKU1 infant
ODOR urine at birth formula or LOPENALAC
69
Modified diet is always given Diagnostic Tests for
for metabolic disorders Phenylalanine
Done until six (6) to eight (8) Guthrie Test or Capillary Prick
years old Test
o Rationale: This is a test for the presence
It is at this age of Phenylketonuria
that MAXIMUM Basic Nursing Responsibilities
BRAIN in performing the Guthrie Test
DEVELOPMENT o Warm the heel of the
occurs foot to improve
This is the also the period circulation
wherein mental retardation If result is less
has the last chance of than 2 mg/dl,
developing this is a
NORMAL
Important Concepts on Mental RESULT
Retardation If result is
Normal blood level or greater than 4
Therapeutic level of mg/dl, this
Phenylalanine is six (6) to indicates a
eight (8) mg / dl. POSITIVE
If blood level of Phenylalanine RESULT FOR
is greater than 10 – 15 mg / GUTHRIE TEST
dl, this would cause mental or the presence
retardation of
If pediatric has a blood phenylketonuria
phenylalanine level of 12 o Before client
mg/dl, the nurse should: undergoes Guthrie
o Continue modified diet Test, patient should
o Never stop giving foods ingest foods rich in
rich in phenylalanine phenylalanine
Rationale: o For the newborn, give
Decrease in formula milk or breast
phenylalanine milk before undergoing
triggers test
increased False-positive
protein results may be
breakdown obtained if nurse
resulting into a fails to give
sudden increase feeding to the
in phenylalanine pediatric who
levels leading to underwent the
mental Guthrie Test
retardation Important Concept!
Allow child with
Phenylketonuria to go to
70
birthday party but he has to
bring his own type of feeding Never administer PENICILLIN nor
AMOXICILLIN
GALACTOSEMIA Both these drugs contain
Major Problem GALACTOSE
Galactose cannot be Give ERYTHROMYCIN
absorbed instead!!!
This is due to the absence of
the enzyme GALACTOSE COELIAC DISEASE
TRANSFERASE Major Problem
This would give rise to Gluten cannot be digested
increased levels of Galactose
71
▼▼▼
Increased secretion of Renin NEPHROSIS
▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼▼ Cause is UNKNOWN
Conversion of Aldosterone Considered as an
Angiotensin I to ▼▼▼ AUTOIMMUNE disease
Angiotensin II Sodium Retention
▼▼▼ ▼▼▼ ▼▼▼ Nephrosis
Increased BP Periorbital Decreased ▼▼▼
(HPN) Edema; Urine Autoimmune Disease
▼▼▼ Puffiness Output ▼▼▼
Fussy, of the eye ▼▼▼ Anti-bodies produced to destroy the
Irritable Oliguria kidney
▼▼▼ ▼▼▼
72
o Blood Pressure is
NORMAL S is for:
SIGNS
Management of Nephrosis o Increased Blood
Give steroids Pressure
o For o Increased Temperature
immunosuppression o Decreased Respiratory
No Antibiotics Rate
Diet o Decreased Pulse Rate
o Increased protein Widened Pulse Pressure
o Decreased sodium
Decreased fat
73
Mnemonic for signs and
symptoms is CHIPS H is for:
Mnemonic for management is HYPOTHERMIC BLANKET
AHOY DUE TO FEVER
C is for: Y is for:
COMA YES TO ISOLATION
PRECAUTION
Important Concepts!
Alteration in level of CEREBRAL PALSY
consciousness Mnemonic for the different
Coma is the last stage classifications is ARMS
I is for: A is for:
IRRITABILITY ATAXIC CEREBRAL PALSY
o Walking or movement
P is for: problem
PROJECTILE VOMITING and o With unsteady or wide-
PETECHIAL RASHES based gait
S is for: ATHETOID CEREBRAL
SIGNS PALSY
o Ophistotonous arching o Articulation
of the back o Facial Grimacing
o Kernig’s Sign
There is R is for:
resistance at the RIGID CEREBRAL PALSY
knee when it is
pulled Important Concepts!
o Brudzinski’s Sign Loss of active motion
Flexion of the Rigid posture
neck results to
flexion of the hip M is for:
and leg MIXED CEREBRAL PALSY
74
S is for: Head of the femur is
SPASTIC CEREBRAL PALSY displaced
Head of the femur floats in the
Important Concepts! acetabulum
Hyperactive deep-tendon
reflexes Signs and Symptoms of
Hyperactive Stretch muscles Congenital Hip Dislocation
With scissory gait Mnemonic is FLOAT
Walks in a tip-toe manner
F is for:
Management of Cerebral Palsy FOLDS / GLUTEAL FOLDS
Place the patient on BED ARE INCREASED
B is for:
BRACES / SPLINT L is for:
LIMB / AFFECTED LIMB IS
E is for: SHORTER THAN
Promote EXERCISE / UNAFFECTED LIMB
ACTIVE RANGE OF MOTION
EXERCISES O is for:
ORTOLANI’S SIGN
D is for:
DRUGS Important Concepts!
This is used to check for the
Important Concept! presence of Congenital Hip
Administer MUSCLE Dislocation
RELAXANT This is a CLICKING SOUND
on ABDUCTION OF THE HIP
Key Concept!
Never place a cerebral palsy A is for:
patient in a walker ALLIS’ SIGN
This will result into accidents
Important Concept!
MUSCULOSKELETAL SYSTEM One knee is lower than the
DISORDERS IN PEDIATRIC other
NURSING
Congenital Hip Dislocation T is for:
Scoliosis TRENDELENBURG SIGN
Club Foot
o Talipes Equinovarus Management of Congenital Hip
Duchenne Muscular Dislocation
Dystrophy Pavlik’s Harness
Double / Triple Diaper
CONGENITAL HIP DISLOCATION Technique
75
SCOLIOSIS o Pushing self from the
Lateral curvature of the body floor using the hands
Priority is respiration o If client is on the floor,
Ages ten (10) to fifteen (15) or he uses his hands to
adolescents are screened stand up
More common in females This is indicative of Duchenne
Muscular Dystrophy
Screening Test for Scoliosis
Let the pediatric lie down CARDIOPULMONARY
Let the pediatric bend RESUSCITATION (CPR)
If the skirt is oblique, then this
is indicative of scoliosis Important Concepts on CPR!
Then, confirm diagnosis with Do scene survey first
X-ray Ensure safety of the rescuer
Good Samaritan Principle
Confirmatory Diagnostic Test for
Scoliosis
X-ray
Management of Scoliosis
Use MILWAUKEE BRACE
An orthopedic device
Use for twenty-three (23)
hours in a day
Pediatric can swim for one (1)
hour without the Milwaukee
Brace
CLUB FOOT
Talipes Equinovarus (TEV)
Management of TEV
Use Denis-Browne Splint
If client is still growing,
frequently adjust the
therapeutic device
DUCHENNE MUSCULAR
DYSTROPHY
Major Problem
Increased muscle fiber
breakdown due to decreased
DYSTROPHIN
Priority is respiration due to
breakdown of the diaphragm
Gower’s Sign
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