PEDIATRIC NURSING – R.

VILLARAMA
NEONATES (0-28months)  02 Precaution:
IMMEDIATE DELIVER ROOM CARE: 1. NB: Retrolental Fibroplasia
 ESSENTIAL INTRAPARTAL NEWBORN 2. PRE-TERM: Retinopathy of Prematurity
CARE (the fragility of the blood vessels of the
 In support of the Millennium Goals 4 2015 retina)
Sustainable Development Goal: Good Health
and well-Being for People TO REDUCE *CYANOSIS: the more crying, the bluer he gets:
CHILDHOOD MORTALITY TRANSPOSITION OF THE GREAT VESSELS
*02 Mask (5L per minute): if the 02 sat dropped 70% and
NURSING RESPONSIBILITIES CENTRAL CYANOSIS
A AIRWAY *15 minutes – increase the O2 saturation by 5%
B BODY TEMPERATURE *Pulse Oximeter: Heel or Great Toe (Bigger baby)
*Ambient (Environmental) Oxygen: 21%
C CERTIFY THE BIRTH
D DETERMINE ADAPTATION TO EXTRAUTERINE LIFE -
BODY TEMPERATURE TIME BOUND/
APGAR;
BAND INTERVENTION:
INTRAUTERINE: BPS
*Air-conditioned Room: infection control and also machines that
AIRWAY may overheat
TIME BAND/ BOUND INTERVENTION:  Physiological heat loss after birth: 37.2 C down to 35.5
 TIME BOUND – priority intervention to 36.5 C
 Umbilical Cord: “Daluyan ng Buhay”  Maximum is 35.5, anything lower causing EXTREME
HYPOTHERMIA can cause COLD STRESS causing
 Prevent Asphyxiation: Accounts 31% of NB death
ACIDOSIS
 Prevent Aspiration
PRONE TO COLD STRESS DUE TO HYPOTHERMIA
ASPHYXIATION EXTREME HYPOTHERMIA
Umbilical Cord is clamped 
↓ NON-SHIVERING Burns Brown Fats for heat: Not
No more 02 from placenta THERMOGENESIS CHO or CHON since there is
↓  no source
Hypoxia (decreased O2 in tissue) Think about when the person These are the supports of the
↓ shivers takes energy with every organs since ligaments are not
Hypercapnea (increased CO2) shake, what more to a baby yet mature
↓ without glucose
Acidosis: Buffer HCO3, Respiration, Urination  
↓ Increases O2 consumption Ketones/Fatty Acids: The by-
CNS Depression: Respiration is depressed or product of the Fat Metabolism
slowed down; Kussmaul’s Breathing, LOC goes to  
comatose state Decrease O2, Increase CO2  ACIDOSIS
ACIDOSIS 
 oxia – tissue 
 emia – blood EARLIEST SIGN OF CNS DEPRESSION
 Acidosis kills faster than Alkalosis NEONATES: cannot be woken-up
 7.35-7.45 – base NB: Glucose is stored in the liver; 36-39th week, baby stores fat 
 6 lower – acidosis term baby bounces  stores CHO  neonates normally have
 7 above – base hepatomegaly
 Every time you urinate – you bring out acid
 SPONTANEOUS WAKING: Hunger or feeling of
 Neonates must breathe after birth; If not discomfort (position or wet diapers)
ASPHYXATION may result (hypoxia, Hypercapnea,  NEONATES WITH HEPATOMEGALY: they have
Acidosis) an extra supply of glucose for the next few days;
 A Crying Baby is a Breathing Baby Mother’s Milk production is still meager; They
 Neonates breathes after birth by crying so stimulate the would rather rest than to eat.
NB to cry effectively after birth to prevent asphyxiation  Do not push yet if not more than 4 cm
 SUCTION WITH A BULB SYRINGE (unlikely to hit the o PANTING and with CLEANSING
carina) PRN if (with Nasal Obstruction/Meconium BREATH (to relax the uterus)
Stained amniotic fluid) TO PREVENT ASPIRATION o Improper pushing leads to a neonate
 Amniotic fluid is normal to be in the lungs because it with a LONG HEAD due to prolonged
will be absorbed by the pulmonary tissues labor
 TO PREVENT ASPIRATION – turn the baby to lateral  If the baby is not crying well: CONGENITAL
position HYPOTHYROIDISM, CONGENITAL CRETINISM
 TRACHEOESOPHAGEAL FISTULA/ ATRESIA: There  (one reason)
is mucous even in esophagus not only in lungs  ONLY PUSH WHEN: [1] Full dilated; [2] Dilated
 DANGERS OF SUCTIONING: VAGAL STIMULATION and Efface
 bradycardia; reducing 02 reserves  Pelvic Dystocia: the head is in the inlet but the
 Encourage to cry effectively to maximize lung shoulders have not entered the area
expansion

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 PEDIATRIC NURSING – R. VILLARAMA
MANAGEMENT: GRIMACE Reflexes No Grimace Cry, Gag,
 Dry Baby immediately after birth (heat loss by Irritability Response Cough,
Pulls
EVAPORATION)
Away
 Put on top of mother’s body, SSC: Skin to Skin contact APPEARANCE Color Pale/Blue Acrocyanosis Pink/Red
(CONDUCTION): Unang Yakap. Put a bonnet All Over (hands and All Over
o Basinet: Pre warm the area (use a floor feet;
lamp); This is done of the baby’s condition is peripheral
not well (ie Ancephaly, Bad breathing) cyanosis)
 Put under the Floor lamp, drop light or radiant warmer
avoid putting the crib near a cold wall (RADIATION):  Foramen Ovale: Until 3 months
Avoid putting 18-24 inches  Ductus Arteriosus: Fist to close at 1 month
o HEATING MACHINES: Radiant Warmer  Fetal Position: Full flexion; Normal
(best way to heat the baby)  LIMP/FLOPPY TONE
 Other floor lamps does not o Frog Like position: Floppy; Alive but
distribute heat evenly (only in one PREMATURE; affected by DRUGS
area)  blood vessels dilate  o DEMEROL/MORPHINE  CNS
other extremities gets cold DEPRESSION: Baby is given NALOXONE
 Avoid cold draft: AC, fan, open window or door (NARCAN) per ET Tube  reverses the
(CONVECTION) effect of the drug given
 Postpone the bath until temperature is stable (6hrs)  TWILIGHT DELIVERY (Epidural and Demerol): For
 Use WARM WATER during bathing painless delivery; No pushing only contraction so only
FORCEPS ASSISTED DELIVERY
CERTIFY BABY’S BIRTH  UTERINE CONTRACTION: Involuntary, not affected by
 IDENTIFICATION & REGISTRATION anesthetics of opioids or pain relievers
o PLASTIC BRACELET (ANKLE: Security of  CAUSE OF SOME FLEXION: [1] Prolonged Labor:
attachment not the arms because the hands PRIMI up to 15 hrs; [2] HYPOGLYCEMIC: go for CBG;
could be easily removed since the hand is not [3] Fetal Distress: Hypoxia place 02 therapy
flexed; Secondary: Scratching of the face)  To illicit Grimace: May tap the heel (wasting time);
and CRIB CARD Thorough drying the baby; bulb syringe (puts the bulb
o FOOT PRINTS: more reliable (no longer away) Post-Term: Grimace
recommended): Most common source of  Central Cyanosis at birth  Transposition of the Great
infection control and note reliable source of Vessels
security or identifier (since the nurse may not  ACROCYANOSIS: Caused by change in position
clean before stamping and the foot print (sluggish movement) & due to Vasoconstriction
changes with time) o MGMT: Massage the baby to circulate the
o MOST IDEAL: DNA testing (3mL of blood baby and wrap the baby (mummify the baby)
needed) (Cord Blood: Allowed to MILK THE
CORD if we were getting blood specimens
APGAR SCORING INTERVENTION AND
since it belongs to him): COOMB’s test (RH
Incompatibility test) MANAGEMENT
 Not being done currently because  0-3: POOR CONDITION
of [1] expense [2] court cases o RESUSCITATION NEEDED/ NICU
 4-6: FAIR CONDITION
*ONE WEEK OLD: Thumb sucking o Guarded, Closer Monitoring
o Goes to the NICU
*HEEL PRICK: [1] Inborn errors, [2] CBG
o NPO: due to possible C/S (practice before)
*FEMORAL ARTERY TAP: for more blood in neonates if cord
 7-10: GOOD CONDITION
has dried up (10 cc)
o Allowed to do Unang Yakap and Rooming-In
 Local Civil Registrar then PSA for Birth Certificate: REGULAR NURSERY CARE
The certification is the HOSPITAL’S ADDRESS not
 Initial assessment
the parent’s Address o Measurement: Weight/Length/HC/CC/AC
o Color
*SANGUINI (Philippine Law): A child one parent is a  Normal: Pink/Red
FILIPINO by Blood (either mom or dad)  Abnormal:Yellow – pathologic
*SOLI: Citizenship where you are born jaundice
 After 24 hours – normal
DETERMINE ADAPTATION TO EXTRAUTERINE LIFE  Rh Incompatibility
APGAR SCORE: Done in the 1st and 5th minute (In some  Neonatal Hepatitis
hospitals: 10th minute); Virginia Apgar  Biliary Atresia
CRITERIA ASSESS 0 1 2
PULSE CR Absent  100  100 NON TIME BOUND/ BAND INTERVENTION
RESPIRATION CRY Absent Weak, slow Strong,
*If the placenta is left too long: RH incompatibility to the
irregular Regular
ACTIVITY Muscle Limp Some flexion Well
mom
Tone Floppy or little flexed and  EYE CARE / CREDE’S PROPHYLAXIS
Tone; movement moving o Prevent Opthalmia Neonatorum due to
extended maternal Gonorrhea or Chlamydia
arms and o DONE TO ALL BABIES delivered by
legs; frog- NSD or C/S after initial bonding (After
like
position

