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PEDIATRIC NURSING <reviewer rabe>
IMMEDIATE CARE OF THE NEWBORN
8 PRIORITIES OF THE NEWBORN

IN THE FIRST DAYS OF LIFE
Projectile Vomiting surest sign of cerebral

irritation
High pitched, shrill cry
Cushing Triad of ICP

o BP
1.
2.
3.
4.
5.
6.
7.
8.
Establish and maintenance of Airway patency

Promote of adequate circulation
Control of body temperature
Intake of adequate nutrition
Establishment of waste elimination
Prevention of infection
Establishment of an infant parent relationship
Developmental care that balance rest and stimulation for
mental developmental
I. ESTABLISH & MAINTENANCE OF AIRWAY PATENCY

Alerts!
Expulsion is @ 2nd stage of labor

Most neonatal deaths w/in the first 24 hours is due to
INABILITY TO INITIATE AIRWAY.
Lung function begins only after birth.

Never stimulate to cry unless secretions have been
drained out.
Head lower than the rest of the body (except in
increased ICP)
I. Suction secretions properly:
o
o
PR
RR
II. PROMOTE ADEQUATE CIRCULATION

Alerts!
Circulation is initiated by LUNG EXPANSION and

PULMONARY VENTILATION
Completed by cutting the cord
Assess characteristics of cry

o Normal strong, vigorous, lusty cry
Hypoglycemia/ Increased ICP high pitched, small

cry
o Never stimulate crying before all secretion are remove
to prevent aspiration
1.
Feto Placental Circulation
3.
Placenta O2 carried by vein liver Inferior Vena Cava

Right atrium 70% goes to Foramen Ovale Remaining
30 tricuspid valve right ventricle pulmonary artery
lungs for nutrition vasoconstriction of lung tissue pushes
the blood to DUCTOS VENOSUS supply extremities 2
arteries carry unO2 Blood back placenta
Support head and remove secretion, place babys

head to side to facilitate drainage.
2.
MOUTH before NOSE (prevent inhalational reflex =
aspirate pnuemonia).
AVOID PROLONGED (>10 min) and DEEP
SUCTIONING (stimulates vagus nerve BRADYCARDIA)
*Period of 5 10 sec. (full term) & less than 5 sec.
(preterm), should be gentle and quick.
* Prolonged suctioning can cause hypoxia,
laryngospasm and bradycardia due to vagal nerve
stimulation
4.
Evaluate patency: OCCLUDE ONE NOSTRIL AT A

TIME Check for struggle (Choanal atresia)
*** Note: Newborns are obligate nasal breathers!
If not effective requires effective LARYNGOSCOPY to

open airway. After deep suctioning, and ET tube can be
inserted and O2 administration by (+) Pressure Bag and
mask with 100% O2 @ 40 60 bpm.
Alerts in O2 Administration
No Smoking O2 is combustible
Scarring Retina results Retinopathy (O2 overdose)
Diplopia normal in newborns, sign of ICP in

older children
Must be humidified prevent drying of mucosa

Cover the nose and mouth only
Meconium Stain never administer O2 with pressure
causes atelactasis
II. Positioning
Slight trendelenburg
(complications: (a) interferes with the diaphragmatic
expansion as well as abdominal breathing (b) ICP
Right side-lying best position for NB less than 3

mos
Signs of Increased ICP
Abnormal large head
Bulged & tensed fontanel
Ways to facilitate closure of Foramen Ovale
Tangential Footslap
o Cry expands lung pressure from left to
right side of the heart
Proper positioning of the Baby

o Right side lying position pressure on left
side of heart facilitating closure
Best Position immediately after Birth
Structure
Foramen
Ovale
CS supine, crib level position

NSD
Appropriate
Time of
Obliteration
1 year
Ductus
Arteriosus
1 month
Ductus
Venosus
Umbilical
Arteries
2 months
Umbilical
Vein
23
months
2 3 month
Complete
Closure
Structure
Remaining
Failure to
Close
W/in 24
hrs
completed
1 month
W/in 24
hrs
completed
1 month
23
months
23
months
Fossa
Ovalis
Atrial
Septal
Defect
Ligamentum
Arteriosum
Patent
Ductus
Arteriosus
2 3
months
Ligamentum
Venosum
Lateral
Umbilical
Artery
(Intrerior
Iliac Artery)
Ligamentum
Teres
Page 1

(Round
ligament of
the liver)
Physiology of Breastmilk Production

Estrogen, Progesterone releases PROLACTIN acts
on ACINAR/ ALVEOLI CELLS produces FOREMILK
store in LACTIFEROUS TUBULES/ COLLECTING
TUBULES
Sucking stimulates posterior pituitary gland release
oxytocin causes Contraction of smooth muscles of
Lactiferous Tubules milk ejection reflex let down reflex
III. CONTROL OF BODY TEMPERATURE/ TEMPERATURE

REGULATION
Alerts!
The goal of temperature regulation is to maintain

Temperature not less than 97.5 F or 36.5 C
Factors leading to the development of Hypothermia
Preterm are born POIKILOTHERMIC (easily adapt the

temperature of environment due to immaturity of thermo
regulating center of the body HYPOTHALAMUS)
Inadequate subcutaneous tissues
Newborn are not yet capable of shivering
Newborns are born wet float in amniotic fluid
Advantages of Breastfeeding
Economical
Promotes bonding
Contains LACTOBACILLUS BIFIDUS interfere

the attack of pathogenic bacteria in the GIT
Helps in early involution of uterus oxytocin

causes contraction
Always available
Incidence of breast cancer

Breastfed babies have higher IQ than bottle fed
ones
Antibody IgA
Macrophages
Process of Heat Loss
Evaporation body to air
Radiation body to a cold subject not in contact with the

body (thermal shift)
Conduction body to solid objects (cold compress)

Convection body to a cooler surrounding object (fever,
aircon)
Effects of Hypothermia (COLD STRESS)
RR first sign of hypothermia

Hypoglycemia due to utilization of glucose
o Normal 45 55 mg/ dl
Average/ borderline 40 mg/ dl
Metabolic Acidosis due to the catabolism of BROWN FAT

(vest-like, best insulators of newborns) leading to the
formation of ketone bodies
High risk for KERNICTERUS (bilirubin in the brain)

Additional fatigue added to already stressful heart
Disadvantages of Breastfeeding
No iron
Possibility of transfer of Hepa B, HIV, CMV (13

39% possibility)
Father cant bond with the mother and baby

instead, father can sing, suddle, kiss, put baby to
sleep
Alerts!
Freezer good for 6 mos./ dont reheat

Should be stored in a sterile plastic container
Pre Colostrums 6 weeks
Colostrums 3
Stages of Breastmilk
COLOSTRUM
o Present 2 4 days
o Contents
Prevention of Cold Stress
Dry and wrap the newborn
Mechanical measures (radiant warmer, acrylic sided

incubator)
Prevent unnecessary exposure cover areas not being

examined
In case of no electricity
o Cover baby with thin foil (preterm)
o Skin to skin contact human blanket/ kangaroo
care
IV. ESTABLISHING ADEQUATE NUTRITION

Breastfeeding
Best time
NSD ASAP
CS after 4 hours
fats
CHO
Immunoglobulin
protein
fat soluble vitamin
minerals
TRANSITIONAL MILK
Present 4 14 days
Contents
o Lactose
o
o
minerals
water soluble vitamins
Lactose Intolerance deficiency in enzyme

o Lactase responsible for digestion of
Lactose sour milk/ smelling of stool
page2

MATURE MILK
o Present 14 days and above
o Contents
Linoleic Acid responsible for the

development of brain and integrity of
skin
CHO (Lactose)
Protein (lactabulmin)
COWS MILK
fats almost similar to mature milk

Causes constipation
Content
o fats
o
o
o
o
Problems experience in Breastfeeding
ENGORGEMENT
o Feeling of fullness and tension in the
breast (3rd Day)
o Breastfeeding mother apply warm
compress
o Bottle Feeding apply cold compress,
wear supportive bra
SORE NIPPLE/ CRACK NIPPLE

o Crack, red, painful nipple
o Causes
Breastfeeding @ one side only
Unhealthy sexual practices

o Management
Breastfed using the unaffected

side
Manually express milk @ affected

side
Antibiotic (continue
breastfeeding)
MASTITIS
o Inflammation of breast
o Causative Agent: STAPHYLOCOCCUS
AUREUS
o Management
Avoid wearing lined/ wired bra

o 4 weeks Breast Involution
CHO add sugar

CHON casein hard to digest
Minerals (has traumatic effect to kidneys of
babies)
PHOSPHORUS ( causes inversely
proportional effect of Calcium
water to prevent kidney stones
Health Teachings
1. Proper Hygiene
Hand washing, clean areola with cotton and water

or NSS
Cleanse the area with CAKE COLOSTRUM

2. Position while Breastfeeding
Upright Sitting (best position)

3. Stimulate and Evaluate Feeding Reflexes
Rooting Reflexes
Stimulate by touching the side of the cheek or side

of flip then the baby will turn to the stimulus
Purpose: to look for food
4.
6. For proper emptying and continuous milk

production per feeding
Feed the baby at the last breast that you

fed him/ her
Disappear by 6th weeks
Sucking Reflexes
o Stimulate the middle part of the lips and
the baby will suck
o Disappear by 6 months
Swallowing Reflexes
o When the food touches the posterior part
of the tongue, the baby will automatically
swallow
o Never disappears
Extrusion Reflexes
o When food touches anterior part of
tounge, it will extrude/ protrude
o Purpose: prevent poisoning
o Disappears @ 4 moths
Criteria for effective sucking
Babys mouth is hiked well up @ areola
Mother experiences after pain sign of

releasing oxytocin thereby contracting uterus
The other nipple is also flowing with milk

5. To prevent from crack nipples and initiate proper
production of oxytocin
Begin initially for 2 3 mins/ breast
the time 1 min/ breast/ day until it reaches 10

minutes/ breast/ feeding or 20 min/ feeding
Contraindications for Breastfeeding
Maternal Conditions
o HIV
o Hepa B
o CMV
o Coumadin/ Warfarin taking moms give
heparin instead
Newborn Conditions
o Erythroblastocis Fetalis
o Inborn errors of metabolism
Hydrofetalis
Phenylketonuria
Galactosemia
Tay- Sachs Diseas

V. ESTABLISHMENT OF WASTE ELIMINATION
GIT Obstructions
Hirshsprung Disease
Imperforate Anus
Meconium Ileus (common with Cystic Fibrosis)

Different Stools
MECONIUM/ PHYSIOLOGIC STOOL

o Blackish green
o Odorless (sterile intestine)
o Normally passed within 24 hours
o Tar like
o Sticky
page3
TRANSITIONAL STOOL
o Present 4 14 days
o Green
o Loose
o Slimy that may appear like diarrhea to the
untrained eyes
BREASTFED STOOL
o Golden yellow
o Occur almost nearly after feeding
o With sour milk smell
o Mushy
o Soft
BOTTLEFED STOOL
o Pale yellow
o Hard due to casein
o Formed
o Typically offensive odor
o Seldom passed 2 3 days
INDICATION OF STOOL CHANGES
Light Stool
Bright Green
Mucus mixed
Clay Colored
Black
Blood Flecked
Curant Jelly
Fatty, bulky, foul
smelling/
Steatorrhea
Ribbon like
With jaundice
Under phototherapy
Milk Allergy
Bile Duct
Obstruction
GIT Hemorrhage
Anal Fissure
Intussuception
Suspect
malabsorption
syndrome/ Cystic
Fibrosis/ Celiac
Disease
Hirshsprung
disease
.
VI. ASSESSMENT OF WELL BEING
Apgar Scoring
Virginia Apgar
Special Consideration
1st 1 minute determines general coneral condition of

the baby
Next 5 Minute determines the capability of the baby to

adjust extrauterinely (most
important)
Next 15 minutes optional depndent on the 5

minutes apgar score
Components
A ppearance
P ulse Rate
G rimace
A ctivity
Color upon birth is slightly cyanotic

After first cry baby will be pink
Take apical pulse at the lower left
nipple
Determines reflex irritability using
tangential foot slap and catheter
insertion
To determine the degree of muscle
tone
R espiration
Newborns will cry within 30 seconds upon expulsion
ASPHYXIA NEONATORUM failure to cry within 30

seconds because mother received Demerol
NARCAN antidote of Demerol
APGAR SCORING
Criteria
Heart Rate
Respiratory
Effort
Muscle Tone
0
Absent
Absent
Flaccid
Extremities
Score
1
< 100
Slow RR/
Weak
Some reflexes
Reflex
Irritability
No
Grimace
Catheter
Response
Grimace
Tangentia No
l FS
Response
Color
Blue / Pale
Acrocyanosis
High score means healthy baby
2
> 100
Good
strong cry
Well
Flexed
Cough or
sneeze
Cry
Pink
Interpretation
0-3
Severely depressed
Needs CPR
Admission at NICU
4-6
Moderate depression
Additional suctioning
7 10
Good and healthy
CARDIOPULMONARY RESUSCITATION
CPCR cardiopulmonary and cerebral

resuscitation
5 minutes of 02 deprivation will cause irreversible
brain damage
Priority: Airway, Breathing, Circulation
AIRWAY
Clear the airway
Shake the baby
If no response, call help
Immediately do 1 minute CPR before calling for

help
Flat on bed, put a board if the bed is soft
Head tilt chin lift maneuver
No head tilt for suspect of cervical damage
Overextension may cause occlusion

BREATHING
Ventilating the lungs
Check breathlessness
If breathless give 2 breaths
If newborn mouth and nose
If child mouth and pinch the nose
Force puff only
Use one way mask to prevent contact with the

secretion
CIRCULATION
By cardiac compression
Check if pulseless
Use brachial pulse children

No breath + No pulse CPR
page4
1 year old heal of the palm
2.
CPR RATIO
Adult 2:15
Infant 1:5
REPIRATORY EVALUATION
(SILVERMAN ANDERSON INDEX)
Criteria
Chest
movement
Intercoastal
retraction
Xiphoid
Retraction
Nares dilatation
Expiratory
Grunt
No retraction
Score
1
Long on
inspiration
Just visible
No retraction
Just visible
Marked
No dilatation
None
Minimal
Heard by stet
only
Marked
Heard by
ear
0
Synchronized
2
See-saw
Marked
Low score means Good condition of the baby

Interpretation
0 3 normal, no RDS
4 6 with moderate RDS
7 10 with severe RDS
3.
ASSESSMENT OF GESTATIONAL AGE

(Ballard and Dubowitz)
Score
Criteria
Sole
creases
Breast
nodule
(dm)
Scalp Hair
Ear Lobe
Testes and
Scrotom
Less 36 wks
Anterior
transverse only
2 mm
37 38 Wks
Occasional 2/3
Fine and fuzzy

Pliable
In lower canal,
covered testes
with rugae
Fine and fuzzy

Some
Some
intermediate
4 mm (3 5
cm)
39 wks & up
Sole cover with
crease
7 mm (>5cm)
Course and silky
Thick
Testes pendulous,
scrotum full,
extensive rugae
PRETERM BABIES
babies delivered after 20 weeks and before 37 weeks
sign of preterm less 36 weeks according to Ballatrd

and Dubowitz
plus frog legs or lax position
Hypotonic prone to repiratory infection
There is a Scarf Sign elbow passes midline
Square window wrist 90 deg. Angle
Heal to ear sign
Anterior traverse crease
Abundant lanugo
Prominent labia minora and clitoris

POST TERM BABIES
Delivered after 42 weeks
Old mans face classic sign
Desquamation pealing of skin
Long and brittle fingernails
Wide and alert eyes

NEONATES IN THE NURSERY
Nursing Responsibilities upon Receiving the Baby
1. Proper identification
Foot print of the baby and the thumb mark

of the mother
Take anthropometrics measurement
o Length
19. 5 21 inches
Ave:
20 inches
47.5 53 cm
Ave:
50 cm.
o Head Circumference
13 14 inches
33 35 cm
Ave:
34 cm
o Chest Circumference
12 13 inches
31 33 cm
Ave:
32 cm
o Abdominal Circumference
12 13 inches
31 33 inches
Ave:
32 cm
Bathing the baby
o Give oil Bath
To cleanse the baby and spread

the vernix caseosa
2 functions of vernix caseosa
insulator
bacteriostatic
o Full bath is given when cord falls off
o Babies of HIV + mothers will be given a full
bath immediately after the birth to lessen
the transmission of HIV
Dressing the Umbilical Cord
o Strict asepsis to prevent tetanus
neonatorum that is why mothers are given
tetanus toxoid while pregnant
CHN 3 Cleans
Hand
Surface
Cord
o Betadine (Povidone Iodine)
Check 3 vessels (AVA)
If only 2 vessels is seen suspect

that the baby has a kidney
malformation
o 1 inch above the base of the cord when
cutting
o But if IV infusion or blood transfusion is
going to be given to the newborn, leave at
least 8 inches of the umbilical cord
o Umbilical cord is the best site for IV and
blood transfusion because it has no nerve
and no pain
o OMPHALAGIA bleeding of the cord for
more than 30 cc, suspect hemophilia
o The umbilical cord turns black by the 3rd
day and falls of 7 10th day
o UMBILICAL GRANULATION failure of
the cord to fall after 2 weeks without foul
odor, bring the baby to the hospital and
will be given Silver Nitrate or will be
cauterized
o Clean the umbilical cord with saline or
70% alcohol
o It should be dry
o
Infant 1 finger breadth below nipple line, 2 finger
4.
page5
5.
6.
7.
PATENT URACHUS itf the cord is always

moist, suspect a fistula between the bladder
and the umbilicus, do NITRAZINE PAPER
TEST (+ for urine if it turns yellow)
Credes Prophylaxis
o Purpose: to prevent opthalmia neonatorum or
gonnorheal conjeunctivitis
o If mother has an untreated gonorrhea and
passed the baby vaginally
o ERYTHROMYCIN OPTHALMIC OINTMENT
drug of choice, inner to outer canthus
o Before 1989 2 drops of 2% silver nitrate at
lower conujunctival sac
o It should be washed immediately after 1 minute
to prevent burning
Administration of Vitamin K
o Purpose: to prevent hemorrhage related o
physiologic hypoprothrobinemia
o Other name
Aquamephyton, Phytomenadone,
Konakion
0.5 10.5 mg IM @ vastus lateralis or

lateral anterior thigh
o Preterm give 0.5 mg
o Vit. K is synthesized at the intestine
o On the 7th day, there is prothrombin
Weight Taking
o
o
o
o
o
o
o
Normal Weight
3000 3400 gm
3 3.4 kg
6.5 7.5 lbs

Arbitrary Lowe Limit 2,500 grams
Low Birth Weight
< 2,500 g
it is not the same for gestational age

Small for Gestational Age
Less than the 10th % rank

Large for Gestational Age
> 90% rank
Macrosomia baby delivered 4,000 g or

4 kilos
Diabetic mother
Appropriate for Gestational Age
Physiologic Weight Loss
5 10% physiologic weight loss 10th

days after birth
Components:
Temperature
Temperature of the newborn is taken rectally
Rectal temperature taking is done only once to rule out
imperforated anus
Insert thermometer 1 inch inside the anus
Types of Imperforated Anus
1. Atretic no anal opening
2. agenetic/agenesis no anal opening; defective
devt of anus with rectal pouch ending blank
3. Stenosis has opening but very narrow
4. Imperforate anal membrane has opening; translucent
membrane
5. Rectoperineal fistula rectum opening; instead of anus
divert to perineum
6. Rectovaginal fistula instead rectum to anus; rectum to
vagina.
Earliest sign:
1. no mecomium
2. abd destention
3. foul odor breath
4. vomitous of fecal matter
5. can aspirate resp problem
Mgt:
Surgery with temporary colostomy
Repair for imperforate anus (6-12 mos)
*proper cleaning of surgical site
*heat lamp to promote healing
*position sidelying or supine (90 legs apart)
*maintain NGT & IVF nutritional support
Cardiac Rate
Newborn 120 160 bpm irregular
Radial pulse of a newborn is normally absent
If radial pulse is prominent suspect that there is a PDA
Femoral pulse is normally palpable, if absent suspect
Coarctation of Aorta
CONGENITAL HEART DISEASE
Common in Boys
Transposition of the great artery (TOGA)
Truncus Arteriosus
Tetralogy of Fallot
PHYSICAL EXAMINATION AND DEVIATION FROM

THE NORMAL
Important Consideration
If the client is a newborn, cover areas that is not being

examined (prevent hypothermia)
If the client is an infant, he first vital sign to take is the RR

because of fear of stranger will change the normal
respiration. Begin from at least intrusive to the most intrusive
procedure.
If the client is a toddler and preschooler, le them handle the

instruments like stethoscope or play syringe. If the client has
security blanket (like stuffed toy) give it to them to lessen
anxiety
If the client is a school age and adolescent, explain the

procedure and respect their modesty
Common in Girls
o Patent Ductus Arteriosus
o Atrio Septal Defect
Causes of CHD
Familial tendency (Hereditary)
Maternal Exposure to rubella/ German measles

1st month
Failure of the Heart Structure to progress
Two Major Types

1. Acyanotic Heart Defects shunting from left to right
2.
Cyanotic Heart Defects from right to left
page6

Acyanotic Heart Defects with Increase Pulmonary
Blood Flow
1. Vetricular Septal Defect
Opening Between 2 ventricles
Signs and symptoms
o Systolic murmur at lower border of the sternum and
no other significant sign
o Cardiac catheterization reveals increase oxygen
saturation at the right side of the heart
o ECG reveals hypertrophy of the right side of the
heart
o Only 50% of the oxygenated blood will go to the
aorta
Management
o Open heart surgery
o Placing the client on a long tern antibiotic therapy to
prevent the development of sub-acute bacterial
endocarditis
o Protect site of catheterization (right femoral vein)
o Avoid flexion of joints
2. Atrial Septal Defect
Failure of the foramen ovale to close
Signs and symptoms
o Systolic murmur at the upper border of the sternum
with no significant sign
o Cardiac catheterization reveals increase oxygen
saturation at the right side of the heart
o 50% of the blood goes to the right atrium
Management
o Open heart surgery
o Placing the client on a long tern antibiotic therapy to
prevent the development of sub-acute bacterial
endocarditis
3.
4.
Endocardial Cushion Defect
AV canal affecting both the tricuspid & the mitral

valve
Signs and symptoms

o Only confirmed by cardiaccatheterization
o Valves are closed
Patent Ductus Arteriosus
Failure of the Ductus Arteriosus to close
Signs and symptoms

o Prominent radial pulse
o Continuous machinery like murmur
o ECG reveals hypertrophy of the left ventricle
Management
o
Indomethacine prostaglandin inhibitor
that facilitate closure of PDA
o
Ligation of PDA by 2 4 years old
Acyanotic Heart Defects with Decrease

Pulmonary Blood Flow
1. Pulmonary Stenosis
Narrowing of valve of pulmonary artery
Signs and symptoms
o Typical systolic ejection murmur
o S2 sound is widely split
o ECG reveals right ventricular hypertrophy
o Only 50% of the blood goes to the lungs
Management
Balloon Stenotomy
2.
Aortic Stenosis
Narrowing of valve of aorta
Signs and symptoms
o
Typical systolic ejection murmur
o
Murmur
o
ECG reveals right ventricular hypertrophy
o
Only 50% of the blood goes to the body
o
Angina like symptoms may be present
when active
Management
o Balloon stenotomy
3.
4.
Duplication of Aortic Arch

Doubling of arch of the aorta causing compression
to the trachea and esophagus
Signs and symptoms
o Dysphagia due to esophageal compression
o Dyspnea due to tracheal compression
o Left ventricular hypertrophy
o Only 50% of the blood goes to the body
Management
o Close heart surgery
Coarctation of Aorta
Narrowing of ach of aorta
Outstanding signs
o Absent femoral pulse
o BP is higher on the upper extremities and on
the lower extremities
o Epistaxis
o Lesser blood goes to the lower extremities
Management
o Take BP on 4 extremities
o Close hear surgery
Cyanotic Heart Defects with Increase Pulmonary

Blood Flow
1. Transposition of Great Arteries (TOGA)
Aorta is arising from the right ventricle while the

pulmonary artery is arising from the left
Signs and symptoms

o
Cyanosis after 1st cry
Polycythemia because of increase

production of RBC, a compensatory mechanism to
the oxygen supply to the body, the blood become
viscous
o
Polycythemia will lead to:
Thrombuis
Embolus
Stroke (CVA)
o
ECG reveals Cardiomegally
Management
Palliative repair Rash Kind repair
Complete repair Mustard repair
2. Total Anomalous Pulmonary Venous Return
Situation wherein pulmonary vein instead of

entering the left atrium enters the right atrium or
superior vena cava
page7
Signs and symptoms

Open foramen ovale
Mild moderate cyanosis
Absent spleen
Management
o Restructuring of the heart
3. Truncus Arteriosus
Situation in which pulmonary artery and aorta is arising

in one common trunk or a single vessel with ventricular
septal defect
o
o
o
4.
Signs and symptoms

Polycythemia because of increase production of RBC, a
compensatory mechanism to the oxygen supply to the
body, the blood become viscous
Thrombus
Embolus
Stroke (CVA)
Management
o Restructuring the heart
Hypoplastic Left Heart Syndrome
Non functioning left ventricle
Signs and symptoms
o Thrombuis
o Embolus
o Stroke (CVA)
Management
o Heart transplant
Cyanotic Heart Defects with Decrease Pulmonary

Blood Flow
1. Tricuspid Atresia
Failure of the tricuspid valve to open; absence of

opening
Signs and symptoms
Open foramen ovale
Cyanosis
2.

o Thrombuis
o Embolus
o Stroke (CVA)
Management
o Fontan Proledum
Tetralogy of Fallot
4 Anomalies Present (PVOR)
o Pulmonary Stenosis
o
o
o
Ventricular Septal Defect

Overriding of Aorta
Right Ventricular Hypertrophy
Signs and symptoms
High degree of Cyanosis outstanding Sign

Polycythemia because of increase production of
RBC, a compensatory mechanism to the oxygen
supply to the body, the blood become viscous
Thrombus
Embolus
Stroke (CVA)
Severe dyspnea relieved by squatting position

because it will prevent venous return and facilitate
maximum lung expansion
o Knee chest position in infants
There is growth retardation
TET Spells blue spells or short episode of

hypoxia
Syncope faintaing
Mental retardation
Clubbing in fingernails because of tissue hypoxia

late and last sign
X ray reveal a boot shape heart

Management
Oxygen therapy
Morphine sulfate for hypoxic episode
Propanolol (inderal) decrease heart spasm
Palliative repair BLT or Blalock Taussig Shunt

Procedure
Complete repair Brock Procedure
ACQUIRED HEART DISEASE

Rheumatic Heart Disease
Inflammatory disease following an infection caused

by Group A Beta Hemolytic Streptococcus
Affected body parts

o Musculoskeletal
o Cardiac muscle
o Integumentary system
o CNS
Tonsillitis due to love of sweets with no oral hygiene

serving a good medium for bacterial growth causing
inflammation
Group A Beta Hemolytic Streptococcus will release

toxin and enters circulation
Group A Beta Hemolytic Streptococcus is an

anaerobic organism and will stay at the left side of the
heart or the mitral valve as an ASCHOFF BODIES
ASCHOFF BODIES round nodules with multi

nucleated cell and fibroblast that stays in the mitral
valve
Left sided heart failure because of mitral stenosis

due to increase in the size of Aschoff Bodies.
Diagnostic Exam: JONES CRITERIA

Major
Polyarthritis multi joint pain
Athralgia joint pain
CHOREA/ Sydenhamms
Chorea/ St. Vitous Dance
involuntary, purposeless
movement of the hand and
shoulder accompanied by
Minor
Low grade fever
Diagnostic Exams
Antibody
C reactive
protein
ESR
Anti Streptolysin
page8

grimacing
Titer
Carditis signs of tachycardia
Erythema Marginatum
macular rashes
Subcutaneous nodules
Presence of 2 major or 1 major and 2 minor plus a history of
sore throat will confirm diagnosis
Management
Bed rest
Avoid contact sports
Throat swab for C & S
Antibiotics purpose is to prevent recurrence
Aspirin Therapy or salicylates act as an antiinflammatory agent in RHD
Breath Sounds Heard on Auscultation

Vesicular
Soft, low pitched, heard over periphery of
Normal
lungs, aspiration is longer than expiration
Bronshovesicular
Soft, medium pitched heard over major
Normal
bronchi, inspiration equals expiration
Bronchial
Loud, high pitched, heard over the trachea,
Normal
expiration is longer than inspiration
Ronchi
Snoring sound made by air moving
Normal
through mucus in bronchi
Rales
Abnormal
Wheezing
Abnormal
Stridor
Resonace
Hyper Resonance
Crackles (like Celophane) made by air

moving through fluid in alveoli
Denotes pneumonia, fluid in the lungs or
pulmonary edema
Whistling on expiration made by air being
pushed through narrowed bronchi
Denotes children with asthma or foreign
body airway obstruction
Crowing or roster like sound made by air
being pulled through a constricted larynx
Indicative of Respiratory Obstruction
Loud, low tone, percussion sound over
normal lung tissue
Louder, lower sound than resonance,
percussion sound over hyperinflated lung
tissue
1. RESPIRATORY DISTRESS SYNDROME

Lack of surfactant within 24 hours of life
Aka Hyalin Membrane Disease
Common in preterm babies
The alveoli cannot expand properly
Signs and symptoms

Present within 4 hours of life
RR with retraction (1st sign of RDS)

Expiratory Grunting (major sign)
Xiphoid retraction
Flaring nasal flares
Cyanosis
Respiratory acidosis
Management
Head elevated
Proper suctioning
RESPIRATION
Normal Values = 30 60 bpm irregular
Either abdominal or diaphragmatic breathing with short

period of apnea without cyanosis
Normal apnea in newborn is 15 seconds or less

Rate
40 90
20 40
20 30
20 25
18 22
12 20
Using the Silverman Anderson Scoring to

determine RDS
Side effect: Reyes Syndrome encephalopathy

accompanied by fatty infiltration of the organs such as
the heart and liver
Age
Newborn
1 year old
2 3 years old
5 years old
10 years old
15 and above
O2 administration with humidity

Client placed on
o CPAP Continuous Positive Airway Pressure
o PEEP Positive End Expiratory Pressure
o Purpose id to maintain the alveoli partially open and
prevent alveolar collapse
Monitor for acidosis
Surfactant replacement
2. LARYNGOTRACHEO BRONCHITIS (LTB)

Most common form of croup
Viral infection of the larynx, trachea and bronchi
Signs and symptoms
BARKING or CROUPY COUGH outstanding sign
Inspiratory Stridor
Respiratory acidosis
Cyanosis
Death
Diagnostic Exams
o Throat swab for c & s
o ABG
o Chest and x-ray to rule out epiglotitis
Management
o Racemic Epinephrine bronchodilator
o Humidified Oxygen
3.
BRONCHIOLITIS
Inflammation of the bronchioles

characterized by production of tenacious mucus
FLU LIKE SYMPTOMS outstanding

sign
Virus
RR
Causative Agent: Respiratory Syncitial
Drug: Antiviral Ribavirin
LTB and Bronchiolitis ends with Epiglotitis

4.
EPIGLOTITIS
Inflammation of the epiglotitis
Sudden onset
The child always assume the tripod position
Less than 18 months cannot cough must be
placed on mist tent or Croup tie make sure that
the edges are tucked in
o Provide washable plastic toys or materials
o Avoid toys that crate friction
o Avoid toys that are hairy or furry
page9

Blood Pressure
Newborn 80 46 mmHg
After 10 days 100/ 50 mmHg
BP taking begins by 3 years old

SKIN
If cyanotic after the first cry suspect Transposition of the

Great Arteries
SKIN COLOR AND THEIR SIGNIFICANCE

1. Blue cyanosis , hypoxia
2.
3.
4.
5.
White edema
Gray infection
Yellow jaundice or carotinemia
Pale anemia
cord;
decrease
iron
stores;
blood
incompatibility
2. Gray infection
3. Jaundice (Use natural light and blanch skin on the chest
or tip or the nose
- Inability
to
conjugate
bilirubin (decreased
GLUCORONY TRANSFERASE)
-
Normal values:
Total Bilirubin 15.0 mg/dl
**Direct Bilirubin 1.5 mg/dl
**Indirect Bilirubin 13.5 mg/dl
(If value of total bilirubin = 10 to 12 mg/dl, start treatment)
(If value of total bilirubin is >20 mg/dl = KERNICTERUS)
Physiologic jaundice: 2nd to 7'11 day

Breastfed babies have longer physiologic jaundice because
human milk has PREGNANEDIOL depresses gluconyl
transferase, a liver enzyme
Treatment of Pathologic Jaundice:
1. Phototherapy (photoisomerization of indirect bilirubin)
Common skin marks of the newborn:
1.
Desquamation - peeling of
skin; indicates post-maturity
2.
Mongolian spots - bluishblack/slate gray pigmentation across the sacrum or buttocks;

disappear by SCHOOL AGE.
3.
Vernix caseosa - cheeselike material; serves as insulator
4.
Lanugo - fine, downy hair at

shoulders, back and upper arms; disappear by 2 weeks.
5.
Milia - plugged or unopened

sebaceous gland on the cheek or across the bridge of the
nose; disappear by 2-4 weeks
6.
Nevi (Stork bites) - pink or

red flat areas of capillary dilatation seen on upper lids, nose,
upper lip, nape and neck; disappears at 1st and 2nd year.
7.
Erythema toxicum - aka

fleabite.rash; pink papules with vesicles seen at nape, back
and buttocks; appears usually 2nd day; no treatment
needed.
10 pcs 20-watt daylight or blue fluorescent lights (30in

above)
cover eyes and scrotum with an opaque mask
monitor temperature
adequate hydration
turn q 2H to expose all body areas
measure I & Q
2. Exchange transfusion
.
Burn Trauma
by excessive heat
1st Degree
Partial
Thickness
2nd Degree
Partial
Thickness
3rd Degree
Full Thickness
8.
Nevus flammeus - aka

portwine stain; red to purple in color; do not blanch on
pressure and do not disappear; Macular purple or dark red
lesions usually seen on the face or thigh, disappears and
be removed surgically
9.
Nevus Vasculosus/
Strawberry hemangioma - elevated areas formed by
immature capillaries and endothelial cells; complete
disappearance by 10 yrs old.
10.
Cavernous Hemangiomas dilated vascular spaces; Consist of communicating network

of
venules in the subcutaneous
tissue that
never disappear with age.
11.
Forceps marks - disappears
in 1-2 days.
*Hemangiomas - vascular tumors of the skin
Abnormal skin findings:
1. Pallor - excessive blood loss; inadequate blood flow from
Injury to body tissues caused
Characteristic
Involves only the superficial epidermis
characterized by erethema, dryness and
pain
Ex: Sunburn heals by regeneration in 1
10 weeks
Involves the entire epidermis, and portion of
the dermis, characterized by erythema,
blistered and moist from exudates which is
extremely painful
Ex: Scalds
Involves skin layers, epidermis and dermis,
may involve adipose tissue, fascia, muscle
and bone. It appears to be leathery, white
or black, not sensitive to pain since nerve
ending had been destroyed
Ex: Lava Burn
Management:
First Aid
o
Put out the flames by rolling the
child on a blanket
o
Immerse the burned part on cold
water
o
Removed burned clothing (sterile
material)
o
Cover burned part with sterile
dressing
Maintainance of patent airway

o Suction PRN
o O2 administration with humidity
o Endotracheal Intubation
o Tracheostomy
Prevention of shock and flued and

electrolyte imbalances
Colloids to expand blood volume
page10

Isotonic saline to replace electrolyte
Dextrose in water to provide calories
Booster dose of Tetanus Toxoid
Relief pain such as IV analgesic (morphine

sulfate)
Prevention of wound infection

Cleaning and debriding the wound
Open or close method of wound care
Whirl pool therapy
Skin grafting
3rd degree burn
get skin from buttocks or pig skin (xenograft) or from frozen
cadaver
Diet CHON and calories
Atopic Dermatitis
Skin disease characterized by papulo-vesicular
eruthematous lesions with weeping and crusting
Usually caused by food allergen
o Milk
o Eggs
o Citrus Juice
o Tomatoes
o Wheat
Signs and symptoms
o Extremely pruritus outstanding sign
o Linear excoriation
o Crusty
o Lichenification dry and shinny, scaly white skin
Management
o Avoid allergens
o Prosobes/ Isomil hypoallergenic milk
o Prevent infection by proper handwashing, cut the
fingernails
o Hydrate with a burrows solution
o Topical steroid 1% hydrocortisone cream
Impetigo
Skin disease caused by Group A Beta Hemolytic
Sreptococcuscharacterized by papulovesicular lesions
surrounded by localized erythema becoming purulent and
ooze forming honey colored crust
Before the development, the baby should always been
exposed to Pediculosis Capitis (kuto)
Management
o Proper handwashing
o Treated with antibiotic
Complication: AGN
Acne
Self limiting inflammatory disease involving sebaceous
gland, common in adolescents
Comadones composed o sebum that is mainly causing
white heads
Sebum composed of lipids
Management
o Proper handwashing wild mild soap (sulfur soap)
and water, leave for 5 10 minutes or use
tretenoin or Retin A anti acne
Anemia/ Pallor
Caused by
o Early cutting of the cord
o Bleeding disorders/ blood dyscarias
BLEEDING DISORDERS/ BLOOD DYSCARIAS

Hemophilia
Sex linked (X) Recessive disorders
The mother is the carrier
The son is affected
The father transmits to daughter
Deficiency in clotting factor
o Hemophilia A factor 8 classic
hemophilia
o Hemophilia B Factor 9 Christmas
disease
o Hemophilia C Factor 11
OMPHALAGIA earliest sign

o >300 cc loss of blood during cutting of the
cord
the maternal clotting factor is present in the new born
that is why there is a delayed diagnosis of
hemophilia
in toddlers sudden bruising
HEMARTHROSIS major sign repeated bleeding,

bleeding of the synovial membrane
Diagnostic exam: PTT

Nursing Diagnosis: High Risk for Injury
Goal: Prevention of injury
Health Teaching
1. Avoid contact sports
2. Determine the case before doing any invasive
procedure
3. In immunization change needle into smaller one
4. In case of fracture/ injury
*Immobilize and elevate
5 . Cold compress
6. Gentle pressure
7. Blood transfusion of cryoprecipitate
Leukemia
Group of malignant disease characterized by rapid
proliferation of immature RBC
Ratio is 500 RBC : 1 WBC
The client is immunocompromised
Classification of Leukemia
o Lympho affects the lymphatic system
o Myelo affects the bone marrow
o Acute/ Blastic affects the immature cells
o Chronic/ cystic affects the mature cells
Acute Lymphocytic Leukemia
Most common in children
Increase immature WBC
Signs and Symptoms
a. Infection
i. Fever
ii. Poor wound healing
b. Bone weakness and causes fractures
c. Signs of bleeding
page11

i. Blood in the urine
ii. Emesis
iii. Petechiae
iv. Epistaxis
d. Signs of anemia
i.
Pallor
ii. Body malaise
iii. constipation
e. Invasion of the organs
i. Hepatomegaly abdominal pain
ii. Spleenomegaly
2. Diagnostic examinations
a. Peripheral Blood Smear reveals immature WBC
b. CBC reveals anemia and thrombocytopenia;

neutropenia
c. Lumbar Puncture
i. To determine CNS involvement
ii. Fetal position without flexion of the neck
because it will cause airway obstruction
iii. C position or shrimp position
d. Bone Marrow Aspiration
i. Determines the presence of blast cells
ii. Site of bone marrow aspiration iliac
Crest post op : prevent
hemorrhage
*Lie on affected site
e. Bone Scan determines the degree of bone
involvement
f. CT Scan determine the degree of organ
involvement
3. Management Triad
a. Surgery
b. Irradiation
c. Chemotherapy
d. Bone marrow transplant
4. 4 Levels of Chemotherapy
a. Induction
i. To achieve remission
ii. Drugs
IV Vincristine
L Asparagine
Oral Prednisone
b.
Sanctuary
To treat the leukemic cells that has invaded the
testes and CNS
ii. Drugs
intrathecal methotrexate via spine
cytocine
arabinase
steroids
irradiation
c. Maintainance
i. To continue remission
ii. Drugs
oral methotrexate
oral 6-mecaptopurine
cytarabine
d. Reinduction
i. Give anti-gout agent To
ii. To treat leukemic cells after relapse occurse
i.
iii.
Treat hyperurecemic neuropathy

Alopurinol or zyloprene
5. Nursing Management
Assess for common side effects of chemotherapy
nausea and vomiting
Assess for stomatitis ulceration and abcess of oral
mucosa
Oral care
Alcohol free mouthwash
Cotton piedgets
Diet give food acoording to childs preference
Alopecia temporary side effect of chemotherapy
HEMOLYTIC DISORDERS
Rh Incompatibility
Rh = monkey foreign body

Mother (-) no antigen; no protein factor
Fetus (+), Father (+) has antigen and protein factor
4th baby is severely affected

Erythroblastocis Fetalis
o hemolysis/ destruction of RBC leading to O2
carrying capacity leading to IUGR with
pathologic jaundice w/in 24 hours
ALERT! Baby is small and yellowish
Management
o
RHOGAM
Vaccine given to Rh(-) mothers within the first 24
hours or within 72 hours
Given once
If pregnancy was aborted and the mother udergo

D & C, RHOGAM must be given w/in 24 hours, if
not given within 24 hours, mother will produce
antibody
Action: destroys RBC preventing antibody
formation
Diagnostic Test Coombs Test
ABO Incompatibility
Mother Type O; Fetus Type A most common
Mother Type O; Fetus Type B most severe
Hydrops Fetalis
Common in abo incompatibility
o Newborn is edematous, on lethal state,
accompanied by pathologic jaundice w/in 24
hours
Difference from Rh Incompatibility
o First pregnancy is affected
o NB is yellow and edematous
.
Management
o Initiation of breastfeeding, then temporary
suspension of breastfeeding after 4 days
( breastfeeding realeses prenanediole causing
kernicterus)
Pregnanediole delays actions of Glucoonyl

transferase ( liver enzyme that converts indirect
bilirubin into direct bilirubin)
Indirect bilirubin
Fat soluble
Cant be excreted by kidneys
page12
Causes
hyperbilirubenemia causing jaundice
Direct Bilirubin
Water soluble
Can be excreted by the kidneys
o Use phototherapy
o Exchange transfusion for Rh and ABO affectations that
tend to casue a continuous decrease in hemoglobin
during the first 6 months because the bone marrow fails
to produce erythrocytes in reponse to the continuous
hemolysis
posterior/ lambda - 1 x 1 2 3
mos
Noticeable structures of the Head
o
Craniotabes
Localized softening of the cranial bone common
to first bone chiold due to early lightening
If present in older children; sign of rickets or Vit.
D deficiency
o
Seborrheic dermatitis/ Cradle Cap
Scaling, greasing, appearing

salmon colored patches
Usually seen at the scalp, behind

ears and umbilicus
Usually caused by improper

hygiene
Management
Application of baby oil the night before
shampooing the child
Caput Succedaneum
Edema of the scalp due to

prolonged pressure at birth
Present at birth
Crosses the suture line
Disappears 2 3 days
Disappears without treatment
Cephalhematoma
Collection of blood due to rupture

of capillaries of poriosteal capillaries
Present after 24 hours
Does not cross the suture line
Disappears after 4 6 weeks
Disappears without treatment
Hyperbilirubenemia
More than 12mg of indirect bilirubin among full terms
Normal Indirect Bilirubin Level: 0 3 mg/dl
Kernicterus/ Bilirubin Encephalopathy
Irreversible brain damage
> 20 mg/dl of indirect bilirubin among full terms
> 12 mg/ dl of indirect bilirubin among preterm because of
immaturity
Physiologic
Jaundice
Normal
Within 48 72
hrs
Mx:
Expose to early
morning sunlight
Pathologic
Jaundice
Within 24 hours
Yellow upon birth
Breastfeeding
Jaundice
Within 6th 7th day
Due to glucoronyl
transferase
Possible Rh/ ABO

incompatibility
Assessment of Jaundice
blanching of forehead, nose and sternum
yellow skin, sclera
light stool
dark urine
Hydrocephalus
Excessive accumulation of CSF
Types
Communicating/ extraventricula hydrocephalus
No-communication/ intraventricular hydrocephalus/
obstructive hydrocephalus caused by tumor
Signs and symproms
o Signs of increased ICP
o
Management
Phototherapy/ Photooxygenation
Nursing Responsibilities
o Cover the eyes prevents retinal damage
o Height of light from baby 18 20 inches
o Increase Fluid intake
o Cover genetalia prevent priapism ( painful
continuous erection
o Change position
o Avoid lotion and oils
o Monitor I&O best way is to weigh the baby
o Monitor VS
Diplopia eye deviation @ 6th mos and above

Management
Low semi fowlers (30 degrees) best position
o Frontal bossing (prominent forehead)
o Sunset eyes
o Prominent scalp vein
Bronze Baby Syndrome

Transient bronze discoloration of the skin
Minor side effect of phototherapy
HEAD
of its legth
Structures
o sutures
o fontanels
anterior/ bregma 3 x 4 12 18
mos
Therapeutic management
Osmotic Diuretic
o Mannitol
o Diamox / acetazolamide
Seizure precautions
Surgery Shunting
o AV Shunt - atrioventricular
o VP shunt ventriculoperitonial most common
o Best time to shave the head just before the
surgery prevent infection
.
Post VP Shunt management
page13

o Position side-lying on non-operated side
(applicable to all eyes and head surgeries)
o Sign of good shunting sunken fontanel
o Sign of blocked shunting bulging fontanel
o Catheter is changed as the child is growing
o Child with BP shunt is prone to infection
SENSES
Sense of Sight
Sclera
o Normal light blue
o Later Color dirty white
Pupils
o Normal round and adult size
o Coloboma key hole pupils part of the iris is
missing
o Congenital N Cataract whiteness/ opacity of the
lens
Cornea
o Normal round and adult size
o Congenital Glaucoma larger than normal
Test for Blindness
Age
Newborn
Can see @ a
distance of 10 12
inches with visual
acuity of 20/200 to
20/ 800
Infant and children
3 years old
School age
School age adult
Common Test
General appearance
Check ability to follow object pass midline
DOLLS EYE TEST done at approximately
10th day
GLADELLAR TEST test for blink reflex, not
blinking is a sign of blindness
ALLENS CARD test for visual acuity
-familiar pictures are flashed 20 ft a
ISHIARA PLATE test for color blindness
Cover testing test for strabismus
Snellens test
RETINOBLASTOMA
Malignant tumor of the eye
Signs and symptoms
cats eye reflex (whitish glow of pupil)
red, painful eye usually accompanied by glaucoma
Management
Surgery innucleation - removal of the eyeball
Irradiation
Therapy
SENSE OF SMELL
Normal nasal membrane - pinkish
Check for sense of smell
Check for nasal flaring
Sign of Cocaine User
Ulceration and abscess of nasal mucosa
Absence of hair
Epistaxis
Nose bleeding
Management
o Position, upright, sitting, head trilted, slightly
forward
o Gentle pressure
o Cold compress
o Epinephrine last resort
.
SENSE OF HEARING
Normal should be aligned with the outer canthus of
the eye
Low Set Ears is a sign of:
o Kidney malformation
Renal agenesis
Absence of kidney
o Chromosomal Abnormalities
Due to advance maternal age - >35y/o
Types
I. Nondisjunction (uneven divison)
a. Trisomy 21
Down Syndrome
Most common type
Extra chromosome 21
47xx + 21/ 47xy + 21
can be related to advance paternal age
signs and symptoms
o broad nose
o protruding tongue
o low- set ears
o puppys neck
o hypotonia prone to URTI
o simian crease single traverse line in palm
o mental retardation ranging from
educable to institutionalization
b. Trisomy 18
Has 3 numbers of 18 chromosomes
Severely cognitively impaire SGA
o Low set ears, small jaw, CHD, index finger
crosses over the other fingers, rounded soles of
feet
c. Trisomy 13
Pataus syndrome
Extra chromosome 13
Severely cognitively impaired
Signs and symptoms
Microcephaly
Micropthalmia
Cleft-lip and palate
Low-set ears
VSD
Do not survive
c. Turners
o
Gonadal Dysgenesia
o
One functional x chromosome
o
Short in stature
o
Neck appear to be webbed and short
o
COA and kidney problems
o
Only 1 streak (nonfunctional) gonads
o
Secondary sex characteristic does not
develop except for pubic hair
o
Lack ovarian function sterility
o
Cognitively challenged but mostly normal
intelligence.
d. Klinefelters syndrome
o Males with a XXY chromosome pattern
page14

o
o
@ puberty child has poorly developed

secondary characteristics and small testes that
produces ineffective sperm
boys tend to develop Gynecomastia
.
II. Deletion Abnormalities
a. Cri du chat Syndrome
Result of a short arm on chromosome 5
Cats cry
Small head, wide set eyes, downward slant to the

palbepral fissure of the eyes
Severe cognitive impairment

b. Fragile X Syndrome
X linked pattern
One arm of x chromosome is weakened
Most common cause of cognitive impairment in boys
Before puberty, boys typically have maladaptive

behavior like hyperactivity and autism
Large head, long face with high forehead, prominent

lower jaw, large protruding ears
III. Translocation abnormalities
Balance translocation Carrier
Unbalanced Translocation Syndrome

IV. Others
1. Mosaicism
A situation wherein the nondisjunction of chromosome occurs
during mitotic cell division after fertilization resulting to different
cells contains different numbers of chromosomes.
2. Isochromosomes
A situation wherein the chromosome instead of dividing vertically
it divides horizontally resulting to chromosomal mismatch
Otitis Media
Inflammation of the middle ear; Common to children
due to wider and shorter Eustachian tube
Predisposing factors
o Bottle propping
o Cleft lip/ palate
Signs and symptoms
o During otoscopic exam, reveals bulging
tympanic membrane
o Observe for passage of purulent, foul smelling
odor discharge
Management
o Positioning sidelying on the affected side
o Supportive care
Medical management
o Massive dosage of antibiotics
o Mucolytics
o Ear drops
< 3 y/o down and back
>3 y/o up and back
o Surgery
Myringectomy slight incision of
tympanic membrane to prevent
hearing loss
Side effect bacterial meningitis
MOUTH AND TONGUE

Check for symmetry
Bells palsy/ Facial Nerve Paralysis
7th CN injury
usually related to forceps delivery

risk for URTI
Signs and symptoms
o Continuous drooling of saliva
o Inability to open one eye and close the other
Management
o Artificial tear
o Self limiting
o Refer to PT for rehabilitation
TEF/ TEA
No connection between esophagus and stomach
There is a blind pouch
Hydramnios earliest sign intrauterine
Signs and symptoms
o Coughing
o Chocking
o Cyanosis
o Continuous drooling
Management
o Emergency surgery
Epstein Pearls
White glistening cyst
Usually seen on palate, gum
Related to hypercalcemia
Natal Tooth
Tooth at the moment of birth
Related to hypervitaminosis
Management
o Manual extraction if rootless
Neonatal Tooth
Appearance of tooth within 28 days of life
Oral Thrush
White cheese-like, curd like patches
Usually seen in mouth and on toingue
Causative agent C. Albicans fungi

Management
o Do not remove can cause wound
o Wash with cold, bottled water
o Medical Mycostatin/ Nystatin
Kawasaki Disease
Discovered in Korea
Strawberry tongue
Common in asian countries
Criteria for diagnosis
o Fever lasting for more than 5 days
o Bilateral conjunctivitis
o Changes in lips and oral cavity
Dry red fissure lips
Strawberry tongue
Diffuse erythema of mucos
membrane
o Changes in the peripheral extremities
Erythema on the palms and soles
Erythema on the hands and feet
Membranous desquamation from
fingertips
o Polymorphous rash (primarily at trunk)
o Acute non purulent sweeling of the cervical
lymph nodes to > 1.5 cm in diameter
Drug of Choice : ASPIRIN
page15

Cleft Lip
Failure of the median maxillary nasal process to fuse
Common to boys
Surgery cheiloplasty
o Done w/in 1 3 months
o To save sucking reflex
Signs and symptoms
o Evident at birth
o Milk from nostrils spills
o Cold is common
o Frequent URTI and otitis media
Post cheilo sidelying
Nutrition use rubber tip syringe
NECK
Check for symmetry
Congenital Torticollis/ Wry neck
Birth injury of sternocleidomastoid due to excessive
traction during cephalic delivery
A case of incompetence to the one giving birth
Management
o Passive stretching
o Exercise daily
o Surgery
Complication
o Scoliosis
Cleft Palate
Failure of the palate to fuse
Common to girls
Surgery Uranoplasty
o Done w/in 4 6 months
o To save speech
Signs and symptoms
o Evident at birth
o Milk from nostrils spills
o Cold is common
o Frequent URTI and otitis media
Post cheilo prone
Nutrition use paper cup/ plastic cup/ soup spoon
Condition to consider for suspension of operation
If child has a cold/ nasopharyngitis may lead to general
septicemia
General management
Maintainance of patent airway
Proper nutrition
NPO 4 hours post op
Clear liquid
o Popsicle except red and brown in color
o Flavore gelatin
o No ice cream
Observe for bleeding
o Frequent swallowing
Protect suture lines specially LOGAN BAR
o Clean using hydrogen peroxide, bubbles traps
microorganism, more bubbles more
microorganism trapped
o Prevent crying by attending to needs
Therapeutic Management
Emotional support
Proper Nutrition
Cleft lip nipple (long tip, made by silicon)
Prevent Colic
o Burp frequently
o One at the middle of the feeding
o Another at the end of the feeding
o Upright sitting position
o Pat at the back lower to upper
o Prone position
o Right sidelying position facilitates gastric
emptying
Educate parents
Apply elbow restraints so the baby can easily adjust post
op
Congenital Critinism/ Congenital Hypothyroidism

Absence or non functioning thyroid gland
Causes
o Due to delayed diagnosis, thyroid is covered
by sternocleidomastoid muscle
o Hypothyroidism
o Thyroid dysgenesis (absence of thyroid)
o Baby receive maternal thyroxine
Earliest Signs and Symptoms
o Change in sucking
o Change in crying
o Excessive sleeping (16-20 hours/ day)
o Constipation
o Edema moon faced baby
o Mental retardation late sign
Diagnostic Test
o Radioimmunoassay Test
o Protein bounbd iodine
Treatment
o Synthroid / sodium levothyroxine for life
CHEST
Witch Milk
Transparent
Liquid coming out from newborns breast related to
hormonal changes
ABDOMEN
Abdominal Assessment
Inspection
Ausculation
Percussion
Palpation
Diaphragmatic Hernia
Protrusion of stomach contents through a defect in
diaphragm due to failure of pleuroperitoneal canal
to close
Signs and Symptoms
o Sunken abdomen
o Signs of RDS
o Right to left Shunting
Treatment diaphragmatic repair w/in 24 hours
Omphalocele
page16

Protrusion of stomach content between the the junction of
abdominal wall and umbilicus
If small surgery
If large suspend surgery
Apply wet dressing
GASTROINTESTINAL SYSTEM
Functions
Assist in maintaining fluid and electrolytes and acid and

base balance
Processes and absorbs nutrients to maintain and

support growth and development
Excrete wasted products from the digestive process

Supplementary Feeding
Begin 4 6 months
As early as 4 months
Usually at 6 months
.
Principles
Solid food are often according to the following sequence

o Cereals rich in iron
o Fruits
o Vegetables
o Meat
Begin with small quantities
Finger food are offered @ 6 months
Soft table food is offered @ 1 year
Diluted citrus/ fruit juices @ 6 months
Offer new food one at a time with an interval of 4 7

days or 1 week
Never offer half cooked egg may lead to

gastroenteritis/ salmoneliosis
Major Concepts of Fluid and Electrolyte Balance

Distribution of Body Fluids
o Fluids are greater in ECF in infant and children
o Newborns are candidate for dehydration
o Total Body fluid is 65 85% of their body weight
in infants and children
Acid Base Imbalance
Depending upon the following
o Chemical buffers
o Renal and respiratory system involvement
o Dilution of strong acids and bases in blood
Imbalance of Acid
o Respiratory Acidosis
Carbonic acid excess
LTB RDS
Hypoventilation COPD
o Respiratory Alkalosis
Carbonic acid deficit
Hyperventilation
Fever, encephalitis
o Metabolic Acidosis
Base bicarbonate deficit
Diarrhea
Severe malnutrition and dehydration
celiac
o Metabolic Alkalosis
Base bicarbonate excess due to

uncontrolled vomiting
NGT aspiration
Gastric lavage
Pyloric stenosis
Conditions that Produce Fluids and Electrolyte

Imbalance
Vomiting
Forceful expulsion of stomach content
Signs and symptoms
o Nausea
o Abdominal crumping
o Flushing of face
o Watery eyes
Assessment
o Frequency
o Forces
Projectile increase ICP/ Pyloric stenