Documenti di Didattica
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GROWTH
- increase in physical size of a structure or whole. -quantitative change. Two parameters of Growth
1. weight- most sensitive measure of growth, especially low birth rate.
Wt doubles 6 months
3x 1yr
4x 2-2 ½ yrs
2. Height- increase by 1”/mo during 1st 6 months
-average increase in ht -1st year = 50% stoppage of ht coincide with eruption of wisdom tooth.
DEVELOPMENT
-increase skills or capability to function -qualitative
Cognitive development –ability to learn and understand from experience to acquire and retain knowledge.
To respond to a new situation and to solve problems.
Average IQ – 90-100
Gifted child- > 130 IQ
V. Late childhood
1. Pre adolescent 11 –13 yrs
2. Adolescent 12 - 18 – 21
PRINCIPLES OF G & D:
1. G&D is a continuous process -begins form conception- ends in death - womb to tomb principles
2. not all parts of the body grow at the same time or at same rate.
- asynchronism
Patterns of G&D:
1.) renal
digestive grows rapidly during childhood
circulatory
musculoskeletal
2.) Neuromuscular tissue (CNS, brain, S. cord)
-grow rapidly 1-2 years of life
-brain achieved its adult proportion by 5 years.
3.) Lymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide
protection
-infection
-tonsil-adult proportion by 5 years
4.) Repro organ- grows rapidly at puberty Rates of G&D
1. fetal and infancy – most rapid G&D
2.adolescent- rapid G&D
3.toddler- slow G period
4.Toddler and preschool- alternating rapid and slow
5. school age- slower growth fetal and infancy- prone to develop anemia
A. Directional trends- occur in a regular direction reflecting the development of neuromuscular function.
These apply to physical, mental, social and emotional development and includes.
a. cephalo-caudal “head to tail” -occurs along bodies long axis in which control over head, mouth
and eye movements and precedes control over upper body torso and legs.
b. proximo- distal “Centro distal” -progressing form center of body to extremities.
c. symmetrical- at side of body develop on same direction at same time at same rate.
d. mass specific “differentiation”- child learns form simple operations before complex function of
move from a broad general pattern of behavior. To a bore refined pattern.
B. Sequential- involves a predictable sequence of G&D to which the child no9rmally passes.
1. locomotion- creep than crawls, sit then stand.
2. socio and language skills- solitary games, parallel games
C. Secular- worldwide trend of maturing earlier and growing larger as compared to succeeding
generations.
Theorists:
Psychosexual theory:
Stages of Psychosocial
b.) Autonomy vs Shame and Doubt-18mons-3 years --- independence /self government
-develop autonomy on toddler
1. give an opportunity of decision making like offer choices.
2. encourage to make decision rather then judge.
3. set limits
c.) Initiative vs Guilt- 4-6 years
-learns how to do basic things
-let explore new places and events
-activity recommended- modeling clay, finger painting will enhance imagination and creativity and
facilitate fine motor development
3.) secondary circular reaction 4-8 months -activity not related to body
-discover object and person’s
permanence
-memory traces present
-anticipate familiar events.
Tertiary circular reaction 12-18 months -use trial and error to discover places
and events
-“ invention of new means”
-capable of space and time perception
(hits fork, spoon on table or drops fork)
Pre-conventional Level 1
Conventional Level II
b.) fear of infancy- stranger anxiety begin 6-7 months peak 8 months diminishes 9 months
c.) milestones:
3 months- holds head and chest up when prone -follows obj. past midline
-grasp and tonic neck reflex fading -hand regard (looks at hand)
7 months
- transfer obj. hand to hand -likes obj that are good size
8 months
- sits without support -peak of stranger anxiety
-planters reflex disappears -8-9 months in prep for walking
9 months
-creeps or crawls -neat finger grasp reflex
-combine 2 syllables “mama” and “papa” -needs space for creeping
Toddler
a. Play-parallel play- 2 toddlers playing separately
-provide with similar toys
-squeaky frog to squeeze, waddling duck to pull, trucks to push-push pull toy, building blocks, pounding
peg, toys to ride on
15 months–plateau stage
- walks alone
-lateness in walking- mild mental retardation
-puts small pellets into small bowl -holds spoon well
-seats self on chair -creeps up stairs - 4 - 6 words
Milestones:
Death-sleep only
School Age
Significant Development
a. boys- prone to bone fracture
b. mature vision 20/20
Adolescent
Fear:
1. obesity 2. acne
3. homosexuality 4. death
5. replacement from friends 6. significant person- opposite sex.
