PEDIATRIC NURSING

Growth and Development

Growth Development
Quantitative Chane Qualitative Change
Measurable Observable Dentition:
Increase in Size Increase in skill/ability (Teeth Development)
e.g., Wt, Ht, HC, CC, A.C, D.D.S.T Natal Teeth – teeth that
Dentition are present when a baby is
Weight: DDST is only applicable born.
6-9 lbs. (normal newborn for 6 y/o below: 6 mos. – First tooth erupt
wt.) decrease in ½ lbs. in (lower central incisors)
first week of life: 4 Areas: o Temporary teeth
 double in 6 mos. 1. Gross motor 3 y/o - Milk teeth
 triple in 1 y/o 2. Fine motor (Deciduous Teeth) 20
4x in 2 y/o 3. Language Skill 6 y/o – Deciduous teeth
5x in 3 y/o 4. Socialization start to fall off
Skill
Psychological Develop:
Height: Psychological A. Sigmund Freud: Psychosexual Theory
20 inches (newborn) Development
2x in 4/o Freud’s: Psychosexual Purpose: to satisfy libido (pleasure)
3x in 13 y/o Erikson: Psychosocial
STAGES AGE ZONE OF Freud
inches to feet: Piaget: Cognitive
PLEASURE
Kohlberg: Cognitive
Infant 0-1 Mouth Oral

Growth Chart: (plotting) Toddler 1-3 Anus Anal

Preschool 3-5 Genitalia Phallic

School Age 6-12 (-) Latent
Adolescent 13- Genital
19

Infant: Head is bigger than o ORAL STAGE

the chest - Allow the baby to get used to (masawa)
Circumferences
- Bottle feeding
HC: 33-25 cm
- Pacifier
CC: 31-33 cm
31-33 cm
Soft part in infant Head: o ANAL STAGE
- “Holding on and letting go.”
- Readiness: Toilet Training
1. Physiological
- Myelination of spinal cord (+ muscle
 contraction) for the father’s role
- can stay at least 2 hours if their child is a boy.
- SSW (sit, stand, walk)
2. Psychological
 Principle Task:
- Verbal cues
 Fixation: Exhibitionism, Vanity and PRide
Nonverbal cues
- Guidelines for Toilet Training:
o LATENCY
1. Potty Chain
 School age
2. Dress in easily removed clothing
 Socialization
3. Set a schedule
 Homosexual stage
- Stress: Regression is normal and
temporary
o GENITALS
 Puberty
 Girls: 10-12 y/o (First to hit puberty)
 Boys: 12-14 y/o (2 years behind to girls)
 Signs:

Female Male
Inc. Height Inc. Weight
Inc. Pelvis Inc. testes
Diameter (activation of
testosterone H)
resulting to hairy
appearance in the
skin.
Thelarche (Breast Inc. size Penis
development)
Menarche (First Voice Changes
Menstruation) due to
Testosterone H.

Mnemonic for Freuds: OAPhaLaGe

B. Erik Erikson: Psychosocial Theory

Developmental Virtue
Task
o PHALLIC STAGE Infant Trust vs. Hope
 Sexual identity is known Mistrust
Toddler Autonomy vs. Will
 Boy: Masturbation
Shame and
 Girl: Penis Envy
Doubt
Oedipus Complex Electra Complex (Independence
Mama’s Boy Daddy’s Girl vs.
Son loves Mother Daughter Hates Dependence)
Son Hates Mother Mother Pre-school Initiative vs. Purpose
Daughter Loves Guilt
Father School-Age Industry vs. Competence
Note: It is important Inferiority
Adolescent Identity vs. Role Fidelity
Confusion
Young Adult Intimacy vs. Love
(20-35 y/o) Isolation
Middle Adult Generativity vs. Care
(35-55 y/o) Stagnation
Old Adult Integrity vs. Wisdom
Despair

o Infant: Trust vs. Mistrust”

