TONSILLISITIS

Inflammation of Palatine
tonsils, often as a result of
viral or bacterial infection
(GAHBS)
Commonly affects
children at 5 10 years of
age

SIGNS AND
SYMPTOMS
Enlarged red
tonsils

White
patches of
exudates

Fever
Sore throat

Enlarged
cervical
lymph nodes

Halitosis

Drooling of
saliva

TEST
RESULT
Throat
culture
reveals
infecting
organism

WBC Leukocytosis

Soft or liquid diet

Used of cool mist
vaporizers
Administer salt water
gargles
Adequate fluid intake
Rest periods
Analgesics, Antipyretics
Antibiotics Penicillin
and Erythromycin

TREATMEN
T:

SURGICAL
MANAGEMENT

TONSILLECTOMY
Rose Position
Pre op: history taking,

lab. test, PE, observe for

loose teeth

Immediately report
excessive bleeding
Frequent swallowing
Clearing of throat
Increase PR, decrease BP

PYLORIC STENOSIS

SIGNS AND
SYMPTOMS
Projectile vomiting 3-4 feet
Sour smelling vomitus no BILE
Olive sized mass
s/sx of DHN
Weight loss
Hypoglycemia

TEST RESULT
Characteristics finding is palpable

pyloric mass and visible peristaltic wave

( after eating and before vomiting )
ABG metabolic Alkalosis
Blood test decrease K, Ca, Cl
Utz & Endoscopy revealed
hypertrophy of sphincter

 Definitive diagnosis:
Watching the infant to drink .

Before the child drinks, attempt to

palpate the RUQ for pyloric mass (
round, firm olive ). As infant
drink, observe for peristalsis
movement passing from left to
right across the abdomen

NURSING MANAGEMENT

 Correction of F&E imbalance

Monitor VS and I&O, weigh

child daily
Small frequent feeding
Thickened feeding with HOB
elevated
Burp frequently

SURGICAL
MANAGEMENT

PYLOROMYOTOMY
FREDET RAMSTEDT

Pre op:
Obtain VS
Correction of FE
NPO 6 8 hours
NGT decompression

 Post op:
Provide pacifier
Position on right side
Keep incision clear

CELIAC DISEASE
MALABSORPTION
SYNDROME, GLUTEN
INDUCED
ENTEROPATHY

 Basic problem is sensitivity or

abnormal response to CHON

particularly Gluten factor
Inability to absorb fats
Increase incidence in children
with Down Syndrome and
between 6 18 months

CELIAC CRISIS
Children with Celiac develop
any type of infeciton, a crisis
of extreme symptoms may
occur. Both vomiting and
diarrhea became acute,
children can quickly
experience F&E imbalances

NURSING
MANAGEMENT
Gluten free diet: corn, rice, soy

and potato flour, breast milk, fresh

fruits
Folate supplements
Iron supplements
Vit. A and D in water soluble form
Give small and frequent meals

DEVELOPMENTAL HIP DYSPLASIA

Abnormal formation of hip

joint present at birth (younger

than 3 years of age)
Can be unilateral or bilateral
Females 85%,
Relaxin

BARLOWS
SIGN
Abduct the hips while applying

90 deg. flexion, apply backward

pressure ( downward laterally )
and adduct the hips.
(+) if head of femur is slipping
out

ORTOLANIS
SIGN
abduct the hips while applying

upward pressure over the

greater trochanter and listen for
clicking sound.
(+) with clicking sound

TRENDELENBURGS SIGN
When child rest her weight in

affected side pelvis drops in

normal side because abductor
muscle in affected side is weak.
When child rest in her unaffected
side pelvis remains horizontal

TREATMENT
Treatment after 5 years: rarely

restoring satisfactory hip function

Younger than 3 years old:
gentle manipulation to reduce

dislocation, followed by splint or

cast

 Pavlik Harness method of choice

for long term used, adjustable chest

halter that abducts leg
Spica cast frog cast it
maintains exrenal rotation
Frejka splint holds hip in
abduction, forcing the femur head
into acetabulum.