Significant development:
1. experiences conflict bet his needs for sexual satisfaction and societies expectation
2. change of body image and acceptance of opposite/sex
3. nocturnal emission –wet dreams
4. distinctive odor- due to stimulation apocrine glands
5. sperm is viable by 17 yrs
6. testes & scrotum increase until age 17
7. breast and female genitalia increase until age 18
Problems:
1. vehicular accident 2. smoking
3. alcoholism 4. drug addiction
5. pre marital sex
SHUNTS-shortcuts
Ductus venosus- -shunts from liver to IVF
Foramen ovale- shunts between 2 atrias
Ductus arteriosus- from pulmonary artery to aorta
Obliteration-complete closure
Structure Appropriate time of Structure remaining Failure to close
obliteration
3. Temp Regulation -goal in temp regulation is to maintain it not less than 97.7% F (36.5 C)
-maintenance of temp is crucial on preterm and SGA (small for gestational age)
- babies prone to hypothermia or cold stress
To Prevent Hypothermia:
1.dry and wrap baby
2.mechanical pressure–radiant warmer
Ex: pre-heated first isolette (or square acrylic sided incubator)
3. prevent an necessary exposure –cover baby
4. cover baby with tin foil or plastic
5. embrace the baby- kangaroo care
Sucking--PPG –-to release oxytocin –-contraction of smooth muscles-- lactiferous tubules (collecting
tubules)--milk ejection reflex or let down reflex.
Advantages of Breastfeeding
1. Economical
2. Always available
3. Breastfed babies have higher IQ than bottle fed babies.
4. It facilitates rapid involution
5. Decrease incidence of breast cancer.
6. Has antibodies- IgA
7. Has lactobacillius bifidus- interferes with attack of pathogenic bacteria in GIT
8. Has macrophages
Store milk- plastic storage container
Store milk –good for 6 months from freezer- put room temp. don’t heat
Disadvantages:
1. Possibility of transfer HEP B, HIV, cytomegalo virus.
2. No iron
Stages of Breastmilk:
1. Colostrum- present 2-4 days
content: decrease fats, increase IgA, decrease CHO, decrease CHON, increase minerals, increase fat
soluble minerals
Health Teachings:
1. Proper hygiene- proper hand washing
-care of breast - cotton balls with lukewarm water (Caked colostrum)- dry milk on breast
2. Best position in breastfeeding –upright sitting -avoid tension!
3. Stimulate & evaluate feeding reflexes
a.) Rooting reflex- by touching the side of lips/cheeks then baby will turn to stimulus.
-disappear by 6 weeks- by 6 weeks baby can focus. Reflex will be gone
- Purpose rooting- to look for food.
b.) Sucking–when you touch middle of lips then baby will suck
- Disappears by 6 months
- When not stimulated sucking will stop.
c.) Swallowing- when food touches posterior of tongue then it will be automatically swallowed
d.) Extrusion/ Protrusion reflex-when food touches anterior portion of tongue then food will be
extruded.
Purpose: to prevent from poisoning
Disappear by 4 months & baby can already spit out by 4 months.
2. Transitional stool- green loose & shiny, like diarrhea to the untrained eye
3. Breastfed stool-golden yellow, soft, mushy with sour milk smell, frequently passed
- recur every feeding
4. Bottlefed stool–pale yellow, formed hard with typical offensive odor, seldom passed, 2–3 x/day
- with food added -brown & odorous
A- appearance- color
–slightly cyanotic after 1st cry baby becomes pink.
P- pulse rate –apical pulse –left lower nipple
G- grimace –reflex irritability, tangential foot slap, catheter insertion
A –activity–degree of flexion or muscle tone
R –respiration
Baby cry –within 30 seconds.
Failure to cry after 30 seconds –asphyxia neonaturum
Respirator depression –due mom given Demerol. Administer Naloxone
Reflex irritability
APGAR result
0 –3 = severely depressed, need CPR, admission NICU
4 –6 = moderately depressed, needs additional suctioning & O2
7 - 10 =good/ healthy
Interpretation result:
0 -3 –normal no RDS
4 –6 –moderate RDS
7 –10 –severe RDS
Testes and Scrotum testes in lower canal Some intermediate Testes pendulus
Scrotum–small few Scrotum full extensive
rugae rugae
Bathing
- oil bath
-initial - to cleanse baby & spread vernix caseosa
Functions of vernix caseosa
1.insulator
2.bacterio- static
Babies of HIV + mom –immediately give full bath to lessen transmission of HIV
-13 –39% possibly of transmission of HIV
Dressing the umbilical cord- strict asepsis to prevent tetanus
3 cleans in community
1. clean hand
2. clean cord
3. clean surface betadine or povidone iodine
–to clean cord check AVA, then draw 3 vessel cord
Mgt: silver nitrate or catheterization -clean with normal saline solution not alcohol
-don’t use bigkis –air
-persistent moisture-urine, suspect patent uracus –fistula between bladder and normal umbilicus
Dx. nitrazine paper test
–yellow –urine
mgt: surgery
Weight:
Normal wt 3.000 –3400 gms/ 3 –3.4 kg / 6.5 -7.5 lbs
Arbitrary lower limit 2500 gm
Low birth wt baby delivered < 2500g Small for gestational age(SGA) < 10th % rank or born small
Large for gestational age > 90th % rank or macrosomia >4000 gm
Appropriate for GA –within 2 standard deviation of mean
Physiologic wt loss –5 –10% wt loss few days after birth
PHYSICAL EXAMINATION AND DEVIATIONS FROM NORMAL
A. Important Considerations
1. if client is newborn, cover areas not being examined
2. if client is infant the 1st vital sign to take is –take RR 1st
- begin from least intrusive to the most intrusive area
3.if client is a toddler and preschool, let them handle an instrument like: - play syringe or stet, security
blanket –favorite article. Let baby hold it.