J.E.A.D. 2 UST CON BATCH 2018

 PEDIATRIC NURSING – R. VILLARAMA
delivery to the breast)/complete BF to
prevent ascending infection
o GIVEN ERYTHROMYCIN (Half a
grain of rice [Not cooked rice] given
once or STAT/SINGLE ORDER ;mid-
pocket of conjunctiva; more
Hypoallergenic) although in hospitals
o TETRACYCLINE, ERYTHROMYCIN,
BETADINE EYE DROPS on the lower
conjunctival sac [mid-pocket] (replaced
SILVER NITRATE, the true Crede’s 
causes Chemical Conjunctivitis which
inflames the eyes, Aftercare must be
done with NSS)
PRACTICAL ASPECT
 Instead of directly applying it on the lower
conjunctival sac, apply it in cotton buds first
*Done after BF: Not only the milk (since the milk is not always
there in the first 24 hrs) but the bonding is more important: The
vision of the baby is hindered to see the mom (Consider that
the baby uses scent and touch to locate the nipple; the vision
after 1 week, is very blurred; CRAWLING REFLEX: to search
for the breast).
 CORD CARE
o CLAMP (Hollister Clamp) when no longer
pulsating at 2 cm and 5 cm (Mosquito) from
base
o Prevent infection
o Promote drying – air dry only
o Should fall off between 7 to 10 days
o DON’T MILK
 Useless
 Squeezing the cord causes the
blood to hemolyze along the cord
 blood that enters in the baby is
hemolyzed  formation of bilirubin
 jaundice within the 1st 24 hours
 Adds more blood to the newborn
 neonates are normally
polycythemic
*RBC: Adult:4.5-5 M, for Newborns: 6M or RBC; Adult 12.4
Newborns 18-20; HCT: Adult 37-54% Newborns 55-65%
*Too thick blood or too much for uterine life: normal
Hemolysis (After the three days of life)
*BILIRUBIN: RBC breakdown; Indirect or Unconjugated Bilirubin
(fat soluble is NOT EXCATABLE)  Liver converts it to Direct or
Conjugated through GLUCONYL TRANSFERASE  conjugated
in the urine and into the feces.
*Too much bilirubin for the liver to release  the bilirubin will
circulate to the skin  JAUNDICE  eyes  ICTERIC SCLERA
*No bilirubin in feces  ACHOLIC STOOL
*RBC: 120 days then hemolyzed
*DO NOT MILK CORD ANYMORE: since the baby’s may be
unable to handle all the blood and this may damage the Brain
through hyperbilirubinemia: KERNECTERUS (Similar to Hepatic
Encepalopathy)
o Count the number of Blood Vessels: 2
Arteries and 1 vein AVA
*NOT AVA; Missing an artery: sent to diagnostic test  Heart
Condition or kidney agenesis (one kidney) (Same life span
with two kidneys)
J.E.A.D.
*ONE KIDNEY PRECAUTION
 Avoiding food that have preservatives, high calcium
GABHS INFECTION [Pharyngeal Infections, Boils,
Furuncles, Impetigo {peeling around the neck}]
 NO CONTACT SPORTS [hazing, basketball]
- GLOMERULONEPHRITIS: MC cause Renal failure in
Children
o PREVENT INFECTION: LATER: Clean with
soap and water if soiled; DO NOT PLACE
ALCOHOL only air dry
o PROMOTE DRYING
 Expose to air
 DO NOT USE ABDOMINAL
BINDERS
 Should fall-off between 7-10
days
CULTURAL DIVERSITY: Understand, Accept, Respect
 When the cord is removed unacceptable: [1] Check
point of detachment; [2] Apply alcohol or betadine
soaked cotton ball with pressure; [3] Place it in a
tissue or receptacle and give to the mother (cultural
consideration)
 Pressure and still bleeding: HEMOPHILIA suspect
and may need cauterization
 Placenta: Buried near a tree at a home
3. VITAMIN K
 To promote synthesis of prothrombin
 (AGA Protocol: 1 mg in the VASTUS
LATERALIS: Biggest muscle and most highly
developed; SGA given 0.5mg given twice
[once during birth and one before discharge])
 AVOID USING THE GLUTEAL MUSCLE
(Buttocks)
o Danger of the sciatic nerve 
trauma  paralysis
o ONLY given if the baby is walking
for one year
 Cannot synthesize or make their own clotting
factors which is PROTHROMBIN because
they lack bacterial flora in the intestines
*Vitamin A: Skin problems, Eye problems
AGA (PH Standard): 6.5 lbs (3000 g); 5.5 lbs (2500 g); 7.5 lbs
(3500 g)
*INTRAUTERINE GROWTH CHART: between 10% and
90%; Below is SGA (small for gestational) and more than
90% is LGA (Large for Gestational Age)
1lb = 454g (500g): to convert the AGA
*VITAMIN K: can now be given in ORAL ROUTE; Although,
better given per IM (better absorption and digestion makes it
slower); SCIENTOLOGY (Religion), do not inject their children
 INJECT HEPATITIS (Vastus Lateralis) & BCG
(Right Deltoid or Buttocks)
 INITIAL BATH
o Done best when VS especially is stable
or 6 hours after birth
o DO NOT REMOVE VERNIX CASEOSA
o HOME BATH: Done, anytime as long as
baby is NOT sick and not immediate after
feeding
3 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
o SOAP FOR BABY: Mild Soap (Baby RA 9288: Newborn Screening Act of 2004
Soap or Natural Soaps: Cleaning Agent  Done to diagnose inborn errors in metabolism
and Glycerin) or a soap does not remove  CONGENITAL HYPERPLASIA (CAH)
Acid mantle of the skin of baby (Use o Decreased cortisol production causing
alkaline soap); Wash the head: Afraid severe salt loss – dehydration and
abnormally high level of male sex hormone
*OIL BATH removes the vernix. WATER BATH which does not o If not treated, death in 9-13 days
removes the oil. FLOOR LAMP which may burn the baby o Management: NaCl supplement,
 GALACTOSEMIA
*Initial Bath: 6 hours while at HOME best time is MORNING BATH
o Inability to metabolize galactose in milk sugar
(between 9-10 am) but may also take a bath at night (so you can
– vomiting, diarrhea, liver damage, cataract,
bathe anytime, PRN)
growth failure and brain damage
- DO NOT FOOTBALL HOLD: most likely over the sink
o Management
and you are tired and hungry from work; Do not work
 No animal source milk/no
away from the table
breastfeeding, soy formula – Isomil,
- USE A BASIN
Nursoy, Prosobee
*CHAIR: used to burp the baby
 PHENYLKETONURIA
*USE COTTON BALLS: to absorb the water in the ears when
o Genetic disorder
taking a bath
o Inability to utilize an essential amino acid and
*Anterior Fontanel: Diamond; 16-18 month closes; causing mental retardation.
*Posterior Fontanel: 2-3 month closes o Management is special formula – Low
*CRADLE CAP: Scalp condition causing Crust which stared from Phenylalanine formula: Lofenelac/Phenelac.
seborrheic dermatitis and not properly washed scalp; Soak in oil,  G6PD
to remove with a soft brush o (Glucose-6-Phosphate dehydrogenase)
*CROSS-CUT NIPPLE: used for Sucking and Aspiration o “favism”
problems (PREMATURE BABIES); Needs pressure to come out; o Hereditary, x-linked recessive condition,
over round Nipples which release milk without pressure resulting to breakdown of RBC causing
anemia when exposed to triggers like fava
ROOMING IN (BONDING AND FEEDING): beans, “sulfa” drugs or naphthalene
RA 7600 (1992): rooming-in/ Breastfeeding act of 1992 o Breakdown of RBC causing anemia.
 EO 51: Milk Code of the PH o Management
 BREASTFEEDING: The best feeding, must be  Avoid “triggers” like beans,
done at least 8x/day on demand and exclusive naphthalene, sulfas, antimalarial
 Antibody (IgA): Passive Natural Immunity drug
 DO NOT BF: if [1] ACTIVE TB (RIPES Drugs); [2]  CRETINISM
o Congenital hypothyroidism.
Chemotherapy (SE of the drugs) Radioactive; [3]
o Most common
HIV (only when the baby is positive but if baby is
o Deficiency in thyroid hormones causing
negative, DO NOT BF); [4] Hepatitis; [5] Maternal
physical developmental and mental delay.
Substance Abuse; [6] SURGERY: Bilateral
o Management
Mastectomy, Implants (Unless the implant is the  Thyroid supplements for life
under the mammary glands); GIVE Mother advice (Synthroid);  cause DEATH or
on the use of Breast Milk Substitute: MENTAL RETARDATION.
o TYPE: Infant Formula Only o Done by heel prick when baby is at least 24
o PREPARATION: Sterilization/ Boiling hrs old/ not more than 72 hrs (BEST TIME:
o FEEDING METHOD: DO NOT PROP 48 hrs; PEDIATRICIAN: is the legal suit for
(placing on the pillow or towel to let the the directed if the baby dies, so remember to
baby feed flat) position; burping; sign before discharge against law suit (CAH:
Schedule, give water in between; Cellular dehydration, first to kill)
BONDING through BF  MAPLE-SYRUP URINE DISEASE
o HOW TO KNOW IF YOUR BABY IS o Inability to metabolize AA valine, Leuncine,
HUNGRY Isoleucine  death from cerebral edema
 Sucks his fist o Management
 A diet with carefully controlled
 REMEMBER: Galactorrhea (mother has plenty or levels of the amino acids leucine,
produces lots of milk) release the milk before giving to isoleucine, and valine must be
the baby, baby may drown on milk maintained at all times
 High dose of thiamine/liver
 5-10% weight loss: PHYSIOLOGICAL WEIGHT LOSS
transplant PRN
*Jaundice is only on the SKIN OF THE NEONATE not
on the EYES Icteric (Hard to see since the eyes is
EXPANDED NEWBORN SCREENING PROGRAM
more of pupils)
 January 2014
 Bottle feeding: Give cup instead of bottle (MC cause of
 Optional additional 22 tests
Infections); 30 minutes from boiling (when bubbles
burst and steam is coming out) GROWTH & DEVELOPMENT
 First 7 years are the most crucial; AGE OF WISDOM
(Develop conscience)
 AGE 1: Development of the EGO
 AGE 5: SUPEREGO (Conscious Recall: 5 and on for
memory)

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 PEDIATRIC NURSING – R. VILLARAMA
 GROWTH: is an increase in the number and size of PRE-SCHOOLER (Imaginative, Conscious, Creativity)
cells. Measured in terms of QUANTITY  Loves to share and imitate adults in their play role
 DEVELOPMENT: is capacity of functioning skill. play: COOPERATIVE/ ASSOCIATIVE GAMES
Measured in terms of QUALITY  Role playing games: Play School, play house, Doctor-
o CEPHALO-CAUDAL AND PROXIMO- Nurse Kit, etc
DISTAL SCHOOLER
 Must have a winner at the end of the game;
*MILESTONES: Skills that Nature taught us; natural *Develop a COMPETITIVE GAMES
skill: PREIMITIVE REFLEXES must be removed (ie Moro,  TOYS: Card games, scrabble, Hopscotch (piko),
Startle, Dance); if they are gone, a matured CNS PROTECTIVE Skipping rope, etc.
REFLEX: Cough, yawning, gag
PLAY – universal language of a child
PRINCIPLES OF GROWTH AND DEVELOPMENT: Infant Solitary games Mobiles, rattle, music
box, teething rings
 UNIQUE: INDIVIDUALIZED (Don’t compare your
Toddler Parallel games Push-pull toys, toy
children with each other
telephone, building
 CLOMIPHENE (CLOMID): Fertility Drug; increased
blocks
rate of Twinning or Multiparity
Preschool Cooperative/Associative Play school, play
 4-5 mL is about 60-120M Sperm
games house
 CONTINOUS PROCESS: Life begins at
School Competitive games Cards, scrabble,
CONCEPTION; Begins at conception and cells at
child hopscotch
death
 PLAY: is essential in the life of a child
ASSESSMENT OF GROWTH
o TOY: [1] Developmental Age, [2] SAFETY,
[3] Must have a Purpose and [4] Limitation  Physiologic loss of weight days after birth: 5-10% of
of the Illness {INTEVENTION) Birth weight (Due to water loss: Stool, Fluids from the
 RATE AND GROWTH VARIES intrauterine life, Urine, slow food given due to BF, GH of
o RAPID: Growth Spurts: fast growth; the baby is decreased since it came from the placenta
INFANCY & ADOLESCENT and the T3 T4 of the baby is still low for development)
o SLOW: Growth Gaps: Toddler, preschool, o From the days of deliver: Return to pedia 1
school week after (Dry umbilical stomp and the
 (PHYSIOLOGIC ANOREXIA: Don’t force the child to weight of the baby)
eat; PUNITIVE: you will not get out of the table if you  Most rapid during infancy: DOUBLES AT 6 MONTHS.
don’t eat all everything on the table; GIVE FINGER TRIPLES AT YEAR AT 1 year and ADOLESCENT
FOODS; if it became punitive: Eating Disorder will STAGES
erupt in the future), Preschool, Schooler
 DIRECTIONAL: GROWTH TRENDS IN PHYSICAL GROWTH DURING
o Growth: Horizontal and Vertical CHILDHOOD
o Developmental INFANTS
 Cephalo-caudal (GROSS 0-6 months 5-7 ounces/wk 1 inch/month
MOTOR: Large Muscle Groups) & BIRTH WEIGHT: doubles by 4-6 months
Proximo-distal 6-12 months 3-5 ounces/wk 0.5 inches/month
 FINE MOTOR: Small muscle BIRTH WEIGHT: triples by 1 year
groups TODDLER Quadruples by age 2; yearly gain (4-7
 SIMPLE TO COMPLEX – pounds)
Language PRESCHOOLER Yearly gain (4-7 pounds)
 GENERAL TO SPECIFIC – Birth length doubles by 4 years of age
Interpersonal SCHOOLER Yearly gain (4-7 pounds; birth length 3x
at 13 years old)
GAMES CHILDREN PLAY
INFANT (PIAGET: Sensorimotor) COMPUTING FOR EXPECTED WEIGHT GOMEZ FORMULA
 NO PLAYMATE: May be Parents; MOSTLY: Body  1: Age in months / 2 + 3 or 4 = wt (kg)
(MOUTH, Hands, Feet)  1: Age in months x 2 + 8 = wt (kg)
 SOLITARY PLAY: Plays alone
 Plays with their body and sense (hearing, Seeing and ASSESSMENT
touching) DDST (Denver Developmental Screen Test)
 TOYS: Mobiles, Rattles, Teething rings, Music Boxes MMDST (Metro Manila Developmental Screen Test)
and Squeeze Toys AREAS
 BEST TOY: The mother’s face: STIMULATION
Gross Motor Done by the large muscles
CEPHALOCAUDAL
TODDLER (Narcissism: What’s mine is mine & what yours is
Fine Motor Skills done by small muscle
mine) PROXIMODISTAL groups
 Very Possessive/ Cannot share Interpersonal Skills Social
 Loves to play beside another child another child must Language Regional differences
have each s toy PARALLEL games
 TOYS: Promote skills of walking: Push and Pull toys, DEVELOPMENTAL MILESTONES
and talking: Toy Telephone, Coordination: Blocks; NO CEPHALOCAUDAL (EVEN)
TALKING DOLLS or TALKING ANIMALS; 0 No head control: Head Lag; cradle head and support
 BEST TOY: Tin Telephones head
2 Lifts head: beginning head control; lift head when in
J.E.A.D. 5 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
prone  ANYONE TACHYPNEIC is at risk of Aspiration;
4 Lifts head and chest; full head control Diarrhea (Reason: to decrease Vomiting and rest GI
6 Sits with support tract) and Pneumonia: SO GIVE NON-NUTRITIVE
8 Sits alone SUCKING (Pacifier [May be too big]; So please use
10 Stands with support their THUMBS)
12 Stands alone/walks with support
14-15 Walks alone TODDLER: ANAL/ AUTONOMY VS. SHAME & DOUBT
Cerebral Palsy: Early Manifestation of Milestones (standing due to  Decision making; Choose or you let go and holding it
spasticity) (toddler most likely to let go since it is pleasure)
DEVELOPMENTAL MILESTONES  Finds pleasure in controlling his elimination function
CEPHALOCAUDAL (ODD)  Toilet training begins in the RIGHT PLACE
3 Turns to sides  RECOMMENDED to be started at 18 months (complete
5 Roll-over; dumadapa myelination of the SC and control of the bladder and
7 Bounching; nerve control going down bowels); Bowel first over bladder
9 Crawls  Most important factor is READINESS of the child
(PHYSICAL and PSYCHOLOGICAL [Bigger Pleasure
11 Cruises: they don’t let go when walking; “naggagabay”
than being able to let go]) Completed by 4 y/o (it takes
2 years to finish)
*GLOBAL DEVELOPMENTAL DELAY: Not talking or walking;
 FEELING OF INDEPENDENCE: Behaviors to Observe
Coincides with malnutrition
o NEGATIVISM
*Walking and Talking (they have an inverse development): When
 No! I’m the boss
talking came first but the walking will come late and vice versa;
 Set limits
One skill takes over development over the other, this is called
 Offer acceptable choices
THE PLATEAU PHASE
(secondary choices: Drink
medicine, do you like per cup or by
FINE MOTOR SKILLS
spoon? You can continue what you
DEVELOPMENTAL MILESTONES need to do without the risk of
PROXIMO-DISTAL (FINE MOTOR) saying no)
NEONATE Strong grasp Reflex  They do opposite of your actions
3 Grasp reflex is gone/ Hands are held open; o TEMPER TANTRUMS (non verbal
‘HAND REGARD’: expression of frustration)
Plays with hands; Can be taught with things with  Ignore the behavior or TIME-OUT
the hand (CLOSE-OPEN game); the Brain has (1 minute for each year of life
control to that distance  NOT FOR SCHOOLER
6 PALMAR GRASP; holds feeding bottle with 2 /ADOLESCENT: Go up to your
hands; SIPPY CUP room and stay there
9 PINCER GRASP: Thumb and finger to hold [GROUNDING])
objects; most dangerous GROSS MOTOR: o RITUALISM: Stereotypical behavior; to feel
since they crawl and eat objects on the floor secure
12 Puts things in and out of containers, Puts o DOWDLING:
objects inside mouth, Throws objects  Takes time before following you
 He is trying to decide
DEVELOPMENTAL THEORIES  A lag moment of decision
PSYCHOSEXUAL  Do not Count of the child (isa,
ORAL Smokers, Alcoholics dalawa, tatlo….)
GENITAL  You cannot decide properly in the
OC or not Orderly
future to counter this they usually
GENITAL-PHALLIC Rapist, exhibitionist, given a deadline.
promiscuous (NO INTIMACY);
impotence and frigid (Frigidity PRESCHOOL: GENITAL (PHALLIC)
will not hinder her getting INITIATIVE VS. GUILT
pregnant; she can’t feel)
 OEDIPAL/ ELECTRA
GENITAL-LATENCY o Child turns toward the parent of opposite sex
GENITAL-PUBERTAL o Initiative develops if the child is allowed the
freedom to initiate small activities and is
FREUD: F for Fuck appreciative for it
PSYCHOSOCIAL: Relational o Stage of kusa
RIGID/ EXPLOSIVE o Resolves at the end of 6th year of life
 SON WITH ABUSIVE FATHER TO MOM: I don’t want
INFANCY: ORAL/TRUST VS. MISTRUST to be you & I want to be the good parent, my mother;
 The infant receives stimulation and pleasure through o May become gay or marry a domineering wife
his mouth; Answering their cry (needs) helps develop  6th YEAR: If the dad still tried passive firmness and still
trust: Sucking Pleasure give love to son: Son will love dad and has a better
 Trust develops when the infant’s needs are met - Lust outcome in future
is the foundation of all relationships  ELECTRA COMPLEX:
 Baby uses the mouth to get attention of mother through o Rare
crying; if the mother or primary health giver answer = o Forever competes for relationships in the
TRUST, if not then MISTRUST future
 ORAL RESIDUALS: Oral frustrations, Oral fixation; o The mother competes for the Father’s
Excessive thumb sucking, nail biting, alcoholism, drug affection with the daughter
addiction o I WANT COMPETITION, MISTRESS
J.E.A.D. 6 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
 Behaviors to observe  PRE-TERM: before the complete 38 weeks
o VERY CURIOUS
o WHY STAGE PROBLEMS
o Asks many question: 300-400 questions  All organs are immature
 Awareness of GENDER (SEX MEANS GENDER TO o The respiratory system is not yet fully
THEM) equipped; weak cry (APGAR SCORE 1 – due
o Touches their body (MASTURBATION: dirty to respiration)
yan! Don’t touch that! Meaning this will stop o Surfactant via ET/O2 via CPAP, ventilator,
intimacy and no sex steroids to mom before delivery
o PRESCHOOL does not think that mom and  Regulation of Body Temperature
dad have different sexes/gender roles o Cold stress/Poikilothermia (incubator,
 BETTER TO IGNORE THAN DIERT kangaroo care)
 Exhibits the fear of bodily injury  Nutritional Difficulties
 Very imaginative o OGT feeding/SFF
 FANTASY PLAY  Immature Liver Function
o Hyperbilirubinemia/Kernicterus
SCHOOLER: LATENCY (phototherapy)
INDUSTRY VS INFERIORITY  Low resistance to Infection
 The sexual drive (LIBIDO) is controlled and repressed o Sepsis neonatorum (aseptic principles,
interest in the same sex (NORMAL HOMOSEXUAL) antibiotic)
 Industry develops if the child is permitted to do things
by himself and praised for the results EQUIPMENTS (By priority)
 ACHIEVEMENT ORIENTED YEARS: Wants to prove  Ventilator
their best in school  Neonatologist: for intubation
 Competitive  Incubator
 HEROISM: crush on the opposite sex who is usually  Bili light
older
RESPIRATORY DISTRESS
ADOLESCENT: GENITAL  Immature alveoli with less amount of surfactant (air
IDENTITY VS ROLE CONFUSION sacs keep the alveoli open; Lipoproteins that decrease
 Resurgence of sexual drives alveoli surface tension)
 Develops relationships with members of the opposite  PROBLEMS
sex o Atelectasis: Collapse of the lungs
 Identity develops when there is feeling off o Prolonged Apnea (more than 20 seconds)
belongingness and acceptance by others o Cyanosis
 Behaviors to observe o Asphyxia: Outcome of not getting oxygen
o Undergoes bodily changes corresponding to which increases C02 and causes death
puberty  SYMPTOMS (Obligatory Nasal Breathers)
o Moody and unpredictable o Nasal Flaring: obligate nasal
o Attempts to make decisions for himself & o Fast Breathing (more than 60)
makes long range plans for the future o Chest Indrawing
(CAREER PLANS) o GRUNTING: most accurate sign; umuungol
 PUBERTY (sounds like a near collapsed lung upon
o First change in both sexes: increased height expiration)
and weight (2nd period of growth spurts)  DX
o Female: Widening of Pelvis (OVOID) SILVERMAN-ANDERSON INDEX
o Male: Broadening of the chest and shoulders (Most salient criteria to identify RDS; Reverse scoring vs APGAR)
Chest Movement
FEMALE MALE Intercostal Retraction
THELARCHE: Breast Scrotal size Xiphoid Retraction
Pubarche Adrenarche (Androgen) Nares Dilatation
Adrenarche 1. Pubis Expiratory Grunt
Menarche 2. Axilla 0: No RDS; None
3. Legs 5: Beginning
4. Face 10: RDS
5. Chest
Voice *Seesaw Breathing: Abdomen rises, Chest falls *Flail Chest:
Menarche: 11.5-12 y/o FINALE: Nocturnal Emissions Paralyzed diaphragm
(14-16 y/o) *INTUBATION: Babies that do not breath/CRY
NO MENS: NO WET DREAMS:
Ovary Agenesis -Tripchordi (Undescended MANAGEMENT
Testicles); TESTICULAR CA;  Monitor RDS: Silver Anderson Index
Surgery: ORCHIDOPEXY  MD insert ET: to initiate lung expansion
 Artificial surfactant given per ET (Survanta)
ABNORMAL PEDIATRICS  Give O2 by CPAP via mechanical ventilator or ambu
RISK NEONATES bag: RISK FOR RETINOPATHY OF PREMATURITY
 Common Medical Abnormalities associated: GDM/ DM,  Steroids to mom before delivery: To stimulate the baby
PIH (mild, pre & eclampsia) to increase lung maturity/lung surfactant creation
 THE PREMATURE: refers to the baby who is delivered  FROG LIKE POSITION: Good for respiration and
preterm temperature
J.E.A.D. 7 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
 Retrolental Fibroplasia: for term blindness o Expose all areas [Cover: eyes to prevent
corneal dryness & Genitals to prevent
PRIAPRISM {Constant erection of the penis
due to increased vascular engorgement
POIKOLOTHERMIA
primarily due to heat
 Shifting from hypothermia to hyperthermia
o Causes pain to the baby
 Due to low levels of subcutaneous fats (cannot be o For girls, you don’t need to cover but you can
placed under floor lamp and may absorb the cover due to HUMAN DIGNITY, BURN. To
temperature) determine effects is effective, check the stool
 Hypothalamus is immature which should increase (so covering with a
 NON-SHIVERING THERMOGENESIS diaper or a mask [like a bikini], keep
 MANAGEMENT changing)
o Put in an incubator for maintenance of neutral o TURNINING: on all sides every 30 minutes
temperature setting o Check temp regularly
 PROBLEM o To facilitate effects: Give feedings which will
 No stimulation increase urination and defecation (will
 Neonates most sensitive release bilirubin)
active is touch o Continue contact with parents
 Hearing is acute: so
hearing the machines SEPSIS NEONATORUM
 Smell: not the mother but  Immature immune system
the hospital scent  Low resistance to infection
 ENCOURAGE KANGAROO CARE  MANAGEMENT
 For twins, you place two o The baby will still receive IgA from breastmilk
together (instruct mother to BF through cross cut
 Interlocking (69 or 66 nipple to avoid infection)
[Spooning]: this will be o Instruct to decrease number of visitors
placed depending on the o Strict compliance with nursery aseptic
UTZ in utero) protocol
 Mom and dad is able to o Handwashing and PPE
cuddle o Antibiotics
 Clomiphene: Fertility Drug; Higher chances of twinning
o CLING WRAP POST MATURE INFANT
 To hold the dressings for spina  Born more than 42 weeks in gestation
bifida/neural tube defects (cannot  CHARACTERISTICS: long but thin, dry cracking, no
be taped) vernix and lanugo, long hair and nails, alert look,
 Preserves heat and retain moisture possible IUFD (Intra-Uterine Fetal Death); HERMIT’S
LOOK
NUTRITIONAL DIFFICULTIES  50% Post-Term Babies dies: give mementos (baby
 Prone to aspiration/gastric distention; hypoglycemia bracelet, hair, pictures), to facilitate grieving
 CAUSES  Patient Advocacy: patient assistance program; support
o Poor suck, gaga and swallowing group
 BREAST MILK
o Place in the freezer PROBLEM
o Do not microwave; THAW only through warm  Placental degeneration causing decreased utero-
water bath so that the antibodies do not die placental perfusion
o Do not give per dropper: GAG reflex is poorly  HYPOXIA due to placental insufficiency (Central
developed Cyanosis; from blue to pink when crying; persistent
o Per OGT (Oral Gastric Feeding) since they acrocyanosis is not normal [their cyanosis started in
are nasal breathers utero, from centrally blue to peripherally blue due to
o Use a cross cut nipple (lessens risk for crying]); Give 5L 02 per face slowly will increase 02 stat
aspiration) (will not work with TOGV: the 02 status will continually
o POSITION: elevated head decrease
o AFTER FEEDING: Right side lying (promotes  Intrauterine Hypoxia  Fetal distress  IUFD or
gastric emptying; also done in pedia with MECONIUM ASPIRATION
Chelasia [Immature Cardiac Sphincter or  Intrauterine hypoglycaemia  ACIDOSIS
GERD; Dumping Syndrome)  Hypoglycemia due to decreased glycogen  low blood
 STOMACH SIZE: CALAMANSI glucose in blood  uses fats as alternative source 
ketones accumulates  acidosis
HEMATOLOGICAL DIFFICULTIES:  Fetal Distress (A if the fetal kicks are increased:
 PHOTOTHERAPY: for jaundice RESTLESSNESS; Admit the client): PITOCIN DRIP, to
o Immature liver and cannot create stimulate NSD if possible; if with late deceleration: C/S
Glucoronyltransferase (without this there is  SEIZURE DISORDER (Cerebral Palsy)
an alarming increase in bilirubin, causing  MECONIUM ASPIRATION: infection and RDS
Kernicterus)  CORD PROLAPSE: if movement after BOW has
o The light emitted penetrate skin through and ruptures
converted indirect bilirubin through
 Prenatal Care: 4x (one for each term); best means to
Photoisomerization (conversion in the skin
decrease risk of Pre term and post term
surface
o The better the skin exposure, the better the  POST TERM: easier to prevent
result
J.E.A.D. 8 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
MANAGEMENT
 Monitor cardiac and respiratory status
 Suction meconium-stained secretions
 Manage hypoxia – O2/mask
 ABG for acidosis
 CBG for hypoglycemia
 Antibiotic for MAS
BABY OF DIABETIC MOTHER
 Diabetic mom DOES NOT YET MEAN TO HAVE A
Diabetic Baby (hereditary)
 Diabetic  lacks insulin (key to the cell) (glucose is the
food of the cell)  cell does not open because there is
no key  glucose leaks  hyperglycemia  circulates
in blood  kidneys  kidney gets overwhelmed 
glycosuria  osmolality of blood is high  attracts
fluids to other areas of the body  goes to the tubules
 increased GFR  polyuria
 Cell starved  brain commands the GI system to eat
and eat  patient eat and eat  polyphagia  high
osmolality  brain commands to drink  polydipsia
 He is capable of producing insulin, mother does not 
not used  goes to placenta  placenta gets so much
glucose from the mother  goes to baby  adapting to
the need to produce more insulin  absorbed from the
baby’s body  MACROSOMIA (NV: 5 ½, 6 ½ lbs 7 ½
[AGA]– 2500 gms, 3000 gms, 3500 gms)  2
POSSIBLE COMPLICATION: PRETERM
DELIVERY/POSSIBLE FRACTURED CLAVICLE 
SHOULDER DYSTOCIA  breaking of clavicle done
intentionally in order to save the baby (left clavicle are
mostly the ones fractured)
 AFTER BIRTH HYPOGLYCEMIA  gets so much
glucose, produces more insulin  umbilical cord is
clamped  still produces more insulin
 The Baby’s pancreas increases insulin production
(HYPERINSULINISM); the glucose from mom is
metabolized and absorbed causing MACROSOMNIA
(large Fetus; 8 lbs or 4000 gms [FILIPINO]); the body is
bigger but the head still the same size, the shoulder will
not be delivered (Shoulder Dystocia); This will cause
the baby to go up and down the uterus
 MANAGEMENT
o Monitor signs and symptoms
hypoglycaemia, tremors, irritability,
restlessness
o If lower than 40-60 mg/dL, give glucose
(D50W) per IV bolus
o If with fractured clavicle
 Immobilize across the chest
 Figure of 8 bandage
 Choose left since it is presumed
that the baby is right-handed
 Greenstick Fracture: bent fracture,
healing is faster
 CBG Normal Value for Pediatrics: 40-60 mg/dL
ERYTHROBLASTOSIS FETALIS: BLOOD INCOMPATIBILITY
 Blood type is determined by the father
 Positive: With D antigen
 Negative: Without D antigen
 Rh + can receive both + and –
 Rh – can only receive (-)
MOTHER BABY
RH COMPATIBILITY
Rh - Rh +
Rh + No problem
ABO COMPATIBILITY
Type A Type B
Type B Type A
J.E.A.D.
Type O (U. Donor) Type A or B
Type AB (U. Recipient) No problem
O negative: the most universal donor, given in an emergency
basis
 First baby is not affected since no antibodies are
created
 Utero-placental barrier can let the antibodies go through
PINOCYTOSIS (maternal sinuses) as compared to
other barriers (lungs, kidneys)
 23 chromosomes contributed by the mother  23
chromosomes by the sperm  when sperm penetrates
the egg  the egg will be stimulated to build a wall
around the egg  hyalorudinase  to prevent double
fertilization  cell division  conception  morula 
zygote  fetus
 23 from the egg needed, 23 from sperm have 2 genetic
codes which includes the blood type (X: girl, Y boy)
 The utero-placental barrier can let the antibodies in
through PINOCYTOSIS (maternal sinuses; not
engulfed) as compared to other barriers (Lungs,
Kidneys)
 FIRST BABY (Rh positive) – not affected but he
stimulated the mother (Rh negative) to respond by
producing antibody (Anti-Rh positive)
 SECOND BABY (Rh positive) will be affected. His blood
will be destroyed by the antibody (Anti-Rh positive) from
the mother. – POSSIBLE IUFD; ALIVE BUT WITH
PATHOLOGIC JAUNDICE
 MANAGEMENT
o Exchange transfusion: Removal of baby’s
blood and replacement with fresh whole
blood (Rh Negative); Why not, because
negative can be given to any (Mom’s Blood
cannot be given since it contains Antibodies;
Positive blood cannot be given to the baby
[DAD] the baby’s blood contains the
antibodies already and will only cause bigger
problems) –
 Why Rh negative  Positive is
either (+) and (–)
 Why negative is not allowed – has
antibodies with (+), therefore will
of just destroy it
 Why does the mother cannot
donate – antibodies came from her
(possible if – her sister, father,
grandfather, or anybody from the
father’s clan)
o UMBILICAL LINE: Umbilical vein: enters;
Umbilical Artery: exits
o If mother is not compatible with baby, the
RhIg (RHOGAM) is given to mother within 72
hrs after delivery or abortion of an
incompatible fetus (the RHOGAM will
camouflage the baby’s blood and makes the
maternal blood stop creating antibodies); can
be given before birth, if the mother was given
an invasive procedure – to prevent
production of antibodies
(AMNIOCENTESIS)
o Indirect COOMB’S cord blood; Direct
COOMB’S from the baby (MILK THE CORD
into a sterile container); to determine Rh
antibodies in the baby’s blood which will in
turn determine if there is need for RHOGAM
 If (-), no antibodies yet, can be
given when the baby is delivered
 If (+), exchange transfusion
9 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
NEONATES WITH CONGENITAL DEFECTS  CORRECTIVE SURGERY: If in failure (overworked
ACYANOTIC CYANOTIC heart) and defect is large (No possibility of spontaneous
LEFT TO RIGHT RIGHT TO LEFT closure); Can be done in the specific condition and can
Aorta does not get Aorta gets unoxygenated blood wait
unoxygenated blood o OPEN HEART: inside the heart
VSD TOGV  You stop systole/ asystole of the
ASD TOF heart; injected with high doses of
PDA TA potassium; Connect to a By-pass
COA machine (EXTRACORPOREAL
AS MEMBRANE
PS o CLOSED HEART: outside the heart

ACYANOTIC CYANOTIC OXYGENATOR): oxygenate the blood and bypass the heart; Also
Increased Obstruction to Decreased Mixed blood induce Hypothermia (slows down oxygen demand of all the
pulmonary blood flow pulmonary flow organs) using Hypothermic blanket and tuck the patient with ice;
blood flow from the blood flow Given PLEUR VAC to drain the secretion or CHEST TUBE to
ventricles restore negative pressure
VSD COA TOF TOGV
ASD AS TA TA MEDICAL MANAGEMENT
PDA PS TAVR  OBJECTIVE 1: PREVENT CHF
AV CANAL HLLS CHF MANAGEMENT
Drugs: Digoxin and Diuretic
CONDITION
SYMPTOMS
ACYANOTIC
Breathing
CYANOTIC
Central Cyanosis
D Diet: Decrease Cardiac Demand
Decrease occurrence of infection
Difficulty Clubbing of fingers o Improve the CO: Give DIGOXIN (Cardiac
COMPLICATION CHF Clot (Thrombus) Glycoside): Increases strength of contraction
Cerebral Thrombosis o COLORED FOOD FOR DENGUE: The color
MANAGEMENT Digoxin Prevent “TET” spells change is not for the stool but for the vomitus
Diuretics Polycythemia that may mask the bleeding
Diet – Low monitoring o Prevent Na retention and promote elimination
sodium Phlebotomy of excess fluids (FUROSEMIDE: Diuretics);
Decrease O2 Position – Squat/Knee SPIRINOLACTONE: takes a longer (2 days)
demand Chest effect so give the faster one and simply give
Provide O2 potassium supplements; measure the intake
and output (weigh diaper); Weight is the best
ACYANOTIC HEART CONDITIONS indicator of water loss; Weigh the patient OD;
 Congestion of the heart chambers and causes the heart Monitor potassium (3.5-5.5 mEq/L); Replace
to compensate by increase rate if contraction leading to K loses (SAFEST: Natural; GIT [fresh fruits,
CHF: fruit juices/ if oral do not crush time released
 CC: Early Pulmonary Symptoms: Dyspnea, fast Kalium Durule]; IV potassium is incorporated
breathing, moist cough, rales/ crackles into a side bottle (piggy black) and with a
main line, NEVER PUSH!); Observe in K
 DX: CXR: pulmonary edema and cardiomegaly; but
administration (monitor the ECG; every 15
HEPATOMEGALY could be seen in Cardiac
conditions; 2D-ECHO (echocardiography) & MRI: minutes)
identifies the type of the heart o Give ACE inhibitors
 SURGERY: PH SOCIETY OF PEDIATRICIANS: After o Low Sodium intake: Low sodium formula
5th birthday (the baby will now go to school and (LONALAC), Clarification on solids allowed;
increased activities; able to safe for funding) Not only the salty foods are rich in sodium
 CARDIAC CATHETERIZATION: Identifies pressure (eg Cola [HC03]; breads [HC03]; Tocino
inside the heart (CHF); Also interventional which [Sodium Nitrate])
inserts a stent; the femoral is insertion site;
immobilize the legs (Sand Bags or let the mother MONITOR CR/HOLD IF SLOW
hold), bed rest, Assessment of the site (Circulatory Less than 1 Less 100
problems: clots will form, determine for COOL skin 1-5 y/o Less 80
then check for pedal pulses) 6-10 y/o Less 70
11&above Less 60
RIGHT SIDED FAILURE LEFT SIDED FAILURE EARLIEST SIGN OF TOXICITY:
SYSTEMIC PULMONARY  GIT symptoms; M/V, vomiting, Anorexia, Abdominal
CONGESTION CONGESTION Pain, Diarrhea
 GIVEN BEFORE MEALS: on an empty stomach; Not
Distended neck veins, pedal Dyspnea, rales, productive due to absorption (for most medications this is the
edema, ascites, hepatomegaly cough, rales/cough, pulmonary reason) so that you determine if the problem is caused
edema, FROTHY THICK by the toxicity or the effects of eating being full.
SPUTUM (blood tinged; pink;
rupture of alveolar capillary *IV PEDIA: usually peripheral or in central line
membrane) *IV will burn or turn black in excess potassium
*FIRST SIGN OF HYPERKALEMIA: T-wave peaks (for
*2D echo and cardiac Catheterization: the means to determine ECG); GIVE GICKS: the insulin will trap the potassium into
the intervention the the cell
*Normal Cardiomegaly: Old Age & Sports *Added salt in cooking must be a pinch or at the rate amount to

J.E.A.D. 10 UST CON BATCH 2018

 PEDIATRIC NURSING – R. VILLARAMA
taste
 OBJECTIVE 2: DECREASE 02 DEMAND
o Cluster Nursing Care: Quiet play activities
(Bed Games: Puppets, teddy Bear, Story
Book); Decrease Anxiety and stress level
o SFF
 OBJECTIVE 3: PREVENT RESPIRATORY
INFECTION
o Vitamin C
o Promote immunization
ASD
 PATENT DUCTUS ARTERIOSUS: to bypass

pulmonary circulation; Connection from the aorta to the
pulmonary artery
FORMEN OVALE: Also to bypass the pulmonary
circulation
 CLOSURE in fetal circulation:
o FUNCTIONAL
 It will stop functioning and will
close; The lungs will expand, 02
level in the body; Now the pressure
from the right shift to the left
caused by pressure from opening
of the lungs; The FORAMEN
OVALE (2-3 months is Anatomical
Closure) will now close.; the
increased oxygen will increase 02
levels and collapse the PATENT
DUCTUS ARTERIOSIS (3-4 weeks
or a month is anatomical closure)
o ANATOMICAL
 Foramen Ovale: Not cyanotic but
may become dyspnic; The heart in
this condition will become
congested at the RA since the
shunting from the left side, this will
trigger a compensating mechanism
by contracting faster; The over-
contraction will cause the heart will
get tired and the quality of
contractions diminished, Low
stroke volume = CHF
 Difference to CHF for Pedia is:
Streptokinase (Thrombolytics),
Aspirin, Low fat (Anti Lipidimics);
Same DIGOXIN, DIURETICS,
BETA BLOCKERS
o STARLING’S RULE: the stretches will dictate
the contraction of the heart
VSD
 Same as ASD
 Only in the ventricles
PATENT DUCTUS ARTERIOSUS
 The RV is now over stretched since the blood returns
from the aorta into the heart;
COARTATION OF THE AORTA
 Descending aortic stenosis, now the LV now gets
congested; THE BP becomes HIGH: Higher in the
ARMS (upper Body) than the legs (lower body)
 *Normally: the legs are higher in pressure due to
distance, diameter of the vessels and pressure
 from the heart.
 *For the legs: Add the BP +20 to the Systolic and
Diastolic pressure
J.E.A.D.
AORTIC STENOSIS
 Aortic Valve Stenosis
 Decreased systemic circulation and decreases BP, both
the arms and the legs
PULMONIC STENOSIS
 This may have Cyanotic, since the blood cannot get
oxygenated due to Pulmonic Valve stenosis
CYANOTIC HEART CONDITIONS
 SURGICAL: Palliative CLOSE HEART then
CORRECTIVE OPEN HEART
 MEDICAL/ NURSING MANAGEMENT
PROPANOLOL
P PENICILLIN
PHLEBOTOMY
PROMOTE Fluids
o Decease 02 Demand
o PROPRANOLOL to decrease TET SPELL,
Prophylactic antibiotics for bacterial
endocarditis
o Monitor Hgb and Hct count: detects early
POLYCYTHEMIA
o ASSISTS in Phlebotomy: blood letting and
replace with Plasma of the same amount to
make the blood thinner
o Increase Fluid/ Maintain IVF line as
necessary: Water games (Water guns for
feeding; Grapes oranges, Watermelon;
Jellow)
o Positioning during attacks: allow to squat or
knee-chest, give 02
o Monitor activity tolerance/ LOC: Hypoxic
effect; Initially restless; Decreased 02, the
CHILD is hard to awaken / aroused
 Pain and Hunger: This will wake up a client
TRANSPOSITION OF THE GREAT VESSELS
 Most dangerous; Presents at the moment of birth
 “The Harder they cry, the Bluer they get”
 ONLY HOPE: that the baby has septal defects;
DUCTUS ARTERIOUSUS: if open, the force of the LV
will push the oxygenated blood towards the Aorta
(systemic circulation)
 S/SX: Persistent Cyanosis In spite of vigorous crying;
hypoxia in spite of oxygen therapy; Less symptomatic if
with septal opening
 MGMT: Give prostaglandin E2 to open ductus
arteriosus; PALLIATIVE : Baloon Septostomy;
CORRECTIVE: Open Heart Surgery, MILLER
RASHKIND PROCEDURE
 Prostaglandin is a muscle and BV relaxant; This will
cause the relaxation of BV and keeps the defects open
 *INDOMETHACIN (Prostaglandin Inhibitor): will
close
TETRALOGY OF FALLOT
D Displaced Aorta
R Right Ventricular Hypertrophy
O Opening in the septum (VSD)
P Pulmonary Artery Stenosis
 Pressure on the RIGHT side is higher than left
 May go home or may not diagnosed at birth since S/SX
is not so evident; When he cries the baby turns blue but
when relaxed turns pink;
 S/SX
o As the baby active, the S/SX gets more
pronounced because of increase oxygen
supply or TET SPELLS (you are kinking or
occluding the vessels in the legs
11 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
o The decreased pressure in on the right side
of the heart due to return from circulation
o TET spells will improve circulation); perform
Shamroths
o Boot Shaped Heart (due to cardiomegaly)
 TET SPELL: if can stand (Toddler) SQUAT if Infant
Knee Chest
 Clubbed fingers due to peripheral hypoxia;
POLYCYTHEMIA due to chronic Hypoxia (Blood
clotting due to increased BLOOD products in small BV:
Cerebral Thrombosis [RARE in pediatrics])
 Stunted physical growth and delayed development
NEURAL TUBE DEFECTS
 CAUSE: inadequate intake of FOLIC ACID during
pregnancy; Not enough folic acid
 Posterior lamina is missing or absent  contents went
out
 85% of children with neural tube defects  develop
HYDROCEPHALUS
 Drugs, radiation
 Sources of Folic acid
o Green leafy vegetables o Nuts
o Legumes
o Brown rice
o Strawberries
SPINA BIFIDA OCULTA
 Hidden; no sac
 Usually not visible externally o Dimple at sacral area
 With hair
 No intervention necessary
SPINA BIFIDA CYSTICA
 With sac
 Intervention is necessary
 MENINGOCELE- consist of sac-like cyst of meninges
filled with spinal fluid
 MENINGOMYELOCELE: protrusion of a sac-like cyst
containing meninges, spinal fluid and spinal cord with
its nerves. Paralysis of lower extremities. Clubbed foot-
talipes equinovarum.
 ENCEPHALOCELE: Herniation of the brain and
meninges through a defect in the skull - most
dangerous
 ASSESSMENT
o Observe for movement of the lower
extremities, apply pain;
o With movement: meningocele (+) talipes
equinovarus (clubfoot) - meningomyelocele
 OVERALL GOAL
o Protect the sac against pressure, injury and
infection
 MANAGEMENT
o Surgical closure preferred within 24-48 hours
after birth to prevent local infection and
trauma to the exposed tissues
o Prone position
o Bladder cannot expel all the contents due to
decreased innervation to the detrusor
muscle: Catheterize every 4-6
(Intermittent catheter procedure; straight
catheter; high risk for infection if retention is
still there)
o CERDÉ: Manual Compression from Umbilical
to symphysis pubis
o by BUT don’t
put pressure on the sac
o You can use diapers but don’t put it on
o No problem with breastfeeding
J.E.A.D.
o Cover the sac with sterile gauze (HOLD THE
DRESSING SARAN/ CLING WRAP) with
HYDROCEPHALUS
 Hydrocephalus  enlarged ventricles  brain pushed
against the cranium  increased pressure  baby still
has fontanels, can expand  able to accommodate the
swelling
 May be caused by a tumor
 Complication of encephalitis
 Bulb-shaped head, Sunset eyes, Distended scalp veins;
High pitched cry, Increased ICP (Projectile vomiting)
 Give morphine to decrease pain
 VS: Increased Systolic and normal diastolic (widened
pulse pressure); TEMP (variable, high or normal but
does not go down); RR low; HR low
 TRANSILLUMINATION: placing a strong flashlight by
the head to see the fluid in the head
 More dangerous for adults since there are no fontanels
 MANAGEMENT
o Position side-lying (especially if opisthotonic:
arched bad)
o Assessment of signs of increased ICP:
measure (Earliest sign is Altered LOC:
restless, sleepy)
 Restlessness; for hypoglycemia
while ALOC is increased ICP, in
pedia
o HCOD (head circumference of the day)
o Measures to prevent increased ICP
 SURGICAL MANAGEMENT
o Ventriculostomy to relieve pressure
o Insertion of shunt to bypass the point of
obstruction
 So CSF can be recycled: Drainage
reabsorbed by the blood vessels
mesenteric vessels (the CSF is a
good source of glucose)
o Shunt Revision- based on the length of the
tube inserted in the body (scheduled)
o Obstruction of catheter (unscheduled shunt
revision); this happens when the S/SX
returns or Increased ICP
o Medications are not effective
o In adults, permanent shunting is done with:
 Removal of brain lesion
 Clipping of aneurysms
o Post-op Nursing Care of Shunt Insertion:
 Routine post-op VS monitoring
 Position: FLAT on the unoperative
side to prevent pressure on the
shunt valve and too rapid drainage
and reduction of CSF that may
cause subdural hematoma
 Do not carry the infant
 Monitor for increased ICP
 Observe for abdominal distention
(peritonitis or abdominal ileus)
hrs GASTROINTESTINAL
CLEFT LIP AND CLEFT PALATE
 Cleft Palate: MC in males
 Cleft lip: MC in females
 Vitamin A, Intake of Anticonvulsants, Hereditary
 Can cause problems with airway
 Cleft palate: speech, defects in ear, hearing problem
 SURGERY is a PRIORITY
 Will have coping problems as they grow up
12 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
 RULE OF TEN
o 10 weeks (2 ½ months)
o 10 pounds
o 10 grams of hemoglobin (no anemia;
Hemoglobin is the only one being followed for
surgery to push through)
o Less than 10,000 WBC (no infection; a ls a
response to trauma; n. 12,00 to 13,000
during delivery)
 SURGERY
o CHEILOPLASTY/Z-PLASTY
 Cleft Lip Repair
 Usually done 3 times
 Not un urgent procedure, not life
threatening
 Delayed until they are no longer
surgically at risk; delayed primarily
since grafting if too big of a cleft
palate (10 months are now chosen
for next surgery since they will start
talking at this time towards
toddlerhood)
 POST OP: Feeding technique: dropper used with SAP;
drop at side; No nipple since the baby can’t have
negative pressure
o Position: NEVER ON PRONE (No head
control) Prevent tension on the suture lines:
LOGANS to hold suture in place
o Anticipate needs to lessen crying
o Use of arm restraint
 CLOVE HITCH: not a good means
to stop the child from holding the
sutures; attached to the bed
 ELBOW DEVICE: makes him able
to move the hand
 Restraint removed every 2 hours;
need consent
 Clean suture lines after feeding;
CLEFT PALATE
 SURGERY
o URANOPLASTY/PALATOPLASTY
 Done before speech development
begins
 Cannot be done in the same time
with cheiloplasty
 POST-OP
o SHOULD BE DONE ON PRONE: To promote
natural drainage of secretion
o Observe for bleeding: Frequent swallowing
o Use ELBOW RESTRAINT
 To protect suture lines
 Prevents flexion of the arm
o Feeding device post-op
 Drink from cups
 Use a big spoon to feed taken from
an EDGE of the spoon; No straw
since this will cause negative
breastfeeding
 ESSR: enlarge nipple, suck (give
time), swallow (give time), rest
 Speech Rehabilitation/Hearing Test
– nasal twang
ATRESIA OF THE ESOPHAGUS TRACHEOESOPHAGEAL
FISTULA
 No connection between the upper and lower segment
of the esophagus
 S/SX
o Mom with polyhydramnios
J.E.A.D.
o Baby is drooling/ Very mucousy: the only time
suctioning is acceptable
o 3Cs
 Coughing
 Choking
 Cyanosis
 TEST FEEDING: the nurse gives sterile water and will
test the presence of TEF; If the baby manifests the 3
Cs, withhold the next feeding; if not, BF will be given
 DX: NGT Coiling/ Xray
 MX:
o PRE-OP
 Surgery ASAP
 Prevent aspiration: Suction PRN
(assess the baby for need or
postpone suction [Check the 02
saturation, bradycardia,])
 Strict NPO
 Promote nutrition: Gastrostomy
feeding (Check for patency by
flushing down with a small amount
of water)
 TPN as ordered (check blood
sugar) Check for patency of the
tube; DO NOT RUN IN HOT
WATER, use a dry warm floor lamp
to prevent the ; CBG for pedia: 40-
60 mg/dL
 Hyperglycemic  refer to MD 
give insulin as ordered
CHALASIA / GASTROESOPHAGEAL REFLUX (GER)
 Caused by immaturity of the cardiac sphincter
 MANIFESTATIONS
o Frequent reflux of stomach content right after
feeding
o No precipitating factors
 MANAGEMENT
o Self-limiting (resolves as the child gets older)
Proper feeding technique
o Small frequent feedings
o Thickened formula / breast milk
o Upright position during feeding
o Burp frequently during feeding
o Right lateral semi-upright position after
feeding
 MEDICINES
o Metoclopramide (Reglan) to increase Lower
esophageal sphincter tone and to stimulate
upper GI tract motility.
o Ranitidine (Zantac) to inhibit gastric
secretions
 SURGERY: NISSEN FUNDOPLICATION
 Give thickened milk: use AM or cereals to thicken the
milk;
 During is upright but Right side lying to let the fluids into
the small intestines
 Adult are left side-lying after eating since it must stay in
the stomach for digestion
PYLORIC STENOSIS
 Caused by hypertrophy of the muscles of the pyloric
sphincter
 Gradual hypertrophy of muscles of pyloric sphincter 
accumulation of food in stomach  increased pressure
 vomiting  F&E imbalance  hypokalemia 
alkalosis
 SMALL INTESTINES (all other food items absorbed
and digested here): is for chemical digestion while the
stomach is mechanical digestion (absorbs alcohol here)
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 PEDIATRIC NURSING – R. VILLARAMA
 MANIFESTATIONS HIRSCHSPRUNG’S DISEASE
o Hours after they eat  abdomen is distended  Congenital Aganglionic Megacolon
o Positive peristaltic wave (waterbed) OBSTRUCTION DESCRIPTION DISEASE
o Projectile vomiting (yellow, acidic, sour smell) Stomach Curdled milk or Chalasia
o Milk (curdles) acidic in nature
 Dehydration Small intestines Bile stained Intussusception
 Metabolic alkalosis Large intestines Fecaloid Hirschsprung’s
 Hypokalemia Disease
 Weight loss  CELLS: nerve supply, nerve cells; Absence of
o Palpable olive-shaped mass in RUQ: parasympathetic nerve supply (ganglion cells) on the
Palpatory technique is least reliable large intestines
 DX: Give Barium through GASTRIC LAVAGE per NGT;  Part affected constricts
XRAY: String Sign  4 segments of large intestine
 SURGERY: o Ascending
o FREDET-RAMSTEDT Procedure o Transverse
(PROCEDURE for NCLEX) o Descending
o PYLOROMYOTOMY WITH PYROPLASTY o Recto-sigmoid
(PROCEDURE for PNLE)  If large intestines is full of contents  reverse
 PREOP peristalsis  small intestine absorb the toxins 
o Correct existing fluid and electrolyte stomach breaks down fecal matter
imbalance  MANIFESTATIONS:
o IVF for dehydration/KCL for hypokalemia and o IN THE NURSERY: Delayed meconium
alkalosis Correct nutritional imbalance o EARLY: Ribbon-like/pellet-like stool
o Thickened formula/TPN PRN o LATE: Constipation (stool is very hard,
 Rice cereal (cereal) quality!); Diaphragmatic effect: casing DOB
 Use “am” since the accumulation is moving up
 Denser, heavier  more difficult to o Weight loss
vomit o Abdominal distention with possible fecaloid
vomitus
INTUSSUSCEPTION o WINK TEST: place a cotton bud with
 Telescopes/ invaginates into the lumen of another petroleum in and out of the anus to stimulate
 Most common in infants passage of meconium; the bay at times is just
 MANIFESTATIONS lazy to defecate
o Bile stained vomiting (green, bitter) since it  DX: Rectal Biopsy
comes small intestines  PRE-OP:
o Blood vessels caught between the layers  o Promote elimination: regular colonic irrigation
decreased blood supply  necrosis  (versus enema, the adult uses enema
bleeds  currant jelly stools (blood with because there is sphincter control but the
mucus in the stool) Not like Melena: went to baby has none; Colonic irrigation using
the stomach and is Dark or Black in color asepto syringe to insert fluids and suck up
o Small intestines telescopes near the the fluids) & palliative colostomy
Appendix  Appendix might burst  o No need for sterile NSS: Colonic Irrigation 1L
perforation  peritonitis + 1 tsp of Salt
o Sausage-shaped mass o Promote nutrition: High Calorie, high CHON,
o Spasmodic abdominal pain Vitamins, LOW in residue (no roughage/ fiber
 MANAGEMENT due to the obstruction); SFF if with distention;
o BARIUM HYDROSTATIC REDUCTION Cook the Fruit (Puree the Fruit) and
TECHNIQUE vegetables are also FULLY cooked if ever
 GI tract is a hollow organ  difficult given
to visualize a hollow organ without o Barium enema to determine extent: pig’s tail!
contrast LOW ENEMA CAN: must  CORRECTIVE SURGERY: ENDORECTAL PULL-
be lower since fast uptake of the THROUGH PROCEDURES: SOAVE PROCEDURE:
enema, the intestines will not MC in the PH, retains the anus
absorb the barium and cause the
baby to poop) IMPORFORATE ANUS
  MC in Girls
the telescoping with barium given
 MANIFESTATION
under pressure (HIGH ENEMA
o Absence of meconium
CAN
o Unable to insert rectal thermometer
Spring: the barium goes round and
o If female: meconium passes via vagina
round in the images which is the
(recto-vaginal fistula)
image for intussusceptions
o If male: meconium passes through urinary
o MANUAL REDUCTION: through explore
bladder - greenish urine (recto-vesical fistula);
laparotomy; simply pull them apart
violates sterility of urinary bladder
o BOWEL RESECTION and ANASTOSMOSIS:
o PASSAGE OF MECONIUM: best way to
cut the segments
really determine for imperforate anus
 MANAGEMENT
o STEP 1: Colostomy in the nursery (Palliative)
with fistullectomy (repair the fistula)
 Prevents in creating a fistula

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 PEDIATRIC NURSING – R. VILLARAMA
o STEP 2: Before 1 year old (10 months):  MANAGEMENT
CORRECTIVE SURGERY: ANOPLASTY/ o If (+) GABHS (Group A streptococcal
PULL- THROUGH PROCEDURE Infection; Also from Otitis media, impetigo
o STEP 3: After 6 months, closure of the [[skin infection], boils, tooth cavity, furuncle)
colostomy  Antibiotic (PENICILLIN/
 Must heal first before closing ERYTHROMYCIN if with allergy)
colostomy  Health center: Cotrimoxazole/
 Must delayed to allow the child to Amoxycillin
feel the urge After 6 months o THROAT SWAB and Culture & Sensitivity: to
 May be prone to fecal spillage; determine the main pathogen of the infection
problem with control since only and give the best antibiotics
internal sphincter is present  Soft to liquid diet in small frequent feeding
 Avoid foods with easy transit; dairy  Comfort measures:
products or food with high fat o Safe throat remedies: Calamansi, ginger,
tamarind, breastmilk
NEPHROLOGY o Calamansi- not given if with tonsillitis
WILM’S TUMOR/ NEPHROBLASTOMA o Warm saline gargle
 CC: abdominal mass Pre-op: o Antipyretic PRN (Acetaminophen/
 Avoid pressure over the mass Paracetamol) (Biogesic, Tempra, Tylenol,
o Do not put on prone position Calpol); NO NSAIDS (Ibuprofen), NO ASA:
o Do not wear tight waist band  Gastric upset (earliest)
o Do not vigorously scrubbing the body  Tinnitus (few days after intake)
o Do not palpate  Bleeding (prolonged use)
 MANIFESTATION: Vague weight loss  Reye’s Syndrome
 Less than 12-years old
NEPHRITIS NEPHROSIS/NEPHROTIC  Viral infection
SYNDROME  SURGERY (PLANNED-REQUIRED SURGERY: similar
CAUSE GABHS Unknown; autoimmune to tonsillectomy & circumcision)
S/SX -Inflammatory -Proteinuria o 2 criteria: big tonsil which causes dyspnea,
-Hematuria -Hypoproteinemia collection of pus, recurrent inflammation 3
-Hypertension -Decreased plasma times a year or more
-Periorbital edema osmotic pressure  fluid o Tonsillectomy when on preschool (not in
(local), edema due to shifting  edema  infants/toddler); no incision
inflammatory ascites and anasarca  GENERAL ANESTHESIA
-Hyperlipidemia  Uses retractor to open mouth
DX -Increased BUN, -Protein in the urine  Use cold knife or if bleeder use
Creatinine -Decreased serum protein cautery
-Increased ASO titer o ADENOIDINITS: Pharyngeal tonsils
(NV: 0-200 IU) o LINGUAL TONSILS: Base of the mouth
-RBC in the urine o TUBAL TONSILS: at the level of the
-Renal biopsy Eustachian Tube
MGMT -CBR in acute stage -Must ambulate (get out of o If unconscious: prone position
-Anti-HTN bed); hydrostatic  PRE-OP
-Diuretics pneumonia, thrombus o Check dental (loose teeth) and bleeding
-Antibiotics (does not formation bed sore status (bleeding disorder) - prevent aspiration
respond to penicillin) -Diuretics  OPERATION
-Decreased Na, -Steroids (Prednisone): can o GENERAL ANESTHESIA
decreased CHON lead to bloated effect  POST-OP
(variable), if increased -High CHON, Low Na, Low o Prone or Lateral position while asleep/
creatinine fat diet unconscious
-Skin care; Additional -Skin care  Promote natural drainage of
pillows for periorbital -Ambulate as tolerated secretion
edema o If conscious: Semi fowler’s & mouth to the
left, lateral or side-lying or position of comfort
*Complication of long term Steroids: Cushing’s Syndrome o Observe for bleeding
*Pedal Edema; Elevate  Frequent swallowing and
*Periorbital edema: Elevate the head restlessness
 If bleeding  provide kidney basin
RESPIRATORY PROBLEMS  spit blood
THROAT PROBLEMS: PHARYNGITIS/TONSILITIS  Check dressing; Constant
 Caused by GABHS swallowing (Don’t let them swallow
 MANIFESTATIONS: the blood; the mucosal lining of the
o Kissing tonsils (Airway obstruction); Can’t be stomach will be irritated and cause
removed if it is inflamed because tonsils are vomiting so let the client spit unto a
highly vascular kidney basin)
 NO emergency tonsillectomy: wait till infection is over  ALOC: Restlessness
and swelling is controlled and the infection/ pus will o Prevent bleeding
move faster to the lymphatic  Ice collar- vasoconstriction and
decreasing pain
 Avoid suctioning, throat clearing

J.E.A.D. 15 UST CON BATCH 2018

 PEDIATRIC NURSING – R. VILLARAMA
 Avoid Valsalva maneuver: frozen
osterized papaya
o BLEEDING PRECAUTION x 7-10 days: the
anesthesia has a vasoconstrictive effect to
stop bleeding but after the effects are off, the
patient now can bleed
o Diet resumes once fully awake and can
swallow; Not abdominal surgery (needs for
peristalsis or flatus must return)
 COLD, CLEAR, NON-IRRITATING
 Cool water, ice cold apple juice,
frozen gelatin, suck on frozen
popsicle, sherbet (Arce Dairy)
 Ice cream NOT ADVISABLE, if
given, make sure child drinks lots
of cold water after
 Iced cold ginger ale
 Then SOFT diet then DAT
 No red colored juices
SPASMODIC CROUP/LARYNGOTRACHEOBRONCHITIS (LTB)
 ETIOLOGY: Virus
 MANIFESTATIONS
o Hoarseness of voice
o Cough-brassy spasmodic seal like sound,
successively
o Inspiratory stridor
o Fever
o Laryngospasm  respiratory distress 
Brain Hypoxia  Unconsciousness
 MANAGEMENT
o Supportive Care
o Avoid respiratory irritants and sudden
temperature changes: strong odors are
irritant plus pollution
 Prevent coughing causing
laryngospasm and respiratory
distress
o Feed and hydrate with aspiration precaution
o Decrease demand for oxygen
o Administer high humidity with MIST
THERAPY during attacks
 Cool mist vaporizer (steam
inhalation: turns water to mist)
 Bring child inside steamy bathroom
for 15 minutes
 “suob”/ “tuob” – pakulo, ilagaysa
plangana, towel to inhale; Add salt
o COUP TENT: Avoid the use of toys that have
batteries; Check the clothing and bedding if
wet since it will be a cause of pneumonia
o VICKS, VAPORUB: rubbed into the chest to
be inhaled
o Proper fever control (NO ASPIRIN)
o Promote fluids with SAP
BRONCHIAL ASTHMA
 The onset or duration of asthma defines it as acute or
chronic
o Large Airways or upper: Acute
o Lower or smaller airways: Chronic  may
reach alveoli later on in life  EMPHYSEMA
o Asthma in children is only acute; Only
bronchioles are affected; Condition can be
reversed
 2 KINDS OF ASTHMA:
o EXTRINSIC ASTHMA: allergen from the
outside (food [MC], environment)
 Foods rich in protein, iodine
J.E.A.D.
 Foods with artificial colors: Yellow
Pigment number 5 (Milk
Chocolates)
 Foods with preservatives
 NO EGG whites below 1year old
o INTRINSIC ASTHMA: idiopathic/ inert on the
patient
 Stress
 Anxiety
 Mechanisms responsible for symptoms:
o Bronchospasm
o Inflammation and edema of the airways
o Allergy: Bronchial Asthma
o Infection Cause: Asthmatic Bronchitis
o Position: Orthopneic
o Hydration: With SAP, avoid Vitamin C and
milk
o Breathing exercise (purse-lip)
ASTHMA
Acute Chronic (COPD)
Affects bronchial area only Lower or smaller airways
Good prognosis/Reversible Irreversible
Cure is possible No cure; Remission and
Exacerbation
Same causes:
Extrinsic Asthma – triggers that produced symptoms (easy to
control)
Intrinsic Asthma – caused by the person itself ex. stress, anxiety
Mechanisms responsible for symptoms:
1. Bronchospasm
2. Inflammation and edema of the airways
3. Accumulation of tenacious secretions
Death due to RESPIRATORY ACIDOSIS
Allergologist
Allergen control: skin testing followed by hyposensitization (for 3
years) to increase tolerance
Management during Exacerbation
*Administer bronchodilators/aerosol
*IVF drugs (Intal (chromolyn sodium: due to activity;
aminophylline, steroids)
*Salbutamol best given via Nebulization via ORAL and best when
crying;
*For pedia who cannot hold their breath use SPACER Steroids
given best per spacer *Position: orthopneic position
*Allay anxiety
*Promote oral fluids with aspiration precaution – limit milk (thicker
secretion), avoid Vitamin C (allergen)
*Promote breathing exercise (purse lip breathing: trumpets; Pin-
Wheel toy)
Status asthmaticus – do not respond to treatment; given steroids
STATUS ASTHMATICUS: needs steroids does not get affected
by bronchodilators
For Infants for orthopneic position: Baby Bear Hug Position (mom
will hug and lie high fowlers to let client breathe) Adolescent:
change toys into sports; SWIMMING: BUBBLING under the
water; Use a basin of water and immerse head and breath out
bubbles
EPIGLOTTITIS
 Air is obstructed
 CAUSE: HEMOOPHILUS INFLUENZA (HIB)
 S/SX: Drooling, Dysphonia, Dysphagia, Distress
(Choking sign) child sits upright leaning forward with
chin thrust out (Tripod/sniffing position)
 DX: Lateral Neck X-Ray
 MANAGEMENT
o Hospitalization ASAP
16 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
o Do not insert anything into the mouth (trigger
gag reflex  vagal stimulation causing
constriction and further obstruction); NEVER
MAKE A BLIND FINGER SWEEP (CPR); NO
tongue depressor
o Prepare tracheostomy set at bedside: The
laryngoscopes blade cannot be inserts so ET
tubes are contraindicated
o IVF for antibiotic (Cephalosporin) for 7-10
days (lesser is for hydration)
o Corticosteroid PRN to decrease inflammation
o Prevention by immunization: H Influenza
Type B (Hib) vaccine; At the same time of
pentavalent + HiB; 6-10-14 weeks
RHEUMATIC FEVER
 Complication of -strepto infection - Jones Criteria
Assessment
 MANIFESTATIONS
o Migratory polyarthritis: joint pains
o Chorea (St.Vitus Dance): involuntary jerks/
misconstrued as mannerisms
o Erythema marginatum: rashes on the trunk
o Subcutaneous nodules on the extensor side
o Carditis: endocarditis (covers the chambers
and forms the valves)  Mitral valve stenosis
 Regurgitation  Mitral Valve Proplapse 
VALVE REPLACEMENT
 DX
o Jones Criteria plus ASO titer = rheumatic
fever
 Normal value of ASO (Anti-
streptolysin O) = 0-200 IU
o Echocardiography: if with valve damage
(Mitral valve: stenosis/insufficiency)
RHEUMATIC HEART DISEASE
 MANAGEMENT
o OBJ 1: Decrease demand from the
weakened heart
 CBR/Modify lifestyle after
discharge: HOME SCHOOLING
(THEY GO TO SCHOOL) or may
go to school without PE
 Cluster care
o OBJ 2: Prevent further cardiac damage
(RHD)
 Meds: Penicillin IM once a month
for 3-5 days/ASA/Steroids; May be
given oral penicillin after the
injection; 2.5 distilled water and 2.5
lidocaine toreduce pain; let the
client walk; Do not place ice which
will cause stasis so place warm
compress
 *More than 2 mL: NOT the Deltoid
 EMLA (Eutectic Mixture of Local
Anesthetics) patch: topical
lidocaine; numbs the part to be
injected
o OBJ 3: Safety precaution for chorea
KAWASAKI’S DISEASE
 Mucocutaneous lymph node syndrome; fatal and rare
 ETIOLOGY: unknown
 MANIFESTATIONS
o Fever unresponsive to antibiotic, conjunctival
inflammation, strawberry tongue, erythema of
palms and soles with peeling, cervical
lymphadenopathy
J.E.A.D.
oMost dangerous when coronary artery is
involved; aneurysm formation and risk for
rupture
 MANAGEMENT
o High dose of IV GAMMA GLOBULIN
o Aspirin
o Monitor cardiac status. Assess for symptoms
of CHF o Monitor I&O
o Comfort measures: skin and mouth care
o Promote adequate rest
HEMATOLOGIC PROBLEMS
*Aplastic anemia- occupation (rad tech)
IRON DEFICIENCY ANEMIA
 Above 6 months- at risk for anemia
 Iron from mother has been used up and due to
overfeeding of milk
 ADOLESCENT: due to weight reduction diet and heavy
 MANAGEMENT
o Introduction of supplementary/
complementary
o feedings at 6 months (one at a time only to
rule-out allergy)
o Iron rich foods:
 Cereals to LUGAW
 Potato, Egg yolk
 DO NOT GIVE EGG
WHITE UNTIL BABY IS
ABOVE 1-YEAR OLD
(ALLERGY)
o Dark green leafy vegetable; the darker the
leaves, the higher the iron content
o Dark meat (organ meat), beef liver
= o Iron fortified milk preparation
o Supplemental iron preparation (FeSO4) with
Vitamin C
 Tell mother that stool turns black
 Don’t drink with milk: prevents
absorption of iron
 Use straw, brush teeth and tongue
HEMOPHILIA
 Deficient in Factor VIII (Antihemophilic Factor;
Hemophillia A, classical hemophilia)
 Pattern of transmission is X-linked
 Transmitted as X-linked from carrier MOM to
AFFECTED SON (symptomatic)
 Daughter gets it as a trait from carrier mom
(asymptomatic)
 Affected son gives it to daughters as a trait only
 Affected sons will have all normal sons
 MANIFESTATION
o Early Symptom
 Prolonged bleeding from the
umbilical cord
 Early petechiae: found in the neck ,
Axilla, Groin, in between the
cheeks of the buttocks
o Late Symptoms
 Easy bruising
 Easy epistaxis and gum bleeding
o HEMARTHROSIS: bleeding in between the
ball joints (pain and swelling); Most common
in the Hinge Joints; Given morphine,
tramadol, Demerol
o INTRACRANIAL HEMORRHAGE: bumps
cause bleeding major cause of death
 MANAGEMENT
o Transfusion of Factor VIII, cryoprecipitate,
platelet concentrate
17 UST CON BATCH 2018
 PEDIATRIC NURSING – R. VILLARAMA
o Vasopressin (ADH): activates clotting factors  Lumbar puncture
o Prevent bleeding (avoid trauma); No contact  To determine CNS involvement
sports  MANAGEMENT (4 PHASES)
o Soft bristled tooth brush o REMISSION INDUCTION
o No aspirin  V (systemic chemotherapy)
o Can undergo circumcision, removal of teeth:  Protective isolation
as long as Factor VII is ok o CNS PROPHYLACTIC/SANCTUARY
 P: protect (protective devices): THERAPY
knee pads, helmets;  Intrathecal chemotherapy
 R: rest (immobilize)  Sanctuary therapy
 I: ice (vasoconstriction)
 C: compress (apply pressure) o INTENSIFICATION/CONSOLIDATION
 E: elevate (above the heart) THERAPY
 S: support (parents, MDs, RNs,  Regular systemic and intrathecal
dentist, PT, nutritionist, psychiatric, chemotherapy
etc.)  Hair fall
o MAINTENANCE THERAPY
THALASSEMIA/ MEDITERRANEAN ANEMIA  Combining drug regimen with
 Hereditary as recessive trait (both patients as periodic CBC, CXR, Lumbar Tap
asymptomatic carrier) o 2 years of remission is considered cure
 25% of having thalassemia after delivery 
 Production of very fragile Hgb that is unstable: easily LYMPHOCYTIC MYELOCYTIC
hemolysis -Lymphoblasts from lymphatic -Lymphoblasts from myeloid
 Bone marrow (flat bones compensates) compensates system stem cell (which becomes
by producing more blood causing aesthetic problem -Most common in paediatrics RBC, WBC, Platelets)
due to hypertrophy: BOSSING -Good prognosis -Common in adults
 TYPES -Poor prognosis (6 months to 2
o ALPHA Thalassemia years)
o BETA Thalassemia
o TYPES **Most ideal: BONE MARROW TRANSPLANT (Most Ideal)
 T MINOR: t trait with mild  Difficult to find a compatible match
microcytic anemia  Should be HLA compatible (Human Leukocyte Antigen)
 T INTERMEDIA with splenomegaly
and moderate to severe anemia CHILD’S CONCEPT OF DEATH
 T MAJOR: COOLEY ANEMIA;  Below 5 years old
 DIAGNOSIS: Hemoglobin Electrophoresis o Death is a form of a sleep; Reversible
 MANAGEMENT  6-9 years old
o Blood transfusion every 30 days to maintain o Death is a person; reversible
Hgb level above 9.5g/dL o Grim Reaper, Bogeyman, Devil monster,
 Problem with IRON “Kamatayan”
HEMOSIDEROSIS and  Above 9 years old
HEMOCHROMATOSIS due to o End of life on earth; Irreversible
accumulated iron in the organs and
tissues due to frequent transfusion
 Requires CHELATION therapy with
Fe DEFEROXAMINE (IV or SQ)
with Vitamin C Oral chelators:
DEFRIPRONE for the developing
hemosiderosis
o SPLEENECTOMY as PRN
 Do not palpate the area

LEUKEMIA
 Most common form of childhood cancer
 Malignant disease of the bone marrow and the
lymphatic system


 Immature WBC not capable of phagocytosis is formed

 3 Primary consequences:
o Infection
o Anemia
o Bleeding tendencies
 MANIFESTATIONS
o Earliest sx: Intractable infection
o Bone pain
 DX
o Peripheral blood smear
o Bone Marrow biopsy (more definitive)
 Position: Prone in children
 Site: Iliac crest
J.E.A.D. 18 UST CON BATCH 2018