CHILD HEALTH NURSING

Growth and Development

Growth increase in phsical si!e o" the #od $%&antitative
chan'e(
Development pro'ression in s)ill and or a#ilit to
"&nction $%&alitative chan'e(
*rinciples+
A contin&o&s process
, od sstems don-t develop at the same rate
C ephaloca&dal
D evelopment proceeds "rom pro.imal to distal
E levation "rom 'ross motor to re"ined s)ills
/ or pla is the &niversal lan'&a'e o" children
G rowth rate varies
H as to "ollow a de"inite and predicta#le pattern o" trends
I mportant indicator o" development is the #ehavio&r
0 &st as each child is &ni%&e
Sta'es o" Growth 1 Development
,asic Divisions o" Childhood
Sta'e+
Neonate "irst 23 das o" li"e
In"ant 4 mo 4 r
Toddler 4 5 r
*reschooler 5 6 r
School A'e 7 42 r
Adolescent 45 28 r
In"anc *eriod
A rapid 'rowth and development
4 month &ntil 4 ear
Eri)son + Tr&st vs9 :istr&st
/re&d + ;ral $ID(
*ia'et-s + Sensorimotor sta'e $8<2 ears old(
4 month+ neonatal re"le.
4<= months+ primar circ&lar reaction $#od is center o"
attention(
=<3 months+ secondar circ&lar reaction $"rom #od to
environment(
3<42 months+ coordination o" secondar reaction
42<43 months+ tertiar circ&lar reaction $trial 1 error(
/ear + Stran'er An.iet
*la + Solitar
Tos + mo#ile> rattle> teethin' rin's> m&sical tos> cri#>
'm
Toddler
A'e 4 to 5 ears
,ow<le''ed
Characteri!ed # alternatin' rapid and slow rate o" 'rowth 1
development
Eric)son + A&tonom vs9 Shame 1 do&#t
/re&d + Anal $EG;(
*ia'et-s + *reconcept&al ? *reoperational sta'e $5<= ears
old(
A toddler draws concl&sion onl "rom the o#vio&s "acts that
the see
43<2= month+ invention o" new means thro&'h mental
com#inations
@ohl#er' + Level 4+ *reconventional
Sta'e 4+ $2 <5 ears old(
*&nishment?;#edience orientation
/ear + Separation An.iet
*la + *arallel
Tos + *&sh and p&ll
*re school period
A'e 5 to 6 ears
Eric)son + Initiative vs9 G&ilt
/re&d + *hallic
*ia'et-s + Int&itive sta'e $6<7 ears old(
A ssimilation
, ma'ical thin)in'
C enterin'
D on-t aware o" reversi#ilit
E 'ocentrism
/ antas role
@ohl#er' + Level 4+ *reconventional
Sta'e 2+ =<A ears old
Individ&alism
/ear + :&tilation and castration
*la + Associative 1 Imitation
Tos + a simple Bi'saw p&!!le> dolls> colorin' #oo)>
pencils> pens> craons
School period
A'e 7 to 42 ears
, havin' a slow period o" 'rowth and development
Eric)son + Ind&str vs9 In"eriorit
/re&d + Latenc
*ia'et-s + Concrete operations $A<42 ears old(
Aware o" reversi#ilit
, ind&ctive reasonin'
Conservation 1 Classi"ication
Development o" Lo'ical tho&'ht patterns
@ohl#er' + Level II+ Conventional
Sta'e 5+ A<48 ears old
;rientation to interpersonal relations o" m&t&alit
Sta'e =+ 48<42 ears old
:aintenance o" social order
/ear + Displacement "rom school
*la + Cooperative 1 Collecti#les
Tos + Remote control 'ames> 'ame #all> ta#le 'ames
Adolescence
A'e 45 to 28 ears
Accelerated 'rowth and mat&ration in"l&enced # hormonal
chan'es
Characteri!ed # 'rowth sp&rt which #e'ins earl in 'irls>
a#o&t 4<2 ears ahead than #os
Eric)son + Identit vs9 Role con"&sion
/re&d + *&#ert?Genital
*ia'et-s + /ormal sta'e $42 ears old 1 a#ove(
A#stract thin)in'
, ded&ctive reasonin'
@ohl#er' + Level III+ *ost<conventional
Sta'e 6+ 42 ears and over
Social contract $"ollows standards o" societ "or the 'ood o"
all people(
Sta'e 7+ 42 ears and over
Universal ethical principle orientation
/ear + Displacement "rom peers
*la + Athletic 1 Sports
Tos + :&sic 'ad'ets etc9
:aternal<In"ant #ondin'
A special m&t&al relationship #etween mother and in"ant
, est initiated immediatel a"ter #irth
C an #e achieved within the "irst 58 min&tes or
D &rin' the "irst period o" reactivit
E .hi#ited thro&'h+ ,reast"eedin'
Roomin'<in
Senses stim&lation
Assessment
Initial care o" the new#orn
Assessment
o#serve or assist with initiation o" respirations
assess ap'ar score $pls see ta#le #elow(
monitor "or nasal "larin'> 'r&ntin'> retractions 1 a#normal
respirations
o#tain vital si'ns
o#serve new#orn "or si'ns o" hpothermia or hperthermia
assess 'ross anomalies

Interventions
S&ction mo&th> then nares with #&l# srin'e
Dr new#orn and stim&late crin' # r&##in'
:aintain temperat&re sta#ilitC wrap new#orn in warm
#lan)ets and place stoc)inette cap on new#orn-s head
@eep new#orn with mother to "acilitate #ondin'
*lace new#orn at mother-s #reast i" #reast"eedin' is planned>
or place on mother-s a#domen
*lace new#orn in warmer
*osition new#orn on side or a#domen or in modi"ied
Trendelen#&r' position to "acilitate drainan'e o" m&c&s
Ens&re new#orn-s proper identi"ication
/ootprint new#orn and "in'erprint mother on identi"ication
sheets
*lace matchin' identi"ication #racelets on mother 1 new#orn

Ap'ar Screenin' test $# Dr9 Dir'inia Ap'ar(
< Done twice at 4 and 6 min&tes respectivel
Criteria 8 4 2
HR+ a#sent E488 F488
RR+ a#sent wea) cr vi'oro&s cr
Re"le.
Irrita#ilit+
no response 'rimace vi'oro&s cr
:&scle
tone+
limp?"laccid minimal "&ll "le.ion
S)in color+ #l&e acrocanosis pin)
Scores+ Interpretation
*oor < needs immediate C*R
/air < needs "&rther o#servation 1 stim&lation
A<48 Good < health
Estimation o" A'e o" Gestation # Dr9 ,allard-s and D&#owit!
Criteria+
49 *hsical characteristics
*re<mat&re Term /&ll<term
S)in+ ver thin>
'elatino&s> 1
visi#le #lood
vessels
smooth>
thic)> less
visi#le #lood
vessels
parchment>
leather>
crac)ed>
wrin)led
Lan&'o+ A#&ndant thinnin' #ald
*lantar
creases+
anterior
transverse
2?5 with
creases
entire sole
w? creases
,reast+ strippled
areola
raised
areola
"&ll areola
Ear+ "lat 1
"olded
thin 1 so"t thic) 1
"irm
Genital
$:(+
&ndescended
testes
intermediate "&ll
descended
Genital
$/:(+
prominent
la#ia 1
clitoris
la#ia minora
1 clitoris
partl
covered #
la#ia maBora
completel
covers
minora 1
clitoris
29 Ne&rom&sc&lar characteristics
*re<mat&re /&ll term
*ost&re+ e.tension "le.ion
S%&are window+ G8H an'le 8H an'le
Arm recoil+ FG8H an'le EG8H an'le
Scar" si'n+ el#ow passed
midline
not passed
*olpliteal an'le+ FG8H an'le EG8H an'le
Heel to ear+ positive ne'ative
59 Ne&rolo'ical assessment
Re"le.es+
Rootin'+ elicited when N, chee) is to&ched and t&rns towards
the stim&l&s
E.tr&sion+ "ood placed on in"ant-s ton'&e is thr&st "orward
and o&t o" mo&th
Tonic nec)+ as head is t&rned to one side> arm 1 le' on that
side e.tends with opposite e.tremities in "le.ion
*almar 'rasp+ elicited # placin' "in'er in the N, palm
:oro?Startle+ new#orn smmetricall a#d&cts and e.tends
arms
Steppin'+ hold the N, in a vertical position allowin' one "oot
to to&ch a ta#le s&r"ace
,a#ins)i+ dorsi"le.ion o" #i' toe and "annin' o" all "o&r toes as
sole "oot is stro)ed "rom heel
*ro"ile o" a New#orn
A9 ,irth wei'ht+ 296 to 59= )' $696 to A9A l#s(
,I+ do&#les at 7 months
triples at 42 months
%&adr&ples at 2 J ears
L,I+ E 2>688 'rams
Der L,I+ E48
th
percentile
LGA F=>888 'rams or FG8
th
percentile
,9 ,irth len'th+ =7 to 6= cm $43<22 inches(
C9 Head Circ&m"erence+ 5= to 56 cm $4596<4= inches(
D9 Chest Circ&m"erence+ 52 to 55 cm $42<4592 inches(
E9 Dital Si'ns
Temperat&re + GA97 to G397H/ $5796 to 5A HC( a.illar
Heart rate + 428 to 4=8 #pm
RR + 58 to 78 #reaths per min&te
,* + 38?=7 mmH'
*hsical Assessment
Head
Anterior "ontanel+ so"t> "lat diamond shaped> 5 to = cm wide
# 2 to 5 cm lon'
< closes #etween 42<43
months
*osterior "ontanel+ trian'&lar> 4 cm wide
< closes 2<5 months
Cap&t s&ccedane&m+ swellin' o" scalp ca&sed # prolon'ed
la#or
< crosses over s&t&re
line
< 'rad&all disappears
at a#o&t third da o" li"e
Cephalhematoma+ collection o" #lood ca&sed # increase
press&re o" #irth
< ca&sed # r&pt&re o"
periosteal capillar
< a#sor#ed within 5<7
wee)s
69 Craniota#les+ locali!ed so"tenin' o" the cranial #ones
< ca&sed # press&re o" the "etal s)&ll
a'ainst the mother-s pelvic #one in &tero
< condition corrects itsel"
witho&t treatment in "ew months
/ace+ o#serve "or smmetr
Ees
A ss&me permanent color #etween 5 1 42 months o" a'e
, l&e or 'ra irises
C ornea ro&nd
D &e &ntil =<7 months+ stra#ism&s
E rthromcin anti#iotic ointment at #irth
/ or protection a'ainst chlamdia in"ection or ophthalmia
neonator&m
G ets s&#conB&nctival hemorrha'e+ a red spot on sclera on
inner aspect o" ee d&e to press&re at #irth $a#sor#ed in 2<5
wee)s(
Nose+ nasal "larin' indicates respirator distress
Ears
The pinna normall ali'n "rom inner to the o&ter canth&s o"
the ee
The low set ears indicate+
Chromosomal disease
@idne disease
Cranio"acial lesions
Test new#orn hearin' # rin'in' a #ell held 7 inches "rom
each ear
:o&th
: oniliasis $;ral thr&sh(?Candidiasis white chees patches in
m&co&s mem#rane and ton'&e
; #serve "or Cle"t lip and palate
U s&all #lowin' #&##les?m&c&s?droolin' indicates
tracheoesopha'eal "ist&la and esopha'eal atresia
T on'&e appears lar'e and prominent
T eeth $Natal( m&st #e eval&ated "or sta#ilit> i" loose>
needs e.traction to prevent aspiration
H avin' white 'listenin' well circ&mscri#ed cst commonl
seen in palate ca&sed # e.tra load o" maternal calci&m
Epstein pearl
Nec)
Short ch&## with creased s)in "olds
Chec) "or ri'idit o" nec) Con'enital Torticollis?:enin'itis
Chest
An en'or'ed #reast d&e to in"l&ence o" maternal hormones
A#domen
A #dominal conto&r sli'htl protr&#erant
, owel so&nds occ&r 4 ho&r a"ter #irth
C hec) "or 'astrochisis and omphalocele
D &e a"ter an ho&r+ &m#ilical cord st&mp appears white
'elatino&s> with red and #l&e strea)s
E nco&ra'e inspectin' cord clamp "or
#leedin' and+
4
st
ho&r o" li"e K cord is shrin)ed 1 dr> t&rns #rown<li)e
2
nd
to 5
rd
da K #lac)
7
th
to 48
th
da K #rea)s "ree
$leaves a 'ran&lated area that heals "ollowin' a
wee)(
/ or presence o"+
49 peristalsis and palpa#le olive shaped mass $ *loric
stenosis(
29 palpa#le sa&sa'e shaped mass $Int&ss&sception(
Imper"orate an&s
Tpes o" stools+
:econi&m 4
st
stool passed # the new#orn
stic)> 'reenish #lac)> or tar<li)e $odo&rless(
Transitional passed # N, #e'innin' 2
nd
or 5
rd
da o" li"e
'reenish ellow 1 loose $odo&rless(
:il) stool
,reast<"ed #a# stool+ li'ht ellow and so"t $sweet smellin'(
/orm&la<"ed #a# stool+ #ri'ht ellow and "ormed $noticea#le
odor(
Genital
49 :ale 'enitalia
A 'enesis a#sence o" or'an
, &rinar meat&s o" penis located+
Dorsal $a#ove( epispadias
Dentral $#elow( hpospadias
C rptorchidism &ndescended testes> ma lead toL
D- "ollowin' complications+
a( In'&inal hernia
#9( Sterilit
c( Testic&lar cancer
E ctopic testes ina#ilit o" testes to
enter scrot&m d&e to clos&re o"
scrotal sac
29 /emale 'enitalia
Swollen d&e to e""ect o" maternal hormone
*se&domenstr&ation
E.tremities
A rms and le's appear short
, clenched 1 "isted hands
C rease $simian( associated with down sndrome
D i'its $"in'ers 1 toes( assessment+
Sndactl we##in'
*oldactl e.tra "in'ers 1 toes
Adactl a#sence o" one or more di'its
E .tra pad o" "at in sole o" "oot "lat sole $normal(
/ eet is plantar "le.ed indicates cl&#"oot
G ets #owed 1 short N, le's $normal(
H ip dislocation or Dsplasia # ;rtolani test
I n a#d&ctin' the hips o" the new#orn+
#oth hips sho&ld a#d&ct completel so the lie almost "lat
a'ainst the mattress 438H
,ac)
A mass> t&"t o" hair> dimple $incomplete clos&re o" verte#rae(
indicates Spina ,i"ida
, normall "lat and strai'ht
C &rve o" #ac) &s&all develops at 6<7 months
S)in
Assessment+
A red pin) s)in $normal(
, l&e hands and "eet acrocanosis
C anosis hpo.ia
D- colors+
pallor anemia
ellow Ba&ndice $within 2= ho&rs K patholo'ic(
DIII9 :aBor Developmental :ilestone
2 months head la'
social smile
cooin'
5 months li"ts head 1 sho&lders
= months li"ts chest
6 months roll over
7 months sit with s&pport
palmar 'rasp
A months trans"er o#Bect hand to
hand
3 months sit witho&t s&pport
G months crawls
48 months p&lls sel" to standin'
44 months cr&ises $wal)s with
s&pport(
42 months stands alone
holds c&p 1 spoon
46 months wal)s alone
43 months r&n 1 B&mp in place
2= months open doors # t&rnin' door )no#s
58 months can B&mp down "rom stairs
*ediatric Disorders
I9 Ne&rolo'ical Disorders
A9 Hdrocephal&s e.cess o" CS/ in the ventricles or the
s&#arachnoid space
F Comm&nicatin' hdrocephal&s or e.traventric&lar
hdrocephal&s+ "l&id can reach the spinal cord
F ;#str&ctive hdrocephal&s or intraventric&lar
hdrocephal&s+ with #loc)a'e on passa'e o" "l&id
< Ca&ses o" E.cess CS/+ ;verprod&ction o" "l&id # choroid
ple.&s in 4
st
or 2
nd
ventricle
;#str&ction o" the passa'e
o" "l&id in the narrow a%&ed&ct o" slvi&s
$most common(
Inter"erence with the
a#sorption o" CS/ "rom s&#arachnoid space
< S?S.+ A nterior "ontanel #&l'in'
, ones o" the head are widel separated that prod&ces a
crac)ed<pot so&nd K :acewen-s si'n
, row #&l'es $#ossin'(
C hec) "or s&n<settin' ees
D- increase in IC*
E rrita#ilit shrill hi'h pitched cr
< :ana'ement+
4( aceta!olamide $Diamo.(+ promote e.cretion o" "l&id
2( Dentric&loperitoneal sh&nt+ "l&id drains into the peritone&m
F headache 1 lac) o" appetite+ earliest
common si'ns o" mal"&nction
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or Ine""ective Cere#ral Tiss&e *er"&sion r?t IC*
/lat on #ed prevent rapid draina'e o" CS/ leadin' to
r&pt&re o" cere#ral arteries
Avoid lin' on side w? sh&nt prevent press&re on
valve
Care"&ll elevate 46 58 de'rees i" IC*
2( Ris) "or Im#alance N&trition> less than #od re%&irements
r?t IC*
S&pport heads when "eedin' hold head w? whole palm to
avoid p&nct&re o" the s)&ll
Iatch o&t "or poor> ine""ective s&c)in' si'n o"
IC*
,9 Ne&ral T&#e Disorders
4( Spina ,i"ida ;cc&lta posterior laminae o" verte#ra "ail to
"&se d&rin' em#ronic development
S?S.+ Dimplin' at the point o" poor "&sion
w? a#normal t&"ts o" hair or discolored s)in
on site
2( :enin'ocele menin'es coverin' the spinal cord herniate
thro&'h &n"ormed verte#rae
S?S.+ *rotr&din' mass at the center o" the #ac)
Covered # a laer o" s)in or clear d&ra mater
5( :elomenin'ocele spinal cord 1 menin'es protr&de
thro&'h the verte#rae
S?S.+ /laccid 1 lac) o" sensation o" the lower e.tremities
Loss o" #ladder and #owel control
< Ca&ses+ Lac) o" "olic acid
Heredit
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or In"ection r?t r&pt&re or #acterial invasion o"
ne&ral t&#e sac
*rone )eeps "low o" "eces 1 &rine awa "rom the disorderC
p&t "olded towel &nder the a#domen to "le. in"ant-s hips
red&cin' press&re to sac
Side lin' p&t rolled #lan)et or diaper #ehind &pper 1
separate one #ehind their lower #ac) $no press&re on the
lesion(
p&t "olded diaper #etween the le's $prevents s)in s&r"ace
"rom to&chin' 1 r&##in'(
*lace a st&rd plastic wrap #elow the menin'ocele
Sterile> wet compress w? NSS over the lesion do not
remove> B&st add "l&id
2( Ris) "or Im#alance N&trition+ less than #od re%&irements
r?t di""ic&lt ass&min' normal "eedin' position
Ens&re lesion is not pressed # s&pportin' arm d&rin' "eedin'
Ihen #&##lin' in"ant> advise not to pat #ac) over
the disorder
I" lesion is lar'e prone or side lin' when "eedin' w? pillow
or "olded diaper &nder the head
C9 :enin'itis < in"ectio&s process o" the menin'es d&e to
#acteria> vir&ses> tra&ma 1 in"ections
< D.+ CS/ analsis o#tained # l&m#ar p&nct&re
< S?S.+ A n&chal ri'idit
, r&d!ins)i-s
@ erni'-s si'n
< N&rsin' Intervention+ Respirator isolation within 2= hrs
d&rin' anti#iotic treatment
D9 Cere#ral *als < ne&rom&sc&lar disa#ilit in which the
vol&ntar m&scles are poorl controlled
< Ca&ses+ Low #irth wei'ht
,irth inB&r
*remat&re #irth
< S?S.+ * ost&re is a#normal> ri'id 1 "i.ed
A rchin' o" the #ac) $;pisthoton&s(
L imp or "lopp #od post&re
S cissorin' o" le's
M et crawls instead o" wal)in'
< Tpes+
4( Spastic e.cessive tone in the vol&ntar m&scles
2( Ds)inetic or Athetoid involves a#normal invol&ntar
movement
5( Ata.ic w? aw)ward> wide #ased 'ait
=( :i.ed spastic N athetoid or ata.ic N athetoid
< N&rsin' Interventions+ S a"et
S el" Esteem
S &pport 'ro&ps
II9 Respirator Disorders
A9 *harn'itis in"ection and in"lammation o" the throat
4( Diral
S?S.+ sore throat> "ever 1 'eneral malaiseC enlar'ed re'ional
lmph nodes> erthema in the #ac) o" pharn. 1 palatine arch
< :ana'ement+
a( acetaminophen> i#&pro"en
#( Iarm heat to the e.ternal nec) area "or com"ort
c( Gar'le w? warm water
2( Streptococcal ca&sed # GA,HS
< S?S.+ ethema in the #ac) o" throat 1 palatine tonsils>
enlar'ed tonsils> white e.&dates in tonsillar crpts> petechiae
on palate> hi'h "ever> e.tremel sore throat> di""ic&lt
swallowin'> overall lethar'> headache
< :ana'ement+
a( /&ll 48 das anti#iotic treatment $*enicillin G or
Clindamcin(
F advise parents to strictl "ollow the co&rse to
prevent hpersensitivit or a&toimm&ne reaction to 'ro&p A
strep ca&sin' rhe&matic "ever or 'lomer&lonephritis
,9 Tonsillitis < in"ection and in"lammation o" the palatine
tonsils
<Ca&ses+
in <5 ?o+ viral
in school a'e+ GA,HS
< S?S.+ droolin'> di""ic&lt swallowin'> hi'h "ever> lethar'>
enlar'ed> #ri'ht red palatine tonsils
< AS; Titer
< :ana'ement+
4( Antipretic> anal'esic
2( /&ll 48 das anti#iotic treatment $*enicillin or Amo.icillin(
5( Tonsillectom $"or chronic tonsillitis(
F done when or'ans aren-t in"ected
< *rone or side lin' position+ head lower than chest to drain
#lood
< Chec) si'ns o" #leedin'+ p&lse 1 RR> "re%&ent swallowin'>
throat clearin'> "eelin' o" an.iet
< Restrict child-s activit $no 'mnastics 1 swimmin'( &ntil
a"ter A
th
da
F 4
st
da+ clots "orm on area
F 6<A das+ clots lse?dissolve(
< ;""er sips o" clear li%&id> popsicles or ice chips
< Avoid acid 1 car#onated #evera'es
< Avoid red "l&id s&ch as @ool Aid
C9 Cro&p or Larn'otracheo#ronchitis in"lammation o"
larn.> trachea 1 maBor #ronchi
< Ca&se+ 7 mos<5 ?o parain"l&en!a vir&s
< S?S. happens at ni'ht+ C rac)les?Ihee!es
R &dd> #rass spasmodic
co&'h
Retractions

; #str&ction o" airwa
U s&all a hoarse voice
* ersistent larn'ospasm
< :ana'ement+
4( R&n shower or hot water tap in #athroom+ )eep child in this
warm> moist environment
2( Cool moist air w? de.amethasone or racemic epinephrine
< N&rsin' Dia'nosis with Intervention?s+
4( Ine""ective Airwa Clearance r?t edema 1 constriction o"
airwa
Do not elicit a 'a' re"le.
@eep child "rom crin'
D9 Epi'lottitis in"lammation o" the epi'lottis
< Ca&ses+ pne&mococci> streptococci> staphlococci
< S?S.+ 5D-s+
Droolin'
Dspnea
Dspha'ia
< :ana'ement+
4( Never attempt to vis&ali!e the epi'lottis directl w? a
ton'&e #lade or o#tain a throat c&lt&re to prevent 'a''in' and
o#str&ction o" 'lottis
2( Tripod position
5( Enco&ra'e Hi, vaccine
=( ;2 hood> :ist tent> Cro&pette> Cool ;2
6( cephalosporin $Ce"&ro.ime(
7( *rophlactic tracheostom to prevent total o#str&ction
A( *rophla.is "or si#lin's
E9 Asthma chronic in"lammator disease o" the airwas
< S?S.+
Di""ic&lt e.halin' Ihee!in'
Dspnea Copio&s w?
white casts m&c&s
Lon' e.pirator rate Dehdration
< :ana'ement+
4( Avoid co&'h s&ppressants
2( /or mild #&t persistent asthma+ inhaled anti<in"lammator
corticosteroid $"l&ticasone(
:oderate persistent smptoms+ lon' actin' #ronchodilator
N "l&ticasone
Severe persistent+ oral 1 inhaled corticosteroid N lon'
actin' #ronchodilator N short actin' #eta 2 a'onist
#ronchodilator $al#&terol or ter#&taline(
5( Cromoln sodi&m mast cell sta#ili!er
F prevent #ronchoconstriction there# preventin' smptoms
o" asthma
=( montel&)ast $Sin'&lair( le&)otriene receptor anta'onist
F &sed as prophla.is 1 "or chronic asthma
6( theophlline?aminophlline
F S?E+ tachcardia
F A?E+ hpotension
7( Increase "l&id inta)e
F avoid mil) 1 mil) prod&cts $ca&ses thic) m&c&s 1
di""ic&lt swallowin'(
/9 *ne&monia in"ection 1 in"lammation o" alveoli
< Ca&ses+ ,acterial pne&mococcal> streptococcal>
staphlococcal> chlamdial
Aspiration o" lipid or hdrocar#on s&#s
New#orn #orn >2= hrs a"ter r&pt&re o" mem#ranes
New#orn who aspirated amniotic "l&id 1 meconi&m
4( *ne&mococcal a#r&pt> "ollows an URTI
< S?S.+
,lood tin'ed sp&t&m #= 2= hrs
Retractions Nasal "larin'
Thic) p&r&lent sp&t&m a"ter 2=<=3 hrs Chest pain
Dspnea
Hi'h "ever
Chills Tachpnea
D&llness on perc&ssion
Crac)les
< :ana'ement+
ampicillin or 5
rd
'en cephalosporin
amo.icillin<clav&lanate $A&'mentin( "or penicillin resistant
or'anisms
,ed rest
Reposition child "re%&entl avoid poolin' o" secretions
H&midi"ied ;2 alleviate la#ored #reathin' 1 hpo.emia
C*T enco&ra'es movement o" m&c&s
Enco&ra'e to co&'h
Small> "re%&ent "eedin's
2( Chlamdial common in new#orns &p to 42 wee)s
< S?S.+
Nasal con'estion Tachpnea Rales
Sharp co&'h Ihee!in'
< :ana'ement
a( :acrolide anti#iotic erthromcin
5( Diral RSD> m.ovir&s> adenovir&s
< S?S.+
Low 'rade "ever Tachpnea
Non prod&ctive co&'h
Diminished #reath so&nds
< :ana'ement+
a( ,ed rest
#(Antipretic
c( ID/
III9 Cardiovasc&lar Disorders
A9 Con'enital Heart Disorders
< Ca&ses+ /ail&re o" heart to pro'ress #eond em#ronic
development
:aternal r&#ella
Heredit
< 4
st
Classi"ications+ $accordin' to e""ect(
4( Acanotic heart disease has strict&re to #lood "low or
sh&nt that moves #lood "rom arterial to veno&s sstem
$o.'enated to &no.'enated or le"t to ri'ht sh&nts(
2( Canotic veno&s to arterial $&no.'enated to o.'enated
or ri'ht to le"t sh&nts(
< 2
nd
Classi"ications+ $addresses the hemodnamic 1 #lood "low
patterns(
4( Disorders w? increased p&lmonar #lood "low le"t to ri'ht
thro&'h a#normal openin' or connection #etween 2
sstems?arteries
a( Dentric&lar Septal De"ect w? openin' in sept&m o" 2
ventricles
F res&lts to ri'ht ventric&lar hpertroph 1 press&re to
p&lmonar arter
< S?S.+ Eas "ati'a#ilit
Lo&d> harsh pansstolic m&rm&r
*alpa#le thrill?vi#ration
< :ana'ement+
4( Cardiac catheteri!ation
2( ;pen heart s&r'er+ < 2 ?o to prevent p&lmonar arter
hpertension
F p&t Silastic or Dacron patch
F post op+ #e alert "or arrhthmias
#( Atrial Septal De"ect a#normal comm&nication #etween 2
atria
F res&lts to ri'ht ventric&lar hpertroph 1 press&re to
p&lmonar arter
< S?S.+ Harsh sstolic m&rm&r
/i.ed splittin' dia'nostic o" ASD
< :ana'ement+
4( S&r'er #etween 4<5 ?o
F p&t Silastic or Dacron patch
F post op+ watch o&t "or arrhthmias
2( Cardiac catheteri!ation
c( *atent D&ct&s Arterios&s #lood sh&nt "rom aorta to
p&lmonar arter
F res&lts to ri'ht ventric&lar hpertroph
< S?S.+ Iide p&lse press&re
Low diastolic press&re
Contin&o&s machiner li)e m&rm&r
< :ana'ement+
4( ID indomethacin assess side e""ects $red&ced 'lomer&lar
"iltration> impaired platelet a''re'ation> diminished GI 1
cere#ral #lood "low(
2( i#&pro"en "ewer side e""ectsC prophla.is "or preterm
in"ants
5( Cardiac catheteri!ation insert Dacron coated stainless
steel coils $7 mos<4 ?o(
=( D&ctal li'ation
2( Disorders with o#str&ction to #lood "low
a( *&lmonar Stenosis narrowin' o" p&lmonar valve or
p&lmonar arter
F res&lts to ri'ht ventric&lar hpertroph
< S?S.+ Canosis Thrill
Sstolic eBection m&rm&r Iidel split
2
nd
heart so&nd
< :ana'ement+
4( ,alloon an'ioplast
#( Aortic Stenosis strict&re o" aortic valve
F res&lts to press&re 1 hpertroph o" le"t ventricle 1
p&lmonar edema
< S?S.+ Ro&'h sstolic m&rm&r Chest pain
Thrill
I" severe "aint p&lses> hpotension>
tachcardia> ina#ilit to s&c)
< :ana'ement+
4( ,eta #loc)er or Ca channel #loc)er "or sta#ili!ation
2( ,alloon valv&loplast
5( Arti"icial valve replacement
c( Coarctation o" the Aorta narrowin' o" the aorta
< S?S.+ ,* in heart 1 &pper #od :oderatel lo&d
sstolic m&rm&r
Headache No
palpa#le "emoral p&lses
Le' pain Nod&les on
ri#s enlar'e collateral arteries
Derti'o
< :ana'ement+
4( An'io'raph # #alloon catheter
2( S&r'er di'o.in 1 di&retics #= s&r'er to red&ce CH/
$done # 2 ?o(
5( Disorders with mi.ed #lood "low
a( Transposition o" Great Arteries aorta arises "rom ri'ht
ventricle instead o" the le"t> p&lmonar arter arises "rom
the le"t instead o" the ri'ht
< S?S.+ Canotic #irth
< :ana'ement+
4( *GE prosta'landin
2( ,alloon atrial septal p&ll thro&'h
5( Arterial switc+ 4 w) <5 mos a'e
=( Disorders w? decreased p&lmonar #lood "low
a( Tetralo' o" /allot with p&lmonar stenosis> DSD>
overridin' o" the aorta 1 ri'ht ventric&lar hpertroph
< S?S.+ *olcthemia Cl&##in' o" "in'ers
Severe dspnea
S%&attin'?)nee<chest position when restin'
Growth restriction Tet
spells?hpo.ic episodes
< :ana'ement+
4( ,laloc)<Ta&ssi' proced&re no ,* 1 venip&nct&res on ri'ht
arm a"ter proced&re
2( @eep hpo.ic episode to minim&m ;2> s%&attin'?)nee<
chest> morphine or propanolol
5( ,roc) proced&re repair p&lmonar stenosis> DSD 1
overridin' aorta
,9 Rhe&matic /ever a&toimm&ne that occ&rs as a reaction to
a GA,HS in"ection
Si'ns 1 Smptoms $0ones Criteria(
:inor :aBor
*rolon'ed *R 1 OT interval
Elevated sedimentation rate
C<reactive protein
Le&)octosis
Arthral'ia
/ever
*olarthritis
Erthema mar'inat&m
Carditis
Chorea
S&#c&taneo&s nod&les
< :ana'ement+
4( penicillin erthromcin
2( #en!athine penicillin I: $,icillin(
5( Corticosteroid+ S?E+ hirs&tism> ro&nd moon "ace>
s&scepti#ilit to in"ection
=( *heno#ar#ital 1 dia!epam+ "or chorea
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or nonadherance to dr&' therap
Dr&' level m&st #e maintained "or 48<4= das
*rophlactic anti#iotic therap "or atleast 6 rs
a"ter initial attac)
1 when havin' dental or tonsillar s&r'er
C9 @awasa)i Disease m&coc&taneo&s lmph node sndrome
F vasc&litis is the principal 1 li"e threatenin' "indin' #eca&se
it can lead to :I or ane&rsm
Criteria "or Dia'nosis o" @awasa)i Disease
/ever 6 das d&ration
,ilateral con'estion o" oc&lar conB&nctivae
Chan'es o" m&co&s mem#rane o" URT $red pharn.>
lipsC Pstraw#err ton'&eQ(
Chan'es o" peripheral e.tremities $peripheral
erthema 1 edema> des%&amation o" palms 1 soles(
Rash tr&ncal> polmorpho&s
Cervical lmph node swellin'
< :ana'ement+
4( aspirin or i#&pro"en
2( a#ci.ima# platelet receptor inhi#itor
5( ID I'
=( Avoid steroids < ane&rsm "ormation
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or Ine""ective *eripheral Tiss&e *er"&sion
;#serve "or si'ns o" heart "ail&re tachcardia> dspnea>
rales 1 edema
Inspect e.tremities "or color 1 warmth
Chec) capillar re"ill
2( *ain r?t swellin' o" lmph nodes 1 in"lammation o" Boints
*rovide roc)in' 1 holdin'
*rotect edemato&s areas "rom press&re
@eep child "ree "rom heav #lan)ets or clothin'
Use a so"t padded tooth#r&sh "or #r&shin'
ID9 Hematolo'ic Disorders
A9 Sic)le Cell Anemia presence o" a#normall shaped R,Cs
F a&tosomal recessive inherited disorder
< S?S.+ /ever *rotr&din'
a#domen Domitin'
Swellin' o" hands 1 "eet Mellowed
sclera Enlar'ed liver
Enlar'ed spleen
Ac&te #ac) pain
R Sic)le Cell Crisis+ s&dden> severe onset o" sic)lin'
F occ&rs when dehdrated or w? respirator in"ection that
res&lts in lowered ;2 e.chan'e 1 low arterial ;2 level or
a"ter e.tremel stren&o&s e.ercise
< :ana'ement+
4( *ain relie" acetaminophen
2( Ade%&ate hdration
5( ;.'enation
=( Hdro.&rea
6( E.chan'e trans"&sion
< N&rsin' Dia'nosis with Intervention?s+
4( Ine""ective Tiss&e *er"&sion r?t 'enerali!ed in"arcts d&e
to sic)lin'
;2 therap
,ed rest

,9 Thalassemia :aBor?Coole-s anemia a&tosomal recessive
anemia associated with a#normal #eta chains o" ad&lt
hemo'lo#in
E""ects o" Thalassemia :aBor
,od ;r'an or
Sstem
E""ect
,one :arrow Increased "acial mandi#&lar
'rowth
S)in ,ron!e colored
Spleen Splenome'al
Liver 1 Gall#ladder Cirrhosis 1 cholelithiasis
*ancreas Destr&ction o" islet cells 1
D:
Heart /ail&re "rom circ&lator
overload
< :ana'ement+
4( di'italis> di&retics> low sodi&m diet
2( Trans"&sion o" pac)ed R,C
5( de"ero.amine remove e.cess /e
C9 Hemophilia
4( Hemophilia A "actor DIII de"icienc
F se. lin)ed recessive trait
< S?S.+ E.tremel #r&ised lower e.tremities when #&mped
Swollen 1 warm Boints
< :ana'ement+
a( /resh whole #lood or "ro!en plasma
#( desmopressin
2( Don Iille#rand-s Disease?An'iohemophilia inherited
a&tosomal dominant
F with "actor DII de"ect $platelets &na#le to a''re'ate(
< S?S.+ epista.is $maBor pro#lem(
heav menstr&al "low
< :ana'ement+
a( ar'inine desmopressin
5( Christmas Disease or Hemophilia ,C "actor IS de"icienc
F se. lin)ed recessive trait
=( Hemophilia C "actor SI de"icienc
F or throm#oplastin antecedent de"icienc
F a&tosomal recessive
D9 GastroIntestinal Disorders
A9 Cle"t Lip "&sion o" ma.illar and median nasal processes
"ail
F normal+ "&se #etween 6<3 wee)s intra&terine li"e
F more common amon' #os
Cle"t *alate closes at G<42 wee)s intra&terine li"e
F involves anterior hard palate and?or posterior so"t palate
F more common amon' 'irls
< :ana'ement+
Cle"t Lip+ Cheiloplast #etween 7<42 wee)s
Cle"t *alate+ Uranoplast #etween 4<2 ?o
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or Im#alance N&trition> less than #od re%&irements
r?t "eedin' pro#lems
RCle"t lip
S&pport #a# in &pri'ht position and "eed 'entl &sin'
commercial cle"t lip
nipple $,rec) "eeder or Ha#erman(
,reast"eed A<48 das a"ter s&r'er
,&##le well the in"ant a"ter "eedin'
;""er sips o" "l&id #etween "eedin's $)eeps m&co&s
mem#rane moist 1 prevents crac)s 1 "iss&res(
RCle"t palate
Commercial cle"t palate nipple with r&##er
;""er so"t "ood $i" s&r'er is delaed #eond 7 mos(
2( Ris) "or Ine""ective Airwa Clearance r?t oral s&r'er
S&ction $#e 'entle> don-t to&ch s&t&re lines(
5( Impaired Tiss&e Inte'rit at incision line r?t s&r'er
RCle"t lip
T&rn in"ant lateral to the repair or on #ac) $to prevent
press&re on s&t&re line(
S&t&re line is held # a Lo'an #ar
Avoid in"ant crin' as m&ch as possi#le
RCle"t *alate
@eep el#ow restraints
No spoon 1 straw d&rin' "eedin'
@eep on prone position
,9 Tracheoesopha'eal Atresia 1 /ist&la trachea 1 esopha'&s
are connected
Esopha'eal Atresia o#str&ction o" the esopha'&s
< Ca&se+ Terato'ens
< S?S.+ 5C-s
Co&'hin'
Canosis
Cho)in'
< :ana'ement+
4( S&r'er prevent pne&monia 1 dehdration
F close "ist&la 1 anastomose esopha'eal se'ments
F o#serve closel "or A<48 das to chec) "or lea)s
2( Gastrostom empt secretions 1 prevent re"l&. into the
l&n's
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or Im#alance N&trition> less than #od re%&irements
Gastrostom "eedin'
a"ter "eedin'+ )eep the end o" the t&#e elevated with covered
sterile 'a&!e
2( Ris) "or In"ection r?t aspiration
*re;p+ position in an &pri'ht position or on ri'ht side to
prevent 'astric B&ice "rom enterin' the l&n's
/re%&ent oropharn'eal s&ctionin'
@eep in"ant "rom crin'
*ost ;p+ s&ction shallowl
T&rn "re%&entl
C9 Gastroesopha'eal Re"l&. called achalasia in in"ants
F cardiac sphincter 1 lower portion o" the esopha'&s are la. 1
allow eas re'&r'itation
< S?S.+ E""ortless vomitin'
Irrita#le
Episodes o" apnea
< :ana'ement+
4( /orm&la thic)ened rice cereal 4 t#sp cereal?4 o! "orm&la
or #reast mil)
F hold in"ant in &pri'ht position 1 )eep them &pri'ht in an
in"ant chair "or 4 ho&r
2( ranitidine or omepra!ole
5( Ti'htenin'?s&t&rin' o" esopha'eal sphincter
=( /&ndoplication
6( Do not lie down 2 hrs a"ter eatin'
D9 *loric Stenosis hpertroph o" the m&scle s&rro&ndin'
the ploric sphincter
< S?S.+ *roBectile vomitin' immediatel a"ter "eedin' < so&r>
no #ile
Dehdration lac) o" tears> dr mo&th> s&n)en "ontanels>
"ever> &rine o&tp&t> poor s)in t&r'or> wei'ht loss
Al)alosis
Hpopnea slowed respiration
;live shaped mass
< D.+ ,ari&m Swallow
< :ana'ement+
4( *loromotom electrolte im#alance> dehdration 1
starvation m&st #e corrected "irst
2( No oral "eedin's
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or /l&id Dol&me De"icit r?t ina#ilit to retain "ood
:onitor wei'ht 1 &rine o&tp&t
E9 Int&ss&sception inva'ination o" one intestine to another
< Ca&ses+ :ec)el-s divertic&l&m Hpertroph
o" *eer-s patches
*olp
,owel t&mors
< S?S.+ S&dden drawin' &p o" le's 1 cr #eca&se o" pain
Domitin' with #ile
C&rrant Bell stool
A#dominal distention
Sa&sa'e shaped mass $URO(
< :ana'ement+
4( S&r'er
2( Instillation o" water sol&#le sol&tion> #ari&m enema or air
$pne&matic ins&""lation(
< N&rsin' Dia'nosis+
4( *ain r?t a#normal a#dominal peristalsis
2( Ris) "or /l&id Dol&me De"icit r?t #owel o#str&ction
/9 Celiac Disease sensitivit or a#normal imm&nolo'ic
response to 'l&ten "o&nd in ,R;I $#arle> re> wheat 1 oat(
< S?S.+ Steatorrhea A#dominal distention
Dit ADE@ de"icienc :aln&trition
< :ana'ement+
4( Gl&ten "ree diet "or li"e
2( Iater sol&#le "orms o" Dit A 1 D
5( /e 1 "olate
< N&rsin' Dia'nosis with Intervention?s+
4( Im#alanced N&trition> less than #od re%&irements r?t
mala#sorption o" "ood
Record characteristics o" stools
Read "ood la#els care"&ll
Avoid spa'hetti> pi!!a> hotdo's> ca)e> coo)ies
G9 Hirschspr&n'-s Disease?A'an'lionic me'acolon
F a#sence o" 'an'lionic innervation to the m&scle o" a section
o" the #owel
F no peristaltic waves
< S?S.+ Chronic constipation A#dominal distention
Ri##on li)e stools /ail&re to pass
meconi&m # 2= hrs
< N&rsin' Dia'nosis with Intervention?s+
4( Constipation r?t red&ced #owel "&nction
Normal saline "or enemas+ 2 tsp noniodi!ed salt N 4
%&art water
2( Im#alanced N&trition> less than #od re%&irements
No "ried "oods 1 hi'hl seasoned "oods
*ost ;p+ assess "or #owel so&nds 1 passa'e o" "lat&s
H9 Imper"orate An&s strict&re o" the an&s
< S?S.+ A#dominal Distention
:em#rane "illed w? #lac) meconi&m protr&din' "rom an&s
/ail&re to pass meconi&m in the 4
st
2= hrs a"ter #irth
A#sent Pwin)Q re"le.
Stool in va'ina or &rine
< N&rsin' Dia'nosis with Intervention?s+
4( Im#alance N&trition> less than #od re%&irements r?t #owel
o#str&ction and ina#ilit "or oral inta)e
NGT to relieve vomitin' 1 press&re to a#dominal or'ans
Low resid&e diet $rice cereal> strained "r&its 1
ve'eta#les(
2( Impaired Tiss&e Inte'rit at rect&m r?t s&r'ical incision
Avoid rectal temperat&res> enemas> s&ppositories
Clean s&t&re lines with normal saline a"ter #owel
movements
*lace diaper &nder> not on> the in"ant to cleanse at once
the #owel movements
*lace in side lin' position to avoid tension in the perineal
area
Rectal dilatation 4. or 2.?da
DI9 Urinar Tract Disorders
A9 Hpospadia &rethral openin' is on the ventral $lower(
aspect o" the penis
Epispadia openin' is on the dorsal s&r"ace o" the penis
< S?S.+ Co#ra head appearance
Crptorchidism
< :ana'ement+
4( No circ&mcision portion o" "ores)in ma #e &sed d&rin'
repair
2( :eatotom
5( InBecta#le testosterone "or penis 'rowth
,9 Glomer&lonephritis in"lammation o" 'lomer&li that occ&rs
as a imm&ne comple. disease a"ter GA,HS in"ection
< S?S.+ Hemat&ria Reddish #rown?Smo) &rine
Hpertension
*rotein&ria ;li'&ria
A#dominal pain
/ever Edema
*rolon'ed *R interval
Domitin' Headache
T wave inversion
Anore.ia
< :ana'ement+
4( "&rosemide
2( Semi "owlers> di'itali!ation 1 ;2 i" w? heart "ail&re
5( Ca channel #loc)ers
=( @ae.alate "or @ 1 *hosphate
6( Normal salt 1 protein diet
7( Iei'h child dail
C9 Nephrotic Sndrome a#normal loss o" protein "rom the
&rine d&e to altered 'lomer&lar permea#ilit
< Ca&ses+ Anti'en<Anti#od reaction
A&toimm&ne
T lmphocte ds"&nction
< S?S.+ *rotein&ria Hpoal#&minemia
Edema Hperlipidemia
< :ana'ement+
4( Corticosteroids monitor protein loss
F can ca&se c&shin'oid appearance $moon "ace> e.tra "at at
#ase o" nec)> #od hair(
F do not stop a#r&ptl+ can ca&se adrenal ins&""icienc
2( cclophosphamide $Cto.an(
5( Di&retics 1 @ s&pplement
< N&rsin' Dia'nosis with Intervention+
4( Im#alanced N&trition> less than #od re%&irements r?t poor
appetite 1 protein loss
Good protein 1 potassi&m inta)e
:onitor "l&id inta)e
:onitor wei'ht dail $same clothin'> time 1 scale(
Comparison o" /eat&res o" AGN 1 Nephrotic Sndrome
/actor AGN Nephrotic
Sndrome
Ca&se Imm&ne reaction to
GA,HS
IdiopathicC
Hpersensitivit r.n
;nset A#r&pt Insidio&s
Hemat&ria *ro"&se Rare
Edema :ild E.treme
Hpertension :ar)ed :ild
Hperlipidemia Rare or mild :ar)ed
*ea) a'e
"re%&enc
6<48 ?o 2<5 ?o
Interventions Limited activitC
antihpertensivesC
smptomatic
therap "or CH/
CorticosteroidC
cclophosphamideC
di&reticsC @
s&pplement
Diet Normal "or a'e Hi'h protein> low
sodi&m
*revention *revention or
thoro&'h t. o"
GA,HS in"ection
None )nown
DII9 Endocrine or :eta#olic Disorders
A9 *@U a&tosomal recessive
F no phenlalanine hdro.lase+ phenlalanine in the #lood
< D.+ G&thrie #lood test
< S?S.+ :o&s odor Li'ht #londe hair
Der "air s)inned ,l&e ees
< :ana'ement+
4( Lo"enalac low phenlalanine "orm&la
2( Low protein diet
5( Avoid N&trasweet w? aspartane
,9 Cstic /i#rosis w? 'enerali!ed ds"&nction o" the
e.ocrine 'lands
F a&tosomal recessive trait
< D.+ *ilocarpine Iontophoresis+ >78 mE%?L $N Cstic /i#rosis(
< S?S.+ Tenacio&s secretions in pancreas 1 l&n's
Cl concentration o" sweat salt perspiration
,loc)in' o" the vas de"erens $tenacio&s seminal "l&id(
Thic) cervical secretions
Steatorrhea
:econi&m ile&s
:aln&trition
/at sol&#le vitamin de"iciencies
Respirator acidosis
< N&rsin' Dia'nosis with Intervention?s+
4( Ris) "or Im#alance N&trition> less than #od re%&irements
r?t ina#ilit to di'est "at
Hi'h calorie> hi'h protein> moderate "at diet
Ade%&ate salt inta)e
Iater misci#le Dit9 A> D> E
,reast"eedin' w? s&pplemental "orm&la so#ean "orm&la "or
mil) aller' or *ro#ana
Ta)e snthetic pancreatic lipase $Cota!m or *ancrease( with
meals or within 58 min&tes o" eatin'
add to a teaspoon"&l o" "ood> no hot "oods> don-t add to
"orm&la mil)
;""er water "re%&entl
G&ard a'ainst overe.ertion or heat e.pos&re
2( Ine""ective Airwa Clearance r?t ina#ilit to clear m&c&s
Ne#&li!ation or aerosol therap then C*T
H&midi"ied ;2
Add acetlcsteine $:&comst( to mist
No co&'h s&ppressants
/re%&ent reposition
,ed rest plan activities 1 rest period #= meals
DIII9 S)eletal Disorders
Talipes Disorders or cl&#"oot
< Tpes+
4( plantar"le.ion e%&in&s or horse"oot position> "ore"oot
lower than heel
2( dorsi"le.ion heel is held lower than "ore"oot or anterior
"oot is "le.ed toward anterior le'
5( var&s deviation "oot t&rns in
=( val'&s deviation "oot t&rns o&t
6( e%&inovar&s com#ination o" all tpes
7( calcaneoval'&s child wal)s on heel with "oot elevated
< :ana'ement+
4( Cast+ "oot placed in an overcorrected position
e.tends a#ove the )nee to ens&re "irm correction
chan'e diapers "re%&entl to prevent soa)in' o" cast
w? &rine or meconi&m
chec) in"ant-s toes "or coldness> #l&eness 1
circ&lation
2( Denis ,rowne splints+ shoes attached to metal #ar to
maintain position
5( S&r'er
,9 Developmental Hip Dsplasia o"ten re"erred to as
Con'enital Hip Dsplasia
F improper "ormation 1 "&nction o" the hip soc)et
F s&#l&.ation or dislocation o" the head o" "em&r
F aceta#&l&m o" pelvis is "lat or shallow
< Ca&ses+ Heredit
Uterine position
< S?S.+ A""ected le' is shorter> )nee is lower than the other
Une%&al s)in "olds on posterior thi'hs
;rtholani-s si'n $clic) heard on a#d&ction(
< :ana'ement+
4( Splints> Halters> or Casts+ position hip into "le.ed>
a#d&cted positionC traction "or older children
/reB)a splint+ )eep in place at all times e.cept when #athin'
the in"ant 1 chan'in' diapers
Good diaper area care+ chan'e diapers "re%&entl> wash area
w? clear water> appl ointment a"ter each diaper chan'e
*ad ed'es o" #races to decrease irritation
*avli) harness+ adB&sta#le chest halterC worn contin&all
e.cept #athin'
Spica cast or /ro' Le' cast+ assess "or circ&lation
2( S&r'er+ pin is inserted to sta#ili!e the hip