 Dependent
 Make the infant feel like, “You’ll be safe
here.”
 *Gratify immediate needs

o Toddler: Autonomy vs. Shame and Doubt

 Independent (they want to have the
sense of autonomy.
 Characteristic:
 Negativism – Persistent NO for an
answer.
N/r:
a. Do not ask yes/no Q.
b. Offer choices
c. Play games/ challenge the child
RULE: Always let the child win.
 Temper Tantrums – Frustration;
manipulation
N/r:
a. Ignore tantrums
b. Comfort the child (after the
tantrums)
c. Time-out – “Stand in the corner”;
Healthy Punishment
Rule: Time punishment will be as
long as his age.
d. Praise the child - Positive
reinforcement
 Ritualism
 - SIADH/DI (Sydrome Inappropriate
anti diuretic hormone/Diabetes
PEDIATRICS DISORDERS
Insipidus
i. MENINGITIS !!! Monitor Urine Output
a. Causative Agent:
 Bacteria:
 E.coli ii. HYDROCEPHALUS
 Hib (Hemophilus influenza type B) a. Indication:
 Neisseria Meningitis  Big head due to excess CSF (cerebro
 Virus: spinal fluid)
 West nile virus b. 2 kinds:
 Cox sickie Virus 1. Communicating
 Para Myxovirus - “non-obstructive”
b. Mode of Transmission: - Impaired Absorption
 Droplet - Increase CSF
c. Period of Communicating 24-48 hours 2. Non-communicating
IVAB (IV Antibiotic) - Obstructive
d. Sign and symptoms: (Infants) - Blockage cause by tumor or
 Fever or Hypothermia inflammation.
 Irritability c. CSF Glow:
 Poor sucking
 High pitch cry
 Headache
 Bulging fontanelle (infant)
e. Two signs of Meningeal Irritation
 Brudzinski S.
 Batok
 Kernig’s S.
 Knee
f. Diagnostic:
 Lumbar Puncture

d. Sign and Symptoms:

 Macewen’s Sign (crackpot sound on
percussion)
 Sunset Eyes (when the eyeballs rotate
downward)
g. Management:  Increased ICP
1. Isolation: Drop Precaution  Bulging Fontanelle
- Private room  Dilated Scalp Veins
- Surgical Mask e. Management
2. Non-stimulating Environment  Shunt Procedure
3. Monitor complication  Two types of Shunt:
 Acute:
VP shunt VA shunt
- Hydrocephalus
 Ventriculo Ventriculo - Do not use diaper
peritoneal shunt peritoneal shunt Complication: It can
Directed to the result to meningitis
right atrium b. Moisten the SAC
Only done to the - Sterile MOIST NSS
full grown child Post-op:
 Pre-operation:
 Mannitol (Osmitrol)- decreases
cerebral edema
 Acetazolamide (Diamox) – decreases
CSF production
 Post-operation Discharge:
- Enema
 Flat position (first 24 hours) – to the
- CIC (Clean Intermittent
unaffected side
Catheterization)
 Upright position (after 24 hours)
 Monitor complications: 2. S.B occulta
 Infection - Hidden (not obvious)
 Bleeding - Skin
 CSF leakage depression/dimpling of
How to monitor? When there is a the skin
positive for Halo Sign - tuft of hair
 Doscharge: Exencephaly
 Avoid contact sport (outside the
 WOF shunt failure skull)
iii. NTD (Neural Tube Defects) N/R:
a. Description Anticipatory
Grieving
CNS malformation
b. Risk Factors:
 Folic Acid Deficiency iv. CEREBRAL PALSY
a. Description:
BRAIN SPINAL
 Permanent brain damage due to Hypoxia,
Anencephaly (x Spinal Bifida (baby is
cerebrum) alive) infection and
 Irreversible
Types:  In the US, It is subjected for abortion.
1. S.B cystica  Non-progressive
- there is a bulging like b. Types:
in the back of the spine 1. Spastic CP: Most common type;
- more dangerous muscle spasm
- two types of cystica 2. Ataxic CP: Wide Base bait; Area
a. Meningocele affected is Cerebellum
- bulging sac that 3. Dyskinetic CP/Athetoid
contains CSF - Resulting to disorganize movements
b. Myelomeningocele
- patient will move in a writhing
- risk for paralysis due to
motion (work like movements)
bulging CSF with spinal
nerve 4. Mixed: Worst type of CP (since several
Pre-op: parts of the brain is damage)
a. PROTECT THE SAC!
- Prone only c. Sign and Symptoms
- Do not turn side to side
  Persistent Reflexes (disappear by 4-6 vi. KAWASAKI DISEASE
months) a. Description
 Delayed Development “Universal sign”  Mucocutaneous Lymph node syndrome
 Abnormal postures b. Cause
d. Management  Idiopathic
 Muscle relaxant c. Sign and symptoms
 Lioresal (Baclofen)  Fever
 Botulinum – Toxin (Botox)  Strawberry Tongue
**Inject in the Affected Muscles  Inflamed joints (arthritis)
Effect: Reduce Acetylcholine  Red Eyes (conjunctivitis)
resulting to Muscle relaxation in 3  Enlarged Lymph node
months  Desquamation (namamalatmalat)
 Topical Anesthesia (EMLA) d. Complication
 Apply 1 hour before  Coronary Aneurysm
 M.I (myocardial Infarction
 Characteristic in children are severe
v. RHEUMATIC HEART DISEASE (RHD) abdominal pain
a. Cause: Autoimmune (immune system is what  Can only be seen in Kawasaki disease
causing the RHD making it inflamed from  Thrombosis
attacking the causative agent. e. Diagnose
b. Precipitating Factors: GABHS 1. ESR
 Group A - Beta Hemolytic  N.V: 0-20 mm/hr.
Streptococci  Severe elevated
c. Sign and Symptoms: Jones Criteria 2. Platelet: (subacute)
Diagnosed with RHD if you have at least the  Increase platelet causing
following: thrombosis.
(+) Rhd: 2 major s/sx f. Management
(+) 1 major plus 2 minor s/sx 1. Gamma Globulin – STOP the immune
response
Major Minor N/R: Delay vaccination
Carditis Fever 2. Aspirin
Erythema Arthritis
 Antipyretic
Marginatum
 Anti inflammation
Polyarthritis Raised ESR
 Antiplatelet
Subcutaneous ECG changes
3. Abciximab – platelet inhibitor
Nodules
St. Vitus Dance “Proloneg PR
(Sydenhan’s Chorea interval” (ecg
changes) vii. COGENITAL HEART DEFECT (CHD)
d. Diagnostic: a. Description
1. ASO titer “Anti-streptolysin D”
2 genial CHD:
 Indicates that you have a previous GAHBS
infection
e. Management
 Corticosteroids: Anti inflammation
 Drug of choice.
 Aspirin: Antipyretic/Anti inflammation
 Prophylactic Penicillin
 Monthly IM (10-15 years)
Note: If the heart defect (refer below) starts with T or H,
it is considered cyanotic Heart defect.

b. Types:
1. VSD
 Most common heart defects Pulmonary Aortic Stenosis COA
 Murmur in the 4th-5th intercostal space. Stenosis (Coarctation of
 Naay buslot sa mid ventri both right and Aorta)
left
Diagnostic:
 Echocardiography
=ETZ
Management:
 Open heart surgery “Dacron Patch”
2. Atrial Septal Defect
 Left to right shunting in the atrial area
 3rd and 4th ICS murmur
3. AVC Defect (Atrio ventricular Canal
Defect)
 Another name: Endocardial Cushion
Defect
 Common among Down Syndromes
 Defect in the mid part of the heart
 Shunting is left side to the right side
Management:
 Open Heart Surgery (Dacron Patch)
4. PDA (Patent Ductus Arteriosus) 5. Tetralogy of Fallot
 Most common cyanotic heart defect
 Overriding of the aorta
D
R
Opening
 Pulmonary Stenosis Management:
*oxygen
*morphine sulfate

Complication:

 Heart failure:
 Beta Blocker
 Digoxin: Do not administer below 100
 Ineffective endocarditis

G.I (Gastrointestinal)

i. Cleft Lip/ Cleft Palate

a. Risk Factors:
 Genetics
Diagnostic  Gender:
CL: Male
 Echocardiography
CP: Female
 Heart is bootshaped
b. Meds:
 “courer-ern-sabot appearance”
 Valproic Acid
Management  Nifedipine
 Thalidomide
 PGE: Prostaglandin E (open ductus
c. Management:
arterioscus) increase Pulmonary blood
 CL: Cheiloplasty (10 wks; 10 lbs.; 10 g-
flow
Hgb)

 CP: Palatoplasty (12-18 months)
d. Pre-op:
 Special feeding Bottle:
Haberman feeder
Dropper
Principles
 Enlarge the nipple
 Stimulate the suck reflex by touching the
lips
 Swallow (wait for the child to swallow)
 Rest (straddle the child to burp frequently
Corrective surgery: Brock-Procedure to prevent vomiting)
Sign and Symptoms: (General)
Note: While waiting the child for surgery
 Decrease oxygenation
*easy fatigue e. Post-op
*poor feeding  Priority is “Protect the suture line.”
*weight loss  Position: Re
CL: unaffected side
Cyanotic Test spells
CP: Prone Position
Position:  Restrain for both type: Elbow
Management: Remove every 2
 Infant: knee chest position hours (one at a time
 Child: Squating Position
  Olive-shape mass (RUQ)
 Logan’s Bar (CL)  Projectile vomiting
(Immediate after feeding)
 Metabolic Alkalosis (due to persistent
vomiting)
c. Diagnostic
 UTZ
Note: Avoid something hard for CP that enters the d. Management:
mouth.  Pyloromyotomy (a surgery to repair the
pylorus)
 Fredet – Ramstedt Procedure
ii. TEF/ TEA (Tracheoesophageal Fistula *connection*/
Tracheo Esophageal Atresia c
iv. Intussusception
a. Overview
 Telescoping
 Invagination of intestine
b. Signs and symptoms
 Severe; colicky; intermittent abdominal
pain
 Abdominal Distention
 Sausage-Shape Mass
 Currant-Jelly Stool
c. Diagnostic
 Barium Enema (Both therapeutic and
Diagnostic)
Normal: Brown (Report to physician)
 This indicates no need for surgery.
d. Management
 Reduction Surgery

a. Sign and Symptoms:

-coughing v. Hirschsprung’s Disease
Choking a. Overview
Cyanosis  Anganglionic Megacolon
Drooling of cyanosis  Absence; group of nerve cells;
 Ganglion deficient resulting to inability of
b. Management NPO then refer to physician feces to move for excretion.
*ganglion - group of nerve cells
b. Signs and symptoms:
iii. Pyloric Stenosis  No meconium stool: 24-48 hours
a. Description  Abdominal Distention
 Hypertrophy of the pyloric muscle\  Chronic constipation
uncommon condition in infants that  Ribbon-like stool
blocks food from entering the small c. Diagnostic
intestine  Rectal Biopsy
b. Sign and symptoms: d. Management
 Abdominal Distention 1. Palliative:
 Peristaltic waves (left to right)  Colostomy
 2. Corrective 23 pairs chromosomes
b. Types
1. Autosomal Dominant:
viii. Celiac Disease (Gluten enteropathy)  AA = disease
a. overview  Example disease:
 Huntington’s Disease
 Mafan’s Syndrome
 Polycystic Kidney Disease
2. Autosomal Recessive:
 Autoimmune  AA = carrier
 Avoid eating Gluten: Amino acids (Grain  AA = Disease
products)  Example diseases:
b. Foods rich in Gluten  Sickle cell anemia
 Barley – “Beer”  Cystic Fibrosis
 Rye  Tay-sach’s Disease
 Oats  Phenyl ketonuria
 Wheat – “Wheat flour” 3. X-linked Recessive:
c. Signs and symptoms (malabsorption)  Hemophilia; Color Blindness
 Weight loss o PKU: Phenylketonuria
 Malnourished  Autosomal Recessive
 Growth retardation  (-) enzyme – Phenylalanine Hydroxylase
 Liver converts pH into tyrosine turning
Celiac Crisis – Food (Gluten intake) into Melanin, Epinephrine, Thyroxine.
*causing severe abdominal pain steatorrhea
*PA (Phenylalanine) Amino Acid (CHON-rich acids)
d. Management
 Gluten-Free Diet c. Sign and Symptoms:
Substitute Food: - Blonde Hair
 Potatoes - Blue-eyed
 Rice - Fair complexion
 Corn - Growth retardation
- Musty-odor urine
- Mental retardation (due to inc. P.A) which
is irreversible / complication nani.
d. Diagnostic
- Guthrie test
 done after 24 hours
 Necessary to take blood after
feeding
e. Management
- Low phenylalanine diet (low protein diet)
- e.g., PKU Diet (focus on the bull’s eye
area)

GENETIC DISORDERS

a. Overview
 46 Chromosomes
 Cystic Fibrosis

a. Overview
- Exocrine Glands (Duct Glands)
- Sticky secretions
 Lungs: Sticky mucus (resulting to
pneumonia
- Special Milk for PKU: Lofenalac (popular: Management: Chest
Periflex) physiotherapy
 Pancreas: Pancreatic Enzymes (There
will be obstruction); Resulting to
Steatorrhea; Pancreatic enzyme
Sickle Cell Anemia
replacement (Viokase)
a. Overview - Diagnostic: Dx Test CF
- Autosomal Recessive
- African-American
b. Precipitating Factor Hemophilia
- Hypoxia
- Acidosis a. Overview
- DHN X-linked recessive
c. Types of Crisis Boy: XY - disease
1. Vaso-occlusive Crisis Girl: XX – Carries
- Pain: XX – Disease / rare
 Eye b. Types of Hemophilia
 Abdominal Pain - No clotting factor (CF)
 Back Pain  Fresh Frozen Plasma is given
 Hard-foot syndrome (Dactylitis)  Cryoprecipitate
 Priapism (prolonger persistent - Normal Platelet
erection)
- Management:
Hemarthrosis

2. Megaloblastic Crisis
- Decrease Folic Acid (causing enlarged RBC) Down Syndrome (Trisomy 21)
3. Aplastic Crisis a. Overview:
- Bone Marrow Failure - A flattened face, especially the brige of the
- Management: Bone Marrow Transplant nose
4. Sequestration Crisis - Almond-shape eyes that slant up.
- Blood are trapped in the spleen. - A short neck
- Resulting to shock splenomegaly - Small ears
- Treatment: Splenectomy - A tongue that tends to stick out of the
- Prevention: mouth
 Prevent hypoxia by giving - Tiny white spots on the iris (colored part)
vaccination. of the eye.
 Avoid going to high altitude - Small hands and feet
places. b. Risk factors:
 Avoid non pressurize aircraft - Maternal Age: 35 y/o
 Increase fluids - Paternal Age: 55 y/o
RENAL

Nephrotic AGN (Acute

Syndrome Glomerulus
Nephritis
Cause: Idipathic Auto-immune
disease ( post-
 Cleft lip meds for morning sickness
strept
(Thalidomine)
infection)GAHBS
Onset: Insidious Sudden  Thyroxine (T4) – important for growth
Hematuria None (+)Present tea-  Epispadias and Hypospadias (do not circumcise)
colored urine
Proteinuria Massive Mild
Edema Severe Mild
(Anasarca)
*generalized
edema
Hyperlipidemia Present mild
HPN Mild` marked
Nephrotic Syndrome Treatment:

- Steroid
- Diet: Low Na and Low K
- Antihypertensive – CCB, Vasodilators, ACE
inhibitors
- Antibiotics for 10 days: penicillin

ADDITIONAL NOTES!

 Moro reflex until 9 months is ABNORMAL

 Astereognosis – when a person cannot
distinguish an object in the hands
 Vasculitis – inflammation in the blood vessels
 Not all newborn are born color blue
 Balloon valvuloplasty (to widen the opening?)
 If the question is about prioritization, do not
 Currant-Jelly Stool