4. Explain procedure and respect their modesty - school age and adolescent
B. Components:
1. vital signs:
Temperature: rectal- newborn –to rule out imperforate anus -
-take it once only, 1 inch insertion
Imperforate anus
1. atretic –no anal opening
2. agenetic –no anal opening
3.stenous –has opening
4.membranous –has opening
Earliest sign:
1. no meconium
2. abdominal distention
3. foul odor breath
4. vomitus of fecal matter
5. can aspirate –respiratory problem
Mgt: Surgery with temporary colostomy
Causes: 1.familial
2. exposure to rubella –1st month
3.failure of structure to progress
acyanotic L to R
cyanotic R –L
Nursing Care:
Cardiac catheterization: site-right femoral vein
1.NPO 6 hrs before procedure 2
.protect site of catheterization. Avoid flexion of joints proximal to site.
3. assess for complication
–infection, thrombus formation
–check pedal pulses ( dorsalis pedis)
Mgt.
1.) long term antibiotic –to prevent subacute bacterial endocarditis
2.)open heart surgery-
3. Endocardial cushion defects- atrium ventricular (AV) - affects both tricuspid and mitral valve
Dx:–confirmed by cardiac catheterization
Mgt: - open heart surgery
Antibiotics to prevent subacute bacterial endocarditis
7. Duplication of Aortic Arch- doubling of arch of aorta causing compression to trachea and esophagus
Signs and symptoms:
1. dysphagia
2. dyspnea
3. left ventricular hypertrophy
Outstanding Symptoms:
1. cyanosis after 1st cry (due no oxygenation)
2. polycythemia –increased RBC =compensatory due to O2 supply=viscous blood =thrombus = embolus
= stroke
3.ECG –cardiomegaly
Cardiac catheterization–decreased O2 saturation
Palliative repair –rashkind procedure
Complete repair –mustard repair
3.)
Truncus Arteriousus
- aorta & pulmo artery is arising fr 1 single vessel or common trunk with VSD S & Sx 1. cyanosis 2.
polycythemia
–
thrombus = embolus = stroke Mgt: Heart transplant 4.)
Hypoplastic Left heart syndrome
–
non fx Left ventricle 1. cynosis 2. polycythemia
–
throm, emb, stroke Mgt: heart transplant 5.)
Tricuspid atresia
–
failure of tricuspid valve to open S&SX: open foramen ovale (R to L shunting
–
goes to Lt atrium) cynosis, polycythemia Mgt: fontan procedure
–
open tricuspid valve 6.)
Tetralogy of Fallot
P
–
pulmonary stenosis V
–
ventricular SD O
–
overriding or dextroposition of aorta R
–
Rt ventricular hypertrophy S &Sx: 1.
Rt ventricular hypertrophy 2.
polycythemia 4.
severe dyspnea
–
squatting position
–
relief , inhibit venous return facilitate lung expansion. 5.
growth retardation
–
due no O2 6.
syncope 8.
clubbing of fingernails
–
due to chronic tissue hypoxia 9.
mental retardation
–
due decreased O2 in brain 10.
O2 2.
morphine
–
hypoxia 4.
propranolol
–
decrease heart spasms 5.
palliative repair
–
BLT blalock taussig procedure Brock procedure
–
complete procedure
Jones Criteria
Major
Minor
1. polyarthritis
–
1. arthralgia
–
joint pain
2.
chorea
sydenhamms chores or
grimace
3.
carditis
tachycardia
erythema marginatum
-
macular rashes
SQ nodules
increase antibody
“ C reactive protein
“ erythrocyte sedimentation
rate
“ anti streptolysin
ot
iter (ASO)
Criteria:Presence of 2 major, or 1 major and 2 minor + history of sore throat will confirm the dx. Nsg
Care: 1.
CBR 2.
throat swab
–
culture and sensitivity 3.
antibiotic mgt
–
to prevent recurrence 4.
aspirin
–
anti-inflammatory. Low grade fever
–
don
‟t give aspirin.
S/E of aspirin: -
Reyes syndrome
–
encephalopathy- fatty infiltration of organs such as liver and brain Respiration Newborn resp
–
30-60 cpm, irregular abd or diaphramatic with short period of apnea without cyanosis. < 15 secs
–
normal apnea
–
newborn Resp Check Newborn
–
40
–
90 1 yr - 20
–
40 2-3yr 20
–
30 5 yrs 20
–
25 10 yrs 17
–
22 15 & above 12- 20
BREATH SOUNDS HEARD DURING ASCULTATION:
1.) VESICULAR
–
soft, low pitched, heard over periphery of lungs, inspiration longer then expiration -Normal 2.)
BRONCHOVESICULAR- soft, medium pitched, heard over major bronchi, inspiration equals exp. Normal
3.) BRONCHIAL SOUNDS- loud high pitched, heard over trachea, expiration longer than inspiration.
Normal 4.) RHONCHI
–
snoring sound made by air moving through mucus in bronchi. Normal 5.) RALES-or crackles
–
like cellophane
–
made by air moving through fluid in alveoli. Abnormal- asthma, foreign body obstruction. 6.)
WHEEZING- whistling on expiration made by air being pushed through narrowed bronchi .Abnormal
–
asthma, foreign body obstruction 7.) STRIDOR- crowing or ropster life sound
–
air being pulled through a constricted larynx. Abnormal
–
resp obstruction
25
proper suctioning 4.
PEEP - + end expiratory pressure Purpose of #6-7- to maintain alveoli partially open and alveoli collapse
LARYNGOTRACHEOBRONCHITIS
LTB
–
most common
Creup
-viral infection of larynx, trachea & bronchi outstanding sx - croupy cough or barking pathognomonic -
stridor -
labored resp -
resp acidosis -
end stage
–
death Lab: 1.
ABG 2.
dx- neck x-ray to rule out epiglotitis Nsg Mgt: 1. bronchodilators 2.increase o2 with humidity 3. prepair
tracheostomy set
BRONCHOLITIS
- Inflammation of bronchioles
–
tenatious mucus Causative agaent
–
RSV - Resp sincytial viruses Sx: flu like sx Increased RR Drug: Antiviral
–
Ribavirin End stage
–
epiglotitis
EPIGLOTITIS
- infl of epiglottis - emer. Condition of URTI Sx: sudden onset Tripod position
–
leaning forward with tongue protrusion -
< 5 yo
–
unable to cough out, put on mist tent (humidifier o2) or croupe tie Nsg Care: check edges tucked on
mist tent Provide washable plastic material No toys with friction due O2 on No hairy toys
–
due moist environment medium for bacterial growth BP
–
80/46 mmHg newborn BP after 10 days- 100/50 BP taking begins by 3 yo COA
–
take BP on 4 extremities
SKIN:
Acrocyanosis
BIRTHMARKS:
1.
Mongolian spots
–
stale gray or bluish discoloration patches commonly seen across the sacrum or buttocks due to
accumulation of melanocytes. Disappear by 1 yr old 2.
MIlla
–
plugged or unopened sebaceous gland . white pin point patches on nose, chin or cheek. 3.
Lanugo
–
fine, downy hair
–
common preterm 4.
Desquamation
–
peeling of newborn, extreme dryness that begin sole and palm. 5.
Erythema Toxicum
–
(flea bite rash)- 1
st
self limiting rash appear sporadically & unpredictably as to time & place. 7.
Harlequin sign
–
dependent part is pink, independent part is blue (side lying
–
bottom part is dependent pink) 8.
Cutis Marmorato
–
transitory mottling of neonates skin when exposed to cold. 9.
Hemangiomas
–
vascular tumors of the skin
3 types Hemangiomas
a.) Nevus Flammeus
–
port wine stain
–
macular purple or dark red lesions seen on face or thigh. NEVER disappear. Can be removed surgically
b.) Strawberry hemangiomas
–
nevus vasculosus
–
dilated capillaries in the entire dermal or subdermal area. Enlarges, disappears at 10 yo. c.) Cavernous
hemangiomas
–
communication network of venules in SQ tissue that never disappear with age. - MOST DANGERIOUS
–
intestinal hemorrhage Skin color blue
–
cyanosis or hypoxia White
–
edema Grey
–
inf Yellow
–
jaundice , carotene Vernix Caseosa
–
white cheese like for lubrication, insulator BURN TRAUMA
–
injury to body tissue caused by excessive heat.
INFANT
5
-
9 yo
ANTERIOR
POSTERIOR
Ant
Post
Head
9.
5
9.5
6.5
6.5
Neck
Upper arm
Lower arm
1.5
1.5
1.5
1.5
Hand
13
1.25
1.25
1.25
Trunk
13
13
Back
13
13
Genital
1
@ buttocks
2.5@
2.5 @
Thigh
2.75
2.75
Leg
2.5
2.5
foot
1.75
1.75
1.75
1.75
27
DEPTH
1
st
degree
–
partial thickness
–
superficial epidermis - erythema, dryness, PAIN -sunburn, heals by regeneration from 1
–
10 days 2
nd
degree
–
epidermis & dermis- erythema, blisters, moist, extremely painful
scalds 3
rd
degree
–
full thickness- epidermis, dermis, adipose tissue, fascia, muscle & bone
whirlpool therapy
–
drum with solution 7.) skin grafting
–
3
rd
degree
–
thigh or buttocks (autograft), pigs/ animals
–
xenograft frozen cadaver
–
hallow graft 8,) diet
–
increase CHON, increase calories.
ATOPIC DERMATITIS
- infantile eczema (galis) Papulo vesicular erythematus lesions with weeping & crusting Cause
–
food allergies: milk, citrus juice, eggs, tomatoes, wheat Sx: - extreme pruritus, linear excoriation,
weeping crusting; scaly shiny and white
–
lechenification
Goal of care
: decrease pruritus
–
avoid food allergens Diet: Prosobi or Isomil Hydrate skin, borow solution 1% hydrocortisone cream
Prevent infection
–
proper handwahsing, trim nails
IMPETIGO
- skin disease. Causative agent
–
grp A beta Hemolytic streptococcus -
–“KUTO”
-
sebum- lipids causing acne bulgaris Mgt: - proper hygiene- mild soap or sulfur soap- antibacterial retin A
or tretinoi
28
ANEMIA-
pallor
–
deficiency of clotting factor. X linked recessive
–
inherited If mom
–
carrier, son
–
affected If father carrier- transmitted to daughter Hemophilia A
–
deficiency of coagulation component factor 8 Hemophilia B
–
or christmas disease, deficiency of clotting factor 9 Hemophilia C
–
deficiency of clotting factor 11 Assessment: -
umphalagia
–
earliest sign -
newborn growing
–
sudden bruising on bump area- marks earliest sign -
continuous bleeding
–
hematrosis
–
damage or bleeding synovial membrane Dx test : PTT. Partial thromboplastin time
–
reveals deficiency in clotting factor Long Term Goal- prevention of injury Nsg Dx- increase risk of injury
HT:
avoid contact sport, swimming only, don‟t stop im
munization
–
just change gauge of needle Falls
–
immobilized , elevate affected part, apply pressure-not more then 10 min cold compress -determine
case before doing invasive procedure
LEUKEMIA
- grp of malignant disease -
WBC
–
protection from infection, soldiers of body Classification : 1.
Lympho
–
affects lymphatic system 2.
Myelo
–
affects bone marrow 3.
acute / blastic
- affects immature cells 4.
chronic/ cystic
- affects mature cells
MOST COMMON CANCER
–
(ALL)
–
Acute Lymphocytic Leukemia S&Sx: 1. from invasion of bone marrow signs of infection a.)
fever b.)
epistaxis c.)
pallor , body malaise , constipation 2. from invasion of body organ- hepato spenomegaly
–
abd pain , CNS affectation, increase ICP Dx Tests: 1.
CBC
–
determine anemia, leukocytosis, thrombocytopenia neutropenia
29
3.
Bone scan
–
determine bone involvement 6.
CT scan
–
determine organ involvement Therapeutic Mgt:
TRIAD:
1.
surgery 2.
irradiation 3.
S/Effect of Chemotherapy
1. N/V
–
adm antiemetic drugs 30 mins before chemo until 1 day after chemo 2. Ulcerations / stomatitis /
abscess of oral mucosa- (alteration nutrition less body req) - oral care
–
alcohol free mouthwash , betadine mouthwash -
don‟t brush –
use cotton pledgets - topical xylocaine before meals diet-
soft, bland diet according to child‟s preference
Temporary S/E of chemo: Alopecia
–
altered body image Hirsutism
–
hair -give emotional support to parents
ABO incompatibility
–
Most common incompatibility
–
( mom) O
–
( fetus) A Most severe incompatibility (Mom) O
–
(Fetus) B Can affect 1
st
pregnancy
30
Hydrops
(h20)
Fetalis
–
edematous on lethal state with pathologic jaundice Within 24 h Mgt: 1.
needs exchange therapy Hyperbilirubinemia - > 12 mg/dL of indirect bilirubin among full term Normal
–
0-3 mg/dL -
bilirubin encephalopathy -
Kemicterus - > 20 mg/dL among full term & >12 mg /dl of indirect
–
preterm =can lead to cerebral palsy-
Physiologic jaundice
–
jaundice within 48 -72 h (2-3 days) expose morning sunlight Pathologic Jaundice
–
within 24h. Jaundice during delivery. Breastfeeding jaundice
–
caused by pregnanediole Assessment of Jaudice : 1. Blanching neonates forehead, nose or sternum -
yellow skin & sclera - color of stool
–
light stool - color of urine
–
dark urine Mgt: Phototheraphy
–
photo oxygenation Nsg Resp: 1.
cover eyes
–
prevent retinal damage 2.
cover genitals
–
prevent priapism
–
painful continuous erection 3.
monitor I&O
–
weigh baby 6.
monitor V/S
–
avoid use of oil or lotion due- heat at phototherapy = bronze baby syndrome-transient S/E of
phototherapy weigh diaper 1gm = 1cc Head
–
largest part of baby ¼ of its length
Craniostenosis or craniosinustosis
–
premature closing of fontanel Hydrocephalus
–
ant fontanel open after 18 mos Microcephaly
–
small growing brain due- alcohol & HIV mom Anencepahly
–
absence of cerebral hemisphere Craniotabes
–
localized softening cranial bone. Common
–
1
st
born child -due early lightening (2 weeks prior to EDD) Rickets of Vit B deficiency
–
soft cranial bone in older children Caput Succedaneum
–
edema of scalp due prolonged pressure at birth Char: 1.
present at birth 2.
31
Cephalhematoma
- collection of blood due to rapture of pericostal capillaries Char : 1.
present after 24 h 2.
„craddle cap”
Scaling, greasy appearing salmon colored patches
–
seen on scalp behind ears and umbilicus Cause: - improper hygiene Mgt: 1.
proper hygiene 2.
baby oil
Hydrocephalus
–
excessive accumulation of CSF 1.
communicating
–
extra ventricular hydrocephalus 2.
fontanel bossing
–
prominent forehead -
sclera
–
normal color
–
light blue then become dirty white pupil
–
round- adult size coloboma- part of iris is missing sign: key hole pupil whiteness & opacity of lens
congenital cataract cornea
–
round & adult size large
–
congenital glaucoma
Test for blindness
common tests 1. newborn
–
general appearance - can only see 10
–
12 “
- visual acuity 20 /200 to 20/ 800
Doll‟s eyes test
- test for blindness -
done 10
th
day -
pupil goes opposite to direction when head is moved Globellars test
–
test for blink reflex. Points near nose
–
baby should blink
32
2. Infant & children - appearance - ability to follow object past midline 3. 3 yrs
–
school age - general appearance Allen cards
–
test for visual acuity. Show picture 20 ft away Ishiharas plates
–
test for color blindness Prechool E chart - test for stereopsi of depth perception Cover testing test
–
cover 1 eye for 10
–
15 min. Then remove. Test for strabismus 4. School age
–
adult - general appearance - snellens test Retinobastoma
–
malignant tumor of retina Outstanding sign :
oat‟s eye reflex
-whitish glow of pupil -
blindness surgery
–
Enucliation
–
removal of eyeball put artificial aye
NOSE:
1.
flaring alenase
–
case of RDS 2.
cyanosis at rest
–
choanal atresia - post nares obstructed with bone or membrane Sx: 1.
–
nosebleed -
sit upright, head slightly forward to facilitate drainage -
cold
compress , apply gentle pressure, epinephrine most developed sense of newborn
–
sense of touch 1
st
sense to develop & last to disappear
–
hearing
EARS:
1.
33
Chromosomal aberrations
: -advance maternal age 1. non disjunction
–
uneven division
Trisomy 21
- down syndrome - extra chromosome 47xx + 21 - related to advance paternal age Sx: Mongolian
slant Broad flat nose Protruding neck
Puppy‟s neck
Hypotonic
–
prone to resp problem Simean crease
–
single transverse line on palm.
Trisomy 18
“endvard syndrome”
Trisomy 13
- patau syndrome
Turner
–
Monosomy of X synd. -
45x0 -
affected girls -
Sterile
Klinefelters Syndrome
- has male genitalia - 47 XXY - poorly devt secpndary sexual characteristics - no deepening of voice
-small testes, penis -sterile Klinefelter
–
Calvin Kline
–
male Turner
–
Tina Turner
–
female
Otitis Media
–
inflammation of middle ear. Common children due to wider & shorter Eustachian tube Causes 1.)
supportive care- bedrest, increase fld intake Med Mgt: 1. Massive dosage antibiotic Complication
–
bacterial meningitis 2. Apply ear ointment School age
–
up and down
< 3 yo
–
down & back > 3 yo
–
up & back Small child
–
down & back ( no age) surgery (to prevent permanent hearing loss)
–
otitis media
–
myringotmy with tympanostomy tube post surgery
–
position affected side for drainage both
–
put ear plug if tympanous tube falls
–
healed na
Bells Palsy
- facial nerve #7 paralysis R/T forcep delivery Sx.
34
1.
–
white glistering cyst at palate & gums related to hypercalcemia
Hypervitaminosis
Natal tooth
–
tooth at birth. Move with gauze Neonatal tooth
–
tooth within 28days of life
Moniliasis
–
oral candidiasis -
oral thrush -
Nsg Care
–
Can lead to MI
LIPS
- symmetrical
Cleft lip
–
failure of median maxillary nasal process to fuse by 5-8 wks of pregnancy -
common to boys -
unilateral
Cleft Palate
- Failed palate to fuse by 9
–
12 wks of pregnancy -
common to girls -
unilateral or bilateral Sx: 1.
evident at birth 2.
frequent colic & otitis media or URTI Mgt: 1. Surgery cleft lip repair
–
Cheiloplasty =done 1-3 months to save sucking reflex (lost in 6 months ) Cleft Palate- uranoplasty =
done 4-6 months to save speech
Pre op care
1.
proper nutrition
35
3.
apply restraints
–
elbow restraints so baby can adjust post op Condition that warrants suspension of operation -
clear liquids- ( gelatin except red or brown color due may mask bleeding) -
( popsicle- not ice cream) full liquid soft diet regular diet 5. Maintain integrity of suture line such as:
Logan bar
–
wash ½ strength Hydrogen Peroxide & saline solution- Bubbling effect traps microorganism - prevent
baby form crying for pain- analgesic
NECK-
1.)
baby sleeps 16
–
20 h a day earliest sign: 1.
change in crying 2.
change in sucking 3.
sleep excessively 4.
constipation 5.
edema
–
moon face late sign 1.
PPI-protein 2.
radioimmunoassay test 3.
Mgt: synthroid
–
sodium Levothyrosine -synthetic thyroid given lifetime -
tachycardia
–
Sx of hyperthyroidism
CHEST
1.
symmetry 2.
breast - transparent fluid coming out from newborn related to hormonal changes- 3. chest has
retroactive
–
RDS 4. sternum sunken
–
pectus excavation
ABDOMEN
(in order) 1.
inspection I 2.
Auscultation A 3.
percussion P 4.
sunken abd 2.
Sx of RDS 3.
–
absence of abd wall Nsg Mgt: sterile wet dressing
Fx of GIT
1.
excrete waste products from digestive process Recommended Daily Allowance Calories : 120 cal /
Kbw/day (kilo body wt) 360
–
380 cal/ day CHON_ 2.2g /Kbw/day
Principles in Supplementary Feeding
Supplementary Feeding usually
–
6 mos Supplementary feeding given
–
4 mos. a.) solid food offered to ff sequence! 1. cereals
–
rich in iron 2. fruits 3. veg 4. meat b.) begin with small quantities c,) finger foods
–
offered 6 months d.) soft table food
–
37
chemical buffers b.
hypoventilation -
RDS -
COPD -
hyperventilation -
fever -
diarrhea -
severe dehydration -
malnutrition -
uncontrolled vomiting -
NGT aspiration -
Gastric lavage
PROBLEMS LEADIING TO F&E IMBALANCE 1. vomiting
–
forceful expulsion of stomach content Sx: 1.
nausea 2.
dizziness 3.
facial flushing 4.
abd cramping assess: amt, freq, force projectile vomiting= increase ICP or pyloric stenosis Mgt: BRAT
diet - banana, rice
–
cereal, apple sauce, toast
2. Diarrhea
–
exaggerated excretion of intestinal contents Types: Acute diarrhea
–
related to gastroenteritis, salmoneliosis -
dietary indiscretions -
food intolerance 2.
3.
CHO, CHON malabsorption Assess: freq, consistency, appearance of given colored stool. Best criteria
to determine diarrhea : consistency Complication = dehydration Mild dehydration 5% wt loss Moderate
dehydration 10% wt loss Severe dehydration 15 % wt loss
Earliest sx of dehydration
tachycardia increase temp weight loss tachypnea sunken fontanel & eyeballs scanty urine hypotension
absence of tears
Severe dehydration:
Oliguria , Prolonged capillary refill time Mgt: Acute
–
NPO ( rest the bowel ) -
prone to Hypokalemia
–
give K chloride before adm of K chloride
–
check if baby can void, if cant void
–
hypokalemia Drug: Na HCO3
–
adm slowly to prevent cardiac overload
–
congenital aganglionic megacolon Aganglionic
–
absence of ganglion cells needed for peristalis Earliest sign 1.
abd distension 3.
Barium enema
–
reveals narrowed portion of bowel 2.
Rectal Biopsy
–
reveals absence of ganglionic cells 3.
abd x-ray
–
reveals dilated loops on intestine 4.
rectal manometry
–
revels failure of intestine sphincter to relax Therapeutic Mgt/Nsg care 1.
NGT feeding
–
measure tube fr nose to ear to midline of xyphoid & umbilicus 2.
surgery a.)
anastomosis & pull through procedure Diet: Increase CHON, increase calories , decrease residue
–
pasta
GER- Gastroesophageal Reflux
Chalasia
–
presence of stomach contents to esophagus Will lead to esophagitis complication
–
aspiration pneumonia
39
Esophageal cancer
Assessment : 1.
chronic vomiting 2.
organic
–
organ affected 4.
melena or hematemesis
–
esophageal bleeding Dx procedure 1.
barium esophogram
–
reveals reflux 2.
esophageal manometry
–
reveals lower esophageal sphincter pressure 3.
Betanicol ( urecholine)
–
increase esophageal tone & peristaltic activity b.)
Metachloporomide (Reglam)
–
decrease esophageal pressure by relaxing pyloric & duodenal segments -
antacid
–
neutralizes gastric acid between feedings - Maalox Surgery: Nissen funduplication : Chronic vomiting
–
-
PYLORIC STENOSIS
–
hypertrophy of muscles of pylorus causing narrowing & obstruction. 1.) outstanding Sx- projectile
vomiting - vomiting is an initial sx of upper GI obstruction - vomitus of upper GI can be blood tinged not
bile streaked. (with blood) - vomitus of lower GI is bilous ( with pupu) - projectile vomiting
–
increase ICP or GI obstruction - abd distension
–
major sx of lower GIT obst 2.) met alk 3.) failure to gain wt 4.) olive shaped mass
–
on palpation 5.)serum electrolyte
–
increase Na & K, decrease chloride 6.) ultrasound
7.) x ray of upper abd with barium swallow reveal “string sign”
Mgt: 1.
Pyleromyotomy 2.
vomiting 3.)
test if CHON will convert to amino acid specimen and urine mixed with pheric chloride, presence of
green spots at diaper a sign of PKU
DIET:
Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanuts Give
Lofenalac- milk with synthetic protein
Galactosemia
–
deficiency of liver enzyme -
GUPT
–
Galactose Urovil Phosphatetranferase -
–
gluten enteropathy Common gluten food: Intolerance to food with brow B- barley R- rye O- oat W-
wheat
41
Early Sx: 1.
diarrhea
–
failure to gain wt ff diarrheal episodes 2.
constipation 3.
abd pain
–
protruberant abd even if with muscle wasting 2.
lab studies
–
stool analysis 2.
serum antiglyadin
–
confirmatory of disease gluten free diet
–
lifetime all BROW
–
not allowed ok
–
rice & corn Mgt: 1.
vitamin supplements 2.
mineral supplements 3.
steroids
POISONING
- common in toddlers. (falls- common to infant) 1.
1 pecac
–
oral emetic -
15 ml
–
adolescent, school age & pre school -
10 ml to infant 4.
glutamine ( normal a
bsorption)
Malabsorption
Fats
Vit D calcium
Vit K
Inadequate
blood
coagulation
Steatorr
hea
Osteomalasia
Bleedi
n
gg
anemia
42
6.
caustic poisoning
( muriatic acid ) neutralize acid by giving vinegar . Don‟t vomit prepare
tracheostomy set 8.
Lead = Destroy RBC functioning = Hypochornic Microcytic Anemia = Destroy kidney functioning
Accumulation of anemia = Encepalopathy Sx: 1.
beginning sx of lethargy 2.
as lead increases, severe encepalopathy with seizure and permanent mental retardation Dx: 1.
Blood smear 2.
abd x ray 3.
if > 20 ug/dL
–
need chelation therapy = binds with led & excreted by kidney =nephrotoxic
Amogenital
–
fld filled scrotum Tst of Dx: Transillumination with use of flashlight - glowing sign
Varicoseal
–
enlarged vein of epididimis ( girls- vulvular varicosities)
43
Renal Disorder
Cause
Sx
Tx
NSG CARE
NEPHROTIC
SYNDROME
infectious
1.
Anasarca
-
gen
edema
2.
massive
protenuria
3.
microscopic or no
hematuria
4.
serum CHON
decreased
5.
serum lipid
increased
6.
fatigue
7.
normal or
decreased BP
Prednisone
Diuretic
weigh daily
Diet:
Increase CHON
Increa
se K
-
OJ, beef
broth, banana
Decrease Na
AGN ( acute
Glomerulo
Nephritis)
3A’s;
AGN,
autoimmune,
Grp A
Autoimmune
Grp A beta
hemolytic
streptococcus
1.
(PPP) primary
peripheral
periobital edema
2.
moderate
protenuria
3.
gross hematuria (
smokey urine)
4.
serum
K increased
5.
fatigue
6.
increase BP
Complication :
1.
hypersensive
encephalopathy
2.
anemia
1. anti HPN
drug
hydralazine
or apresoline
2. iron
1. weigh daily
2. monitor BP &
neurologiuc status
3. Diet: decrease K,
decrease Na
rupture of sac -
prone pos -
Dx: 1.
uneven hemline 2.
bend forward- 1 hip higher 1 shoulder blade more prominent Nsg care: 1. conservative
–
avoid obesity, exercise 2. preventive
–
Milwaukee brace - worn 23 h a day 3. corrective surgery
–
insert Harrington rod post op- how to move log rolling- move client as 1 unit
EXTREMITIES:
check # of digits = 20 1.
syndactyly
–
webbing of digits 2.
polydactyly
–
extra digits 3.
olidactyly
–
lack of digits 4.
Amelia
–
total absence of digits 5.
–
paralysis- brachial plexus injury or brachial palsy -
birth injury
caused by lateral & excessive traction during a breech injury
Sx: 1.
unable to abduct arms from shoulders, rotate arm externally or supinate forearm 2.
subluxated
–
most common type 2.
dislocated Sx: 1.
limited movement
–
earliest sx 4.
triple diaper 2.
Frejka splint 4.
Pavlik harness 5.
“clubfoot”
a.)
Equinos
–
plantar flexion
–
horsefoot b.)
Calcaneous
–
dorsiflexion
–
heal lower that foot anterior posterior of foot flexed towards anterior leg c.)
–
- to immobilize -
bone alignment -
dry cast
–
natural air not blower -
wt of body on palm! -
Brachial pulsing
–
if wt of body in axila -
Swing Through 2.
Swing to -