CA (PEDIA; 10/07/2023)

GROWTH AND DEVELOPMENT

Growth

Increase in the physical size of an individual; a quantitative change.

Parameters: weight and height

Weight: The most sensitive measure of growth.

Weight milestones:

• 6 months: double
• 12 months: triple
• 24 months: quadruple

Height: Increases by 1" per month during the first 6 months
Average increase in height in 1 year = 50%.

Height stops with the eruption of wisdom teeth.

Development

Increase in skills or capability to function; a qualitative change; maturation or "readiness."

Parameter: task completion
Indicators:

• Fine motor
• Gross motor
• Language
• Social skills

Cognitive development: Ability to learn & understand from experience, acquire and retain knowledge, respond to new situations, and solve problems.

Principles of Growth & Development

• G&D are continuous processes, beginning from conception until death
• Different children pass through stages at different rates (individual variation at regular direction).
• G & D proceed in an orderly sequence (e.g., sitting before creeping, standing before walking).
• All body systems do not develop at the same rate (asynchronous development).

RATES OF GROWTH AND DEVELOPMENT

Fetal & infancy

Most rapid G & D; at risk for anemia.

Toddler

Physiologic anemia due to being picky eaters.

Toddler and preschool

Alternating rapid & slow growth.

School age

Alower growth; least prone to anemia.

Adolescence

Rapid growth due to puberty.

FACTORS OF GROWTH

Hereditary

Race, intelligence, nationality, sex (growth spurt M: 13 yrs; F: 11 yrs)

Environment

Health, parent-child relationship, socioeconomic status, quality of nutrition

DIRECTIONAL TRENDS IN DEVELOPMENT

Cephalocaudal (Head to Tail)

Development progresses from the head towards the feet.

• Infant can lift the head in the prone position in the first 2 months.
• Infant can lift the head and chest in the 3rd month.
• Infant can lift the head, chest, and abdomen by the 4th month.
• Infant can stand by 9-10 months.

Proximodistal

Development proceeds from the central part (proximal) of the body outward towards the extremities (distal).

Symmetrical on Each Side

Development occurs uniformly on both sides of the body.

Mass-Specific (Differentiation)

Progression from simple to complex tasks, differentiating abilities.

Gross to Refined

Development process starts with gross movements and refines into more precise actions.

Sequential

Development follows a sequential order or a specific sequence of milestones.

Locomotion

Developmental stages may include the acquisition of locomotion skills (e.g., crawling, walking).

Social

Social development is an integral part of overall development.

Neonatal Reflexes

Neonatal reflexes must be lost or integrated before a child can progress to more advanced stages.

• Plantar reflex should disappear before walking.
• Moro reflex should disappear before rolling.
• Persistent neonatal reflexes may indicate a neurological problem.

CONCEPTS OF DEVELOPMENT

Behavior

Most comprehensive indicator.

Play

Universal language.

Practice

Learning skills and behavior.

Time

Great factor for learning a skill.

Reflexes

Neonatal reflexes must disappear before development starts.

• Moro reflex should disappear before standing.
• Persistent neonatal reflexes may indicate a neuro problem or developmental delay.

DIVISION OF LIFE

Prenatal: 20 weeks AOG to 28 days of life

Preschool: 4-6 years

Neonate: First 28 days after birth

School Age: 7-12 years

Infancy: 29th day to 1 year

Adolescence: 12-18 years

Toddler: 1-3 years

DEVELOPMENTAL THEORIES

Theories

Infant

Toddler

Pre-school

School Age

Adolescent

Psychosocial

(Erikson)

Trust vs. Mistrust

Autonomy vs. Shame and Doubt

Initiative vs. Guilt

Industry vs. Inferiority

Identity vs.

Role Confusion

Psychosexual (Freud)

Oral

Anal

Phallic

Latency

Genital

Cognitive (Piaget)

Sensorimotor

Preoperational

Concrete Operational

Formal

Operational

Moral (Kohlberg)

Amoral

Pre-conventional

Conventional

Post-conventional

Punish/Obedience orientation

Naive instrumentation

orientation

Law and order

Significant

Person

Primary caregiver

Parents

Family

Teacher

Peers

Peer Group

Opposite Sex

Fears

SIGNS OF SEXUAL MATURITY

GIRLS

BOYS

1. Thelarche (enargement of boobs and genitals)
2. Widening of hips
3. Appearance of axillary and pubic hair
4. Accelerated linear growth
5. Growth spurt (age 9-11)
6. Menarche (last sign of sexual maturity)

1. Testicular (testes and penis) enlargement
2. Deeping of voice
3. Development of muscles
4. Appearance of axillary and pubic hair
5. Growth spurt (age 12-14)
6. Production of viable sperm (last sign of sexual maturity)

INFANCY

Play

• Solitary plays (non-interactive).
• Prioritize safety: Toys must be size-appropriate, non-toxic, and non-detachable.
• Best toy: Rattle. Universal toy: Ball. Color: Red.
• Musical mobiles: Introduce at 2 to 4 months, placed 8 inches away.

Fear

• Stranger anxiety begins at 6 months, peaks at 8 months, and diminishes at 9-12 months.

Diet

• Starts at 4 to 6 months.
• Introduce foods one at a time to identify allergies.

Accidents

• Foreign body aspiration is a concern.
• Males are more prone to Sudden Infant Death Syndrome (SIDS).

Body Weight

• 6 months: Doubles.
• 12 months: Triples.
• 24 months: Quadruples.

TODDLER

Play

• Parallel play: Two toddlers playing side by side but separately w/o sharing toys.
• Best toy: Wagon (push and pull)

Fear

• Separation anxiety begins at 9 months, and peaks at 18 months.
• 3 Phases Of Separation Anxiety: Protect, Despair, and Denial
• Don't prolong goodbyes.
• Say goodbye firmly to develop trust and mention when you will be back (meal times like lunch bc they dont have concept of time).
• Avoid yes or no questions.

Accidents

• Drowinging, burns, and poisoning.

Behavior

• Egotistic, RItualistic, Negativistic, and Temper tantrums.

Cues for toilet training

• Wake up or stays dry for 2 hours
• Able to sit, squat, and walk
• Able to communicate needs
• Able to sit on the toilet for 5-10 minutes

PRE-SCHOOLER

Play

• Associative play: Makes believe toys are alive, imaginary friend, and dresses up.

Fear

• Mutilation or castration (bodily harm), ghost, monster, and dark places.

Accidents

• Drowinging, burns, and poisoning.

Behavior

• Curious, imaginative, and imitative.

Behavior problems

• Telling tall tales: due to overactive imagination.
• Imaginary friend: way to release tension and anxieties.
• Sibling rivalry: from jealousy towards a newly delivered baby.
• Regression: revert to earlier stages of development (thumb sucking).

SCHOOL AGE

Play

• Indoor competitive play: Like tug of war, track and field, and basketball.

Fear

• Failure in school
• Fear of Death
• School Phobia
• Displacement from School
• Loss of Privacy

Accidents

• Poisoning and greenstick fracture

Behavior

• Industrious and modest.
• Often love collecting items, such as stamps.

ADOLESCENT

Play

• Outdoor competitive play: Like intrams and basketball.

Fear

• Rejection
• Body image (obesity and acne)

Accidents

• Motor vehicle accidents, smoking, drug addiction, and pre-marital sex.

Behavior

• Idealistic, Adventurous, Rebellious, and strives for independence.

INFANCY

Neonate

Complete head lag

1 Month

Look at mobile but at midline, only

2 Months

Holds head up when prone.

Social smile, baby coos "doing sound", cries with tears

3 Months

Holds head and chest up when prone

Follows object past the midline.

4 Months

Turns front to back

Makes bubbling sounds, laughs aloud

5 Months

Can roll over

Turns both ways due to developed abdominal muscles

6 Months

Sits with support

Says vowel sounds "ah" and "oh"

7 Months

Transfers objects from hand to hand

8 Months

Sits without support

Plantar reflex disappears for walking preparation

9 Months

Creeps or crawls

Can stand with support

10 Months

Pulls self to stand

11 Months

Cruises

12 Months

Can stand alone momentarily

Walks with assistance

TODDLER

15 months

Walks alone.

Lateness in walking may indicate mild mental retardation.

18 months

Bowel control achieved (bowel before bladder).

Can run and jump in place.

24 months

Daytime bladder control achieved (before nighttime).

"Terrible Two’s" phase.

30 months

Begins brushing teeth. (Watch for tonsillitis, GABHS, rheumatic heart disease, Beta-hemolytic staph)

Initial dentist visit is recommended when temporary teeth are complete.

36 months

Nighttime bladder control achieved.

Rides a tricycle.

PRE-SCHOOLER

4 years old

Can button buttons.

Can jump and skip.

5 years old

Can copy a triangle.

6 years old

Can tie shoes and ride a bicycle.

Has permanent teeth.

SCHOOL AGE

7 years old

Assimilation age

Can copy a diamond

Basic habits and hygiene

Quieting down period

8 years old

Expansive age

Loves to collect objects

9 years old

Coordination improves

Hero worship

10 years old

Can write legibly

Joins organizations or groups

Well mannered in front of adults

11-13

years old

Secret language is common

Sense of humor is present

Share secrets with friends

IMMEDIATE CARE OF NEWBORN

Initiation and Maintenance of Respiration

How to initiate airflow:

• Stimulate crying with a back rub or tangential slap.
• Remove secretions with a bulb syringe.
• Catheter suctioning:
  • Place the head to the side to facilitate drainage of secretions and prevent aspiration.
  • Suction the mouth first before the nose.
  • Suctioning should last 5-10 seconds, be gentle and quick.
  • Evaluate for patency by covering the nostril; additional suctioning may be needed if the baby struggles.
    • Endotracheal tube is inserted and oxygen can be administered by a positive pressure bag and mask with 100% oxygen at 40-60 breaths per minute.

Nursing Alert in O2 Administration:

• No smoking to prevent combustion.
• Always humidify to prevent drying of the mucosa.
• Avoid eye exposure to oxygen bc it can lead to scarring of the retina, leading to blindness (Retinopathy of Prematurity, ROP).
• When newborn is meconium stained, do not administer oxygen with pressure bc it can lead to aspiration.

Establishing Extra-Uterine Circulation

Circulation initiated by lung expansion, completed by cutting the cord.

• Increased PCO2 stimulates the first breath.
• Lung expansion initiates lung circulation.
• Cutting the cord initiates adult circulation.
• Proper position: Right side-lying position.

3 SHUNTS: Openings to redirect blood flow to major body organs:

1. Ductus Venosus: Shunts between the umbilical vein and vena cava.
2. *Foramen Ovale: Shunts between the left and right atrias of the heart.
3. *Ductus Arteriosus: Shunts between the pulmonary artery and aorta.

Control of Body Temperature (Temperature Regulation)

Goal: Maintain temperature not less than 36.5°C (97.7°F) to prevent hypothermia and stress.

• Factors leading to hypothermia: Immaturity, preterm or SGA babies, inadequate subcutaneous fat, wetness, and inability to shiver.

Types of heat loss:

• Convection: exposed to cool air (aircon)
• Conduction: placed on cold surface (metal weighing scale)
• Radiation: near cool object or wall without contact (viewing window)
• Evaporation: through exposed skin (not clothed properly)

Prevention of Hypothermia: Dry and wrap the baby, use a radiant warmer, prevent unnecessary exposure, kangaroo care.

Establish Adequate Nutritional Intake

Physiology of breast milk production: Prolactin (stimulates acinar cells and alveoli to produce milk) and Oxytocin (triggers "milk ejection reflex" or "let-down reflex.")

• Advantages of breastfeeding: Economical, bonding, uterine involution, higher IQ, antibodies.
• Disadvantages: Possibility of transmission of infections, lack of iron.

Stages of Breast Milk:

• Colostrum: 2-4 days post-delivery
• Transitional milk: 4-14 days
• Mature milk: 14 days and beyond; Rich in linoleic acid, brain development

Establish Waste Elimination

Types of stool:

• Meconium (physiologic stool, black, green, sticky, tar-like, odorless; normal).
• Transitional stool (4-14 days after birth, green, loose, shiny, due to breast milk).
• Breastfed stool (golden yellow, soft, mushy, sour milk smell, frequently passed).
• Bottle-fed stool (pale yellow, formed, hard, bad odor, seldom pass/constipated).
• Supplementary stool (4-6 months old with food added, brown, and odorous).

APGAR SCORE

Scoring parameter

Score 0

Score 1

Score 2

Appearance

Blue/pale

Acrocyanosis

Pinkish

Pulse rate

*most important

Absent

<100 (Slow)

>100 (Strong)

Grimace

No Response

Grimace or weak cry

Cough or strong Cry

Activity

Flaccid extremities

Some flexion

Well flexed

Respiration

Absent

Slow, irregular, weak

Good, strong cry

0 - 3: Severely depressed, requiring CPR and NICU admission.

4 - 6: Moderately depressed, needing additional interventions like suctioning and oxygen administration.

7 - 10: Indicates good health

PHYSICAL ASSESSMENT

Body Part

Normal

Abnormal

Head

• Easy for head to mold
• Anterior fontanel: diamond shape, closes at 12-18 months
• Posterior fontanel: triangle shape, closes at 2-3 months
• Caput succedaneum (edema/fluid): Swelling crossing over the suture line, disappears in 3 days
• Cephalohematoma (blood): Collection of blood causing increased ICP, disappears in 3-6 weeks

• Abnormal head shape
• Fontanel abnormalities

Eyes

• Administer 0.5% erythromycin or 1% tetracycline to prevent ophthalmia neonatorum
• Strabismus (cross-eyed) is normal until 6 months

• Eye abnormalities

Ears

• Aligned with eyes

• Low set may indicate Down syndrome (trisomy 21)

Nose

• Should be symmetrical with no deformities
• Nostrils should be patent

• Flaring indicates respiratory distress

Mouth

• Intact palate, lips, and pink gums - Epstein pearls (white)

• Koplik spots (measles)
• Cleft palate and lip

Chest

• Symmetrical and normal shape - Smaller than the head by 1-2 cm
• Witches milk may be present

• Chest abnormalities
• Intercostal retraction (indicates respiratory distress)

Abdomen

• Abdominal circumference < head circumference
• Meconium passed within 24 hours
• Umbilical cord with clamp
• Bowel sounds present after 1 hour

• Abdominal abnormalities

Skin

• Acrocyanosis (pink chest and bluish extremities)
• Physiologic jaundice (peaks at 5th day of life, lasts 10-14 days)

• Skin abnormalities
• Pathologic jaundice
• Other skin issues

Genital region

• Female: pseudomenstruation (pink discharge) - Male: descended testes - First void within 24 hours

• Genital abnormalities (cryptorchidism, hypospadias, epispadias, phimosis, hydrocele)

Back

• No dimpling or opening

• Dimpling or sac (indicates spina bifida)

Extremeties

• Symmetrical arms and legs

• Asymmetrical arms and legs
• Ortolani’s click (indicates congenital hip dysplasia)

CEREBRAL PALSY

Description

Neuromuscular disorder with no muscle coordination

Causes

• Brain anoxia due to prolonged labor/cord prolapse)
• Infection: cytomegalovirus
• Toxoplasmosis due to mother gardening or touching feces of cats

Types

Spastic, Athetoid, Ataxic

Factors

Only recognizable as child begins to learn how to walk and attempt complex motor skills

Sign and symptoms

Infant:

• Abnormal posturing
• Difficulty feeding
• Persistent primitive reflexes
• Delayed development

According to type:

• Spastic: Excessive muscle tone, Scissor gait
• Athetoid: Worm-like, Limp or flaccid
• Ataxic: Awkward wide gait

Diagnostics

Inspection

Nursing management

• Health teaching: CP is nonprogressive. It is a disorder that can be cncite during physical therapy.
• Prevent contractures by doing exercise
• Promote mobility and self-help skills
• Promote ambulation
• Encourage play with other children

Medical management

• Baclofen: muscle relaxant that reduces muscle spasticity.
• Use of assistive devices
• Therapy (pt, ot, speech)

HYDROCEPHALUS

Description

Excessive accumulation of cerebrospinal fluid (CSF) in subarachnoid space due to the anterior fontanel remaining open after 18 months.

Causes

• Birth trauma
• Infection (encephalitis or meningitis)
• Brain tumor
• Excessive CSF production

Types

• Communicating – Excessive CSF production. Fluid may still flow.
• Non-communicating: The CSF flow is impeded or obstructed.

Factors

• Open fontanelle: can accommodate
• Close fontanelle: increased chance of brain damage

Sign and symptoms

Infant:

Toddler:

Nursing management

• Assess head circumference daily
• Protect head with egg mattress
• Induce hypocapnia (increased O2) for cerebral vasoconstriction
• Limit fluid intake to 1200-1500 mL per day
• Prevent increased ICP:
  • Prevent crying
  • No restraints
  • No valsava maneuver
  • Padded side rails for seizures

Medical management

• Osmotic diuretics (mannitol)
• Loop diuretics (furosemide; potassium wasting)
• Corticosteroids (dexamethasone)
• Analgesics

Surgical management

• Ventriculostomy: To relieve pressure
• Ventriculoperitoneal shunt: To bypass fluid to peritoneum and so capillaries absorb the fluid

Contraindications

• Aspirin and ibuprofen bc increases risk for bleeding
• DOC: acetaminophen

NEURAL TUBE DEFECT

Description

Complete closure of spinal column

Causes

• Folic acid deficiency during pregnancy
• Drugs (antidepressants), radiation (x-ray), and hereditary.

Types

• Spina bifida (occult)
  • Dimpling
  • No sac
• Spina bifida cystica
  • Most common
  • With sac (thin and transparent)
  • Types of spina bifida cystic
    • • Meningocele: with CSF and meninges
      • Myelomeningocele: with CSF, meninges, and spinal cord

Sign and symptoms

• Flaccid paralysis of legs
• Altered bowl and the bladder
• Hip and joint deformities

Diagnostics

Assessment and inspection

Nursing management

• Protect sac
  • Cover with moist sterile gauze (nonadhesive and with PNSS)
  • Place in prone position
  • Use aseptic technique
  • Monitor for signs of rupture
• Goal: no pressure, no injury, no infection

Medical management

• Surgical closure with 24-48 hours after birth
• Post-surgical management
  • WOF: infection
  • Maintain
• Rehabilitation
  • Bowel and bladder elimination
  • Proper growth (pt and to)

SEIZURES

Description

• Involuntary contractions of muscles
• Caused by abnormal electrical brain discharges (excitable? tremors?)
• Increase CNS stimulation

Causes

• Idiopathic
• Infection (Meningitis); Brain is irritated
• Trauma
• Hypoglycemia (cold stress hypothermia)

Sign and symptoms

• Newborn
• Difficult to recognize
• Abscenciet/Blak - twitching
• Seizure - Slight? cyanosis? (mouth)
• Apnea
• Limp? / flaccid
• Infant/toddler
• Infantile Spasm
• Myoclonic Seizure
• Slump forward
• Falls from standing position
• Rapid movement of the trunk?
• Stiffening? Contraction of the body
• 3 years old and above
• Febrile
• Fever is cured
• Seizure
• Can last 1-2 minutes
• TSB Fields: VT?
• 5x: diarrhea
• Cool down?

Diagnostics

• CT
• Electroencephalography
• EEG = Brain activity
• Decreased oxygen in the brain

Nursing management

• Maintain the patient's airway and promote safety
• Clean the area of objects
• Protect the head
• No restraint bc it can lead to fracture
• Loose clothing
• Face head to the side after the episode
• Note the time of seizure
• Seizure:
• Suction (machine)
• Oxygen (mask)

MENINGITIS

Description

• Infection of cerebral meninges
• Irritated brain and spine

Causes

• Bacterial
• Streptococcus
• Pneumonia
• E. Coli
• Viral
• Haemophilus Influenzae

Sign and symptoms

• Upper respiratory tract infection
• Headache
• Opisthotonus (arching back)
• Seizures
• (+) Kernig’s Sign
• Knee (pain, resistance?, spasm)
• Cranial Nerve Paralysis

Diagnostics

• Lumbar Puncture
• CSF Analysis
• Increased WBC = increased cloudiness and protein
• Blood culture: To figure out what organism

Nursing management

• Place a patient on respiratory precautions for 24 hours after the start of antibiotic therapy
• Enclose, protect airway, and promote safety measures to prevent seizures
• Monitor and control temperature to prevent febrile seizures
• Perform neurological assessment
• Assess for changes in LOC and irritability
• Monitor intake/output
• Assess nutritional value and food

Medical management

• Antibiotics
• Cefoxitin
• Drink for allergy
• 3rd cephalosporin
• Penicillin G

SICKLE CELL ANEMIA

Description

• Clumping of hemoglobin
• Hemoglobin A is replaced by hemoglobin S

Causes

• Autosomal recessive inherited disorder

Factors

• Fever, stress, dehydration
• Sickle cell crisis

Sign and symptoms

• Pain
• Tachycardia
• Murmur
• Cardiomegaly
• Chest pain (blocked heart)
• Dyspnea (blocked lungs)
• Jaundice (blocked liver)

• Sickle Cell Crisis
• RBC destruction
• Enlarged liver and spleen
• Hemolytic crisis: RBC destruction
• Aplastic anemia - severe

Diagnostics

Sickle Diagnostics - blood test

Nursing management

• Pain relief
• Inhalation
• Oxygenation
• Health education
• Adequate hydration
• Bed rest for decreased oxygen needs
• Prevent infection

Medical management

• Blood transfusion (PRBC)
• Acetaminophen / Narcotic analgesic
• Hydroxyurea: increase hemoglobin production

HEMOPHILIA

Description

• Disorder in blood coagulation
• Client is prone to bleeding

Causes

• Sex-linked recessive trait
• Mother is the carrier
• Son is affected
• Father transmits to the daughter

Types

• Type A: factor VIII (most common)
• Type B: Christmas disease (factor IX)
• Type C: Factor XI

Sign and symptoms

• Early
  • Continuous bleeding in the umbilical cord
  • Can also be seen in early circumcision
• Late
  • Bruising
  • Gum bleeding
  • Epistaxis
  • Hemarthrosis (bleeding in the joint with pain, usually in the knees; defining sign)

Diagnostics

• Low level of partial thromboplastin time
• Normal level of platelet

Nursing management

• PGoals: control bleeding
• Hemarthrosis management
  • Immobilize joint (using splint)
  • Perform passive ROM for distal parts to prevent muscle contracture
• Contraindicated: ibuprofen, aspirin due to increased risk of bleeding
• DOC: Acetaminophen (hepatotoxic)
• One blood draw only
• WOF: Hepatitis in factor 8 medication administration
• Sports recommend: Swimming
• Soft-bristled toothbrush
• Protective gear

Medical management

• Transfusion: Factor VIII (principle: missing factor to transfuse)
• Cryoprecipitate, platelet concentration
• Desmopressin: stimulates the release of factor VIII
• Acetaminophen for pain relief

LEUKEMIA

Description

• Abnormal proliferation of immature WBC (high innmats WBC)
• Cancer in the blood
• High WBC is infection; Low WBC is immunocompromised
• Bone marrow produces too much immature WBC thus produces less RBC and Platelet.

Causes

• Unknow
• Common: Acute lymphocytic anemia

Types

• Radiation
• Chemical exposure
• Genetic factor
• Common among boys

Sign and symptoms

• Low RBC production (anemia)
• Pallow, low-grade fever, lethargy
• Low platelet (bleeding)
• Bleeding
• Low mature WBC (infection)
• Fever, infection

Diagnostics

• Bone marrow aspiration at the posterior iliac crest
• WBC: normal
• HgB: low
• Platelet: low

Nursing management

• Anemia management
• Rest in between breastfeeding
• Oxygen therapy using sterile humidifier and face mask
• Bleeding management
• Soft bristle toothbrush
• Prevent bruising
• No aspirin or ibuprofen
• Infection management (pts who are immunocompromised)
• Isolation
• No fresh fruits, vegetables, and flowers
• Avoid crowds
• Wear surgical mask
• Proper handwashing (>20 secs; soap and water)

Medical management

• Chemotherapy: to target rapidly producing cells
  • Side Effects:
• Alopecia (buy a wig; after 3-6 months the hair will grow back)
• Nausea and vomiting
• Fatigue
• Bone marrow transplantation

VENTRICULAR SEPTAL DEFECT

Description

• Opening between right and left ventricle (goes back to right)

Sign and symptoms

• Brow sweating during feeding or when crying
• Mild: usually asymptomatic, with splitting s2 sounds
• Moderate: sweating during feeding, tachypnea, failure to thrive, and tachycardia
• Severe: with frequent respiratory infection

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Medical management

• Diuretics
• ACE inhibitors (prevent hypertension and decrease afterload)
• Inotropes (digoxin)

Surgical management

• Pulmonary artery banding
• Transcatheter closure
• AKA cardio catheterization
• Can be diagnostic and therapeutic
• Site of insertion: femoral artery
• Flat on bed for 4-6 hours after the procedure
• Prone to bleeding

ATRIAL SEPTAL DEFECT

Description

• Opening between right and left atrium.
• Failure of foramen ovale to close
• Systemic congestion to the right side will lead to JVD

Sign and symptoms

• Swelling of the legs and feet
• Increase palpitation
• Neck vein distention
• Shortness of breath
• Heart murmur
• Fatigue
• Failure to thrive

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Medical management

• Aspirin: Prostaglandin inhibitor to close the structures (ductus arteriosus and foramen ovale)
• Prostaglandin keeps the structures open

Surgical management

• Open heart surgery
• Percutaneous catheter closure through femoral artery

PATENT DUCTUS ARTERIOSUS

Description

• Opening between the pulmonary artery and aorta
• Blood goes back to the heart and causes lung congestion

Sign and symptoms

• Tachypnea
• Diaphoresis
• Difficulty feeding
• Heart murmur
• Weight loss
• *Machinery like murmur”

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Medical management

• NSAID: prostaglandin inhibitor
• Indomethacin administered intravenously 10-14 days of life
• Ibuprofen
• Digoxin and diuretics
• Give aspirin

Surgical management

• Surgical ligation
• Cardiac catheterization

COARCTATION IN THE AORTA

Description

• Narrowing of the aorta

Sign and symptoms

• High BP in upper extremities
• Low BP in the lower extremities
• Bounding pulse in the arms (carotid pulse)
• Weak or absent pulse in the femoral pulses

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Nursing management

• Take 2 BPs; 1 arm and 1 leg

Medical management

• Alprostadil ICV maintains patency of ductus arteriosus before surgery
• Digoxin improved ventricular systolic function
• Betablocke (metoprolol) treats preoperative hypertension
• ACE inhibitors (for hypertension)
• Vasodilators (nittroprusside)

Surgical management

• Resection and end to end anastamosis
• Balloon angioplasty

TETRALOGY FALLOT

Description

• 4 defining structural problems (VROP):
• Ventricular septal defect (VSD open)
• Right ventricular hypertrophy (RV mataba)
• Overriding Aorta
• Pulmonary stenosis (maliit na PA)

Sign and symptoms

• Overall cyanosis: low circulating oxygenated blood
• Blue baby
• Tet spells: position in knee to chest or squats
• Clubbing of fingers
• Main problem is hypoxia

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Medical management

• Alprostadil IV maintains patency of ductus arteriosus before surgery
• Beta-blocker: reduces RV spasm
• Oxygen
• Sedation using Morphine sulfate IV

Surgical management

• Blalock Taussig procedure: a small tube that connects the pulmonary artery and pulmonary vein to allow more blood flow to the lungs.

TRANSPOSITION OF GREAT ARTERIES

Description

• Right ventricle – aorta — systemic
• Left ventricle – pulmonary artery – pulmonary circulation
• Needs patent foramen ovale and ductus arterioles to provide mixing of blood

Sign and symptoms

• Excessive left and right ventricular workload
• Cyanosis shows within hours after birth
• Signs of congestive heart failure
• Pulmonary hypertension

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Medical management

• Alprostadil IV maintains patency of ductus arteriosus before surgery

Surgical management

• Atrial switch operation
• Heart transplant.

TRANSPOSITION OF GREAT ARTERIES

Description

• One trunk - pulmonary artery and aorta combine
• Noted with VSD
• Commonly seen in DiGeorge Syndrome

Sign and symptoms

• Cyanosis shows within horse after birth
• Signs of congestive heart failure
• Polycythemia vera

Diagnostics

• 2D echo (size, structure, and blood flow)
• Chest xray

Medical management

• Digoxin, diuretics, ace inhibitors

Surgical management

• Corrective surgery
• VSD patch

RHEUMATIC HEART DISEASE

Description

• Autoimmune inflammatory disease of the connective tissue

Causes

• Group A beta-hemolytic streptococcus (also causes strep throat and acute glomerulonephritis)

Factors

• Strep throat 4-6 weeks ago

Sign and symptoms

• Musculoskeletal, cardiac muscle, skin, and CNS
• Aschoff bodies round nodules in the mitral valve (LA and LV) thus backflows to the lungs

Diagnostics

• Jones criteria
• Major
• Polyarthritis: multiple joint pain
• Chorea: involuntary purposeless movement of hand and shoulder, accompanied by grimacing (CNS involvement)
• Carditis: signs of tachycardia
• Erythema marginatum: muscular rashes on the skin
• Subcutaneous nodules (mitral valve prolapse)
• Minor
• Low-grade fever
• Diagnostic exams (blood test)
• Antibody
• C reactive protein
• ESR
• Anti streotiysin titer
• Presence of 2 major or 1 major and 2 minor plus a history of sore throat will confirm the diagnosis

Nursing management

• Decrease O2 demands of the heart (+ carditis)
• CBR (complete bed rest)
• O2
• Prevent further cardiac damage
• Safety precautions for chorea
• Safe environment
• Do not restrain
• Seizure precaution (CNS is irritable and excitable)
• Health hisory: ask if infant had strep throat 4-6 weeks ago

Medical management

• Penicillin: for the bacteria
• Aspirin or salicylate: RHD anti-inflammatory
• Question before giving aspirin: No history of viral infection (chicken pox or flu)
• SE and WOF: Reye’s syndrome is encephalopathy accompanied by infiltration of organs (heart and liver)

ASTHMA

Description

• Hypersensitive response to allergens causing inflammation of the airway
• Exposure to allergens leads to the release of mast cells

Factors

• Pollen, molds, house dust, and food
• Exposure to cold air or changing temperature, irritating odors
• Cigarette smoke
• Aspirin
• Stress
• Strenuous activities

Sign and symptoms

• Pathognomonic/hallmark sign: Wheezing on expiration
• Central cyanosis in the mouth
• Inflammation (swelling and edema)
• Bronchoconstriction (CO2 trapping)
• Increased mucus production

Diagnostics

• Hx taking
• Skin test of different allergies
• Pulmonary function test: to check for lung vital capacity.

Nursing management

• Monitor breath sounds
• Upright position (high or semi-fowlers)
• Absent breath sounds (mother may think the baby is okay so auscultate again)
• Good: effective treatment
• Bad: total bronchoconstriction
• WOF: Status asthmaticus (no medication works at all)
• Emergency
• Carbon dioxide narcosis can cause death due to a lack of oxygen in the brain
• Will undergo mech vent
• The best sport for pt with asthma is swimming

Medical management

• Bronchodilator
• Mild: Albuterol (prevent bronchospasm)
• Moderate: Albuterol + cromolyn sodium (mast cell stabilizer)
• Sever: Bronchodilator, Corticosteroid (presence of inflammation, given first to open airway) + Albuterol
• IV fluids
• Metered dosed inhaler (MDI)
• Upright position
• Exhale completely
• Attach MDI to mouth
• Press and inhale
• Hold breath 5-10 secs
• Do not exhale right away
• Exhale slowly
• If corticosteroids:
  • SE: oral thrust or yeast
• Nursing intervention: gargle after administration

CYSTIC FIBROSIS

Description

• Thick, sticky fluid is seen in the lungs, GIT, and reproductive system.
• Defective chromosome 7 (exocrine).
• Lots of secretions in the lungs can lead to pneumonia and respiratory disease.

Cause

• Autosomal recessive disorder

Sign and symptoms

• Respiratory
• Frequent pneumonia
• Persistent cough with mucus
• Wet cough
• Wheezing
• Digestive (- lipase, - amylase)
• Steatorrhea (excessive amount of fats in the poop)
• Absent pancreatic enzymes (- lipase, - amylase)
• Diabetes (high glucose in blood vessels): if prolonged absence of lipase and amylase this can lead to diabetes. if not treated, can lead to nephropathy and retinopathy.
• Malnutrition
• Meconium Ileus: was not able to pass the first stool or constipated due to the poop being too thick.
• Reproductive
• Infertility
• Ectopic pregnancy
• Oligospermia (low sperm count)
• Delayed pub

Diagnostics

• Sweat test: high NaCl in sweat
• Normal: 40-60 mEq
• High: (+) sweat test
• Endoscopy: absence of pancreatic enzymes in the pancreatic and common bile duct.

Nursing management

• Respiratory management
• Principle of Pulmonary hygiene:
  • Liquify, mobilize, and expectorate tenacious secretions
• Hydration
• Deep breathing and CPT
• Coughing and suctioning
• CPT: before postural drainage
• O2 suction
• Postural drainage
• 2-3 hours before meal to prevent vomiting
• Digestive management
• High protein, high calorie, low fat
• WOF: absence of steatorrhea
• Increase OFI

Medical management

• Respiratory
• Bronchodilators
• Antibiotics
• Mucolytics (decrease mucus production)
• Digestive
• Cotaym (synthetic pancreatic enzymes; given after every meal; if effective (-) steatorrhea)
• Multivitamins: ADEK (K is for coagulation; D is for synthesizing calcium; A is for color blindness; E is for the skin)
• Reproductive
• In Vitro Fertilization (3-5 eggs)

SUDDEN INFANT DEATH SYNDROME (SIDS)

Description

• Sudden death of a HEALTHY infant less than 1 year old

Factos

• 1-6 months (learns turning and may suffocate)
• Preterm (immature lungs)
• Sleep position (prone position)
• Nicotine exposure
• Socioeconomic
• Bedding (too much bedding)
• Lack of knowledge of the parents (health teaching)

Sign and symptoms

• NONE

Diagnostics

• Sweat test: high NaCl in sweat
• Normal: 40-60 mEq
• High: (+) sweat test
• Endoscopy: absence of pancreatic enzymes in the pancreatic and common bile duct.

Nursing management

• Sleep in a supine position
• Bedding
• Firm mattress
• No toys, blankets, or pillows
• Avoid overdressing
• Avoid smoking
• No co-bedding (parent sleeps beside the infant)
• Normal room temperature
• So not leave a bottle of milk
• Educate parents during postpartum (educate abt the risk)
• For grieving parents
• Allow expression of feelings and concerns (therapeutic communication; the goal is converse)
• Let them hold the baby (to overcome denial)
• WOF mother’s feelings of guilt (may lead to depression and suicide)

FOREIGN BODY ASPIRATION

Description

• Inhalation of foreign body in the airway

Factors

• Infants and toddlers bc site of gratification is mouth
• Presence of small objects
• Crawling by 9 months
• Unsupervised

Sign and symptoms

• Chocking
• Hard forceful cough
• Airway obstruction: cough with no sound
• Stritor indicates partial obstruction
• Cyanotic
• Inability to cry

Nursing management

• Infant
• Back thrusts
• Prone over your arm and administer 5 quick back blows forcefully between the infant’s shoulder blades using the heel of the hand.
• Child
• Subdiaphragmatic abdominal thrusts
• Adolescent
• If able to cough, encourage
• If cannot cough, do abdominal thrusts

CLEFT LIP AND CLEFT PALATE

Description

• Congenital anomaly: failure of soft tissue or bony structure to fuse during embryonic development

Factos

• Genetic
• Radiation
• Rubella virus (german measles; rubella is measles) infection that commonly causes cleft lip.
• Medication (valproic; anti manic or mood stabilizer)
• Male: lip
• Female: palate

Sign and symptoms

• Frequent infection
• Dry mucus membrane
• Mild retained in folds
• Milk, aspirated, airways

Diagnostics

• In utero sonogram
• Inspection lip.

Nursing management

• Focus on aspiration of milk and nutrition.
• Asses ability to suck, swallow, and breathe during breastfeeding
• Monitor weight due to risk of malnutrition (-) breastfeeding
• Modifying feeding technique
• Use enlarged nipple bottle (block the opening of lip or palate to direct milk to the esophagus)
• Hold upright
• Direct bottle to the side of buccal mucosa and black of the mouth
• Burp after feeding

Medical management

• Lip: Cheiloplasty
• Palate: Palatoplasty

Category

CLEFT LIP

CLEFT PALATE

Gender

Boys

Girls

Clinical Findings

Dry mucous membrane

Accumulation of dry milk in folds

Dry mucous membrane

Accumulation of dry milk in folds

Feeding

Using a rubber medicine dropper

Using a big nipple feeding bottle

Repair Timing

Can be done by 2 ½ to 3 months

Can be done by 12-18 months

Surgical Procedure

Cheiloplasty

Palatoplasty

Checklist for Surgery

10 weeks old

10 hemoglobin level

10 lbs in body weight

Suture is outside

Done before speech development (>6 months)

After palate development

Suture in inside

Position Post-op

Supine

Side lying or pillow at the back to reduce the risk of aspiration

Watch Out For

NONE

Bleeding symptoms such as frequent swallowing and stained red

Post-op Care

Restrained elbow (to prevent traumatizing suture line)

Use Logan bar (to ensure suture is kept intact and prevent it from opening)

Restrained elbow (to prevent traumatizing suture line)

Use Logan bar (to ensure suture is kept intact and prevent it from opening)

Post-op Risks

Otitis media

Improper teeth growth

Otitis media

Improper teeth growth

Follow-up

Child psychologist

Speech therapist

Ear, nose, and throat doctor

Orthodontist for teeth

Child psychologist

Speech therapist

Ear, nose, and throat doctor

Orthodontist for teeth

TRACHEOESOPHAGEAL FISTULA

Description

• Abnormal connection between esophagus and trachea
• Risk for aspiration for all types of tracheoesophageal fistula

Factos

• During pregnancy: polyhydramnios (increase in amniotic fluid)
• If has large stomach but AOG is far (polyhydramnios) which means the baby is unable to swallow the amniotic fluid.

Sign and symptoms

• Seen typically during breastfeeding:
• Coughing
• Choking
• Cyanosis

Diagnostics

• During insertion of NGT there is the coiling of catheter bc may ending
• Xray
• Ultrasound

Nursing management

• Pre-op management
• Suctioning
• Place on NPO (placed on TPN and D5LR when baby is malnourished and dehydrated)
• Offer pacifier (decrease stress when mouth us busy)
• WOF: aspiration
• Complication: pneumonia
• MEasurement of NGT
• Adult: ear, nose, xiphoid process
• Infant: nose to xiphoid process
• Must have water or saliva to swallow during insertion

Medical management

• Repair bc airway is a concern
• Nutrition: TPN or gastrostomy tube
• Surgery
• Anastamosis: stitching of two closed endings to create a passageway
• Closure of fistula: close the connection between the esophagus and trachea

PYLORIC STENOSIS

Description

• The pyloric sphincter is the opening between the lower portion of the stomach and the beginning portion of the small intestine (duodenum).
• Any stricture that causes it to tighten

Factos

• During pregnancy: polyhydramnios (increase in amniotic fluid)
• If has a large stomach but AOG is far (polyhydramnios) which means the baby is unable to swallow the amniotic fluid.

Sign and symptoms

• Hallmark: olive-shaped mass at epigastrium
• Visible peristaltic wave
• Accumulated food in the stomach
• Projectile vomiting
• No bile in vomitus

Nursing management

• Common complication of vomiting is diarrhea
• Give hydration and IV
• Monitor for signs of dehydration
• Oliguria (oliguria; low UO and anuria; no UO)
• Fluid volume deficit
• Dry mucus membrane, skin tenting sunken fontanelles, fever, decrease urine output, and weight loss.
• WOF: hypokalemia (due to vomiting)
• WOF: signs of metabolic alkalosis leading to hypochloremia, hypokalemia, and starvation
• Withhold oral feeding
• Provide pacifier

Medical management

• IV fluids
• Pylorotomy: incision through muscle fibers of the pylorus through laryngoscopy

INTUSSUSCEPTION

Description

• Telescoping of the intestine usually in the junction of the large and small intestine
• Distal ileum (small intestine) and proximal colon

Sign and symptoms

• Hallmark sign:
• Sausage shape mass
• Currant jelly stool: mucus and blood (due to frequent friction when telescoping leads to scraping of cells and bleeding. To lessen the friction and protect the lining, the stomach releases mucus)
• Vomiting with bile (after if the vomit has bile)
• Distened abdomen
• Abdominal pain

Diagnostics

• Ultrasound: to visualize telescoping

Nursing management

• Post-op; WOF: short bowel syndrome (small intestine cannot absorb enough nutrients)
• Diarrhea
• Dehydration
• Complication: enterocolitis due to collection of meconium ileus (no passage of 1st stool). Leads to sepsis
• Fever, bleeding, bloody diarrhea, or explosive diarrhea
• Diet: low-residue diet
• Temporary treatment is abdominal wall stoma.
• Colostomy care:
• Pink is normal
• Red is infection
• Purple is no blood supply

Medical management

• Barium enema introduces force and lengthens the intestine which results in explosive diarrhea
• Bowel resection: surgery to remove part of the small intestine, and large intestine or both.
• Temporary colostomy in the abdominal wall
• Abdominoperineal pull-through (12-18 months)

HIRSCHSPRUNG’S DISEASE

Description

• Aganglionic megacolon: lowers motility usually in the sigmoid colon due to the absence of ganglionic innervation
• No nerves in the sigmoid colon (last part of the large intestine in the left side of the abdomen) leading to no peristalsis and constipation

Sign and symptoms

• Hallmark sign: Ribbon-like stool due to smaller and twites rectum and anus
• Newborns: failure to pass meconium with 24 hours
• Constipation
• Distended abdomen

Diagnostics

• Abdominal x-ray
• Barium enema (chalky white substant which is secreted via stool
• Provide Health teaching that the stool will be white after the procedure until all for the substance is excreted

CELIAC DISEASE

Description

• Against gluten food for life
• Gluten spruce
• GLuten intolerant
• Ingestion of gluten leads to intestinal villi atrophy
• Undigested fats and protein

Sign and symptoms

• Diarrhea
• Steatorrhea (high-fat content in stool; poops float)
• Anorexia (due to no absorption of nutrients)
• Abdominal pain and distention (bc gusto iexcrete agad)
• Deficiency in vitamin ADEK
• Ricketssia: brittle bones that can lead to fracture due to vitamin d deficiency
• Low platelet count: bleeding management due to vitamin K deficiency

Diagnostics

• History (food diary, what the person ate)
• Biopsy of the intestinal mucosa (damage due to prolonged intake of gluten)

Nursing management

• WOF: celiac crisis
• Factor: infection
• Complication:
• Frequent: metabolic acidosis and hyperkalemia due to diarrhea and vomiting.
• Hyperkalemia is due to the exchange of hydrogen and vit k. Vit k goes to the blood as a coping mechanism.
• Health teaching:
• Avoid: baked goods, bread, crackers, pasta, breading.
• Monitor growth
• School-age children teach them to read the ingredients

Medical management

• Celiac diet
• NO BROW (barley; bread, rye; beer, oat; oatmeal, and wheat; wheat bread)
• IV fluids to control the electrolyte imbalances

PHENYLKETONURIA

Description

• Problem in metabolism of phenylalanine (type of amino acid which is from protein; typically found in milk)
• Phenylalanine is needed for thyroxine (can affect IQ) and melanin (white skin; prone to skin cancer)

Sign and symptoms

• Thyroxine deficiency
• Low IQ
• Melanin deficiency
• Non pigmented skin, skin rash
• Blond hair, fair, skin, blue eyed
• High unconverted phenylalanine
• Incerease phenylalanine can lead to the production of pyuric acid leads to metabolic acidosis
• High fat (lipoprotien) breakdown leads to ketones which are the byproduct

Diagnostics

• Guthrie test
• Heel prick in the side
• 24 hours after birth

Nursing management

• Phenylalanine free diet
• No dairy
• High protein food like meat and eggs
• Aspartame (artificial sweeteners)
• Allowed: vegetable, fruits, low protein
• Milk replacement: Lofenalac

NEWBORN SCREENING

Congenital adrenal hyperplasia

• Decreased cortisol, serve salt loss.
• Inability to utilize an essential amino acid, leading to dehydration.
• If not treated can lead to death in 9-13 months
• Treatment: NaCl supplement (tablet or food like canned food)

Galactosemia

• Inability to metabolize galactose in milk
• Signs and symptoms: Vomiting, diarrhea, liver damage
• Complications: cataract, growth failure, and brain damage (due to storage)
• Treatment: No animal source milk and No breastfeeding
• So instead give soy formula: Isomil, nursery, prosobee

Phenylketonuria (PKU)

• Inability to metabolize phenylalanine, leading to mental retardation if not treated.
• Phenylalanine is converted to tyrosine, which is essential for melanin production (may cause hypopigmentation).
• Treatment: Special formula (e.g., Lofenalac/Phenalac)

G6PD (Glucose-6-Phosphate Dehydrogenase) Deficiency

• Breakdown of RBC causing anemia
• Treatment: avoid triggers like beans, naphthalene, sulfate

Congenital hypothyroidism (cretinism)

• Deficiency in thyroid hormones causing physical, developmental, and mental delays.
• Treatment includes thyroid hormone supplements for life (e.g., Synthroid).

NEPHROTIC SYNDROME

Description

• Nephrosis
• Acute glomerular permeability (colloids)
• Acts like a filter of glucose and protein

Cause

• Autoimmune

Factors

• 3 years old
• Common in boys
• SLE (systemic lupus erythema)
• Sickle cell anemia

Sign and symptoms

• Severe proteinuria (albumin; connected to edema bc it keeps water inside blood vessel)
• Edema (extreme) due to colloid oncotic pressure (usually albumin)
• Hypoalbuminemia and Hyperlipidemia
• Cause of liver production of lipoprotein
• Arteriosclerosis: spasm of blood vessel
• Atherosclerosis: caused by high cholesterol

Diagnostics

• Renal biopsy
• CBC: low level of protein
• Urinalysis: high level of protein

Nursing management

• Edema care
• Risk for pressure or skin ulcers
• Edema goes to prominent boney parts
• Diet: high protein, low sodium diet (where salt goes, water follows)
• Health teaching for corticosteroid therapy
• Do not stop abruptly (weaning: lower dosage and frequency)
• Side effects: Moon face (cushing syndrome
• Long term immunisuppresion may occur
• Facemask
• Hand washing
• NO fresh flowers or fruits

Medical management

• IV corticosteroids: treatment edema and protien loss (prednisne)
• IV albumin
• Cyclophosphamide, cyclospoine (pathophysio autoimnesI: immunosuppresors
• Anticholesterol: atorvastatin

NEPHRITIC SYNDROME

Description

• Inflammation of glomeruli of kidney

Cause

• Autoimmune

Factors

• 5-10 years old
• Common in boys
• History of sore throat or tonsillitis

Sign and symptoms

• Hematuria: “tea-colorer” or smokey urine
• Some protein
• Oliguria
• Hypertension
• Increased BUN and Crea (more sensitive) in blood levels

Diagnostics

• Kidney function test
• Anti-streptolysin titer
• 24-hour total urine

Nursing management

• Health teaching: self-limiting disease for 1-2 weeks
• Monitor weight
• Diet: high protein and low salt
• Bed rest
• Antihypertensives
• Skincare
• WOF: congestive heart failure
• Treatment: Diuretics, oxygen, digoxin
• Fluid accumulation
• FVE, crackles, JVD, HTN, bounding pulse.

Medical management

• Diuretics
• Antibiotics: penicillin
• Antihypertensives

NEPHROBLASTOMA

Description

• Most common intraabdominal and kidney tumor
• Cancer of children

Cause

• Genetic
• Congenital abnormalities

Factors

• 3 years old

Sign and symptoms

• Swelling or mass within the abdomen
• Urinary retention
• Hematuria
• Anemia: pallor, anorexia, lethargy
• Hypertension (secretion of renin; ace inhibitor angiotensin receptor)

Diagnostics

• Biopsy

Nursing management

• Avoid palpation of the abdomen
• WOF: the rupture of tumor
• Pre-op:
• Monitor vital signs
• Measure abdominal girth once daily
• Post-op:
• Monitor temp and blood pressure
• Monitor for signs of hemorrhage and infection
• Strict I&O
• Monitor for abdominal distention
• Monitor for intestinal obstruction

Medical management

• Surgery: partial or total nephrectomy
• Chemotherapy

CONGENITAL HIP DYSPLASIA

Description

• Head of femur is above the acetabulum

Cause

• Inherited
• Mechanical breech position
• Presence of relaxin hormone (relaxes pelvic joints and causes waddling gait)

Factors

• Girls
• Sociocultural methods of carrying

Sign and symptoms

• Affected leg is shorted
• Galeazzi sign: one knee is lower
• Ortolani’s sign: clicking
• Barlow’s sign: Feeling of the femur head slipping out
• Unequal number of skin folders on thigh and glutes

Diagnostics

• Radiography
• Ultrasound
• MRI

Nursing management

• Position
• Hip and legs are flexed and are abducted (externally rotated)
• Initial intervention
• Two or three diapers
• Carrting at the hip
• Cast care (Hip spica cast)
• Neurovascular check
• WOF: Compartment syndrome (pallor, paresthesia, pain, pulselessness, poikilothermia)

Medical management

• Frejka splint
• Pavlik harness
• Spica cast

SCOLIOSIS

Description

• Skeletal disorder; curvature of the spine

Factors

• Family history
• Common in adolescent girls

Sign and symptoms

• Kyphosis: Excessive outward curvature of the spine; hunched back
• Lordosis: Excessive inward curvature of the spine; swayback appearance
• Uneven length in bra straps
• Uneven length in skirt

Diagnostics

• Radiography
• Scoliometer

Nursing management

• Usuall diagnosed by the school nurse:
• Adam’s test: bending down infront of nurse
• Starts at 8 years old
• Sports recommended: yoga and swimming
• Common problems: body image and low self esteem
• Bawal shoulder bags
• Post op care:
• Log rolling technique (pt is imobalized and is moved in one go)
• Flat on bed

Medical management

• Milwaukee breace
• For mild scoliosis (more than 20 degrees)
• Worn 16-23 hours per day (except during sleep)
• Do not loosen
• Thin clothing
• Halo traction
• For severe scoclosis
• Corrective surgery
• Use of pins, rods, and screws

FRACTURE

Description

• Break in the continuity of the bone

Factors

• Age (preschool to school age)
• More porous and bone immaturity

Sign and symptoms

• Pain, swelling
• Deformity
• Uneven gait

Diagnostics

• Radiography

Nursing management

• Thorough assessment (rule out abuse)
• IV line access (increased bleeding and open fracture)
• Reduce anxiety of client
• WOF complications:
• Fat embolism (long bone fracture)
• Compartment syndrom
• Health teaching on spleent or cast care
• Keep dry; do not sue hair dryer in warm setting (use palm not fingers)
• Do not insert objects

Medical management

• Initial intervention
• RICE:
• Rest (immobalize)
• Ice with first 24 hours (reduce swelling) (hot after 24 hours for increased blood prefusion)
• Compression (reduce bleeding)
• Elevate (reduce edema)
• Tetanus shot
• Splint
• Cast

PEDICULOSIS CAPITIS (LICE)

Description

• Infestation of lice in hair and scalp

Cause

• Lice
• Female eggs on hair shaft
• Incubation: 7-10 days
• Transmission: direct (person to person) or indirect contact (hygeine items like combs)

Factors

• Day care

Sign and symptoms

• Common site:
• Occipital
• Behind ears
• Eyebrows and eyelashes
• Scratching
• Pruritus
• Irritability

Diagnostics

• Inspection

Nursing management

• Have family checked
• Health teaching
• Use fine tooth comb
• Do not share items
• Bedding anf clothing should be laundered in hot water
• Keep non-essential clothes and toys for 2 weels
• Daily vaccuming

Medical management

• Pediculicide (death)
• Contraindicated for 6 months and below

SCABIES

Description

• Parasitic skin disorder

Cause

• Sarcoptes scabiei (itch mite)
• Incubation:
• Eggs hatch:
• Mode of transmission: contact

Factors

• Day care

Sign and symptoms

• Pruritic papular rash
• Burrow into the skin

Diagnostics

• Inspection

Nursing management

Medical management

• Lindane shampoo
• Contraindicated: 2 years old and below
• Adverse effece: seizure and neurotoxicity
• Permethrin (lotion)
• Applied to cool dry skin
• Applied on all skin

LEAD POISONING

Description

• Excess lead in the blood

Cause

• Exposure to dust, soil
• Adults: plumber, smoker, mechanic
• Near cars and highways
• Pencils, paint, and crayons

Factors

• Toddlers with pica (eating anything edible or not; paint chips)

Sign and symptoms

• CNS
• Permanent cognitive impairment
• Mental retardation
• Renal
• Renal failure: oliguria and hematuria
• Hematology
• Anemia: fatigue, forgetfulness, fainting
• Pallow

Diagnostics

• Blood test
• Normal: 5 mcg/dL
• Toxic: 15 mcg/dL

Nursing management

• Before therapy
• Check for kidney function (BUN and Crea) bc lead is excreted via the urine
• Adequate hydration
• Provide health teaching
• Supervision in playgrounds
• Safe toys
• Monitor children with pica

Medical management

• Chelation therapy
• Calcium disodium edetate
• Succimer
• Based on british anti lewisite:
• Route: IM or IV
• Contraindicated: pt with peanut allergy, G6PD
• Ethhelynneediamine tatraacetic acid (EDIA)

ACETAMINOPHEN OVERDOSE

Description

• Acetaminophen is hepatoxic

Cause

• Toxic dose of 150 mg/kg or higher in children

Factors

• Amount ingested
• Length of time before treatment
• Intentional
• History of liver failure

Sign and symptoms

• First 2-4 hours
• Malaise (generalized fatigue)
• Nausea and vomiting
• Sweating, pallor, weakness
• Hepatic
• RUQ pain
• Jaundice
• Confusion and stupor (hepatic encephalopathy)
• Elevated liver enzymes
• Prolonged Prothrombin time (low levels of vit K)

Diagnostics

• Blood test
• Rumack Matthew Nomogram: test for acetaminophen
• What was ingested?
• What time ingested?
• What time was seen on the flood?

Medical management

• Less than 4 hours: paracetamol at 4 hours post-ingestion
• 4-8 hours post-ingestion: N-Acetylcysteine, add to juice or soda
• If unconscious use gastric lavage and activated charcoal

ACETYLSALICYLIC ACID (ASPIRIN)

Cause

• Household cleaners, detergents, bleach, paint, batteries

Sign and symptoms

• WOF: airway patency
• Burned Mouth, Throat, and Stomach:
• Edema in tongue, lips, pharynx
• Vomiting
• Drooling and inability to clear secretions

Nursing management

• Emergency Room:
• Assess the child:
• Terminate exposure to the poison
• Identify the poison
• Take measures to prevent absorption of the poison
• Document event and assessment findings
• At Home:
• Move the child away from harm
• Call Poison Control Center
• Inform (if known):
• Substance ingested
• Time seen
• Signs and symptoms

Medical management

• Dilution of corrosive water or milk: To reduce the corrosive's strength.
• Contraindicated:
• Induced vomiting
• Neutralization (No activated charcoal, as it can cause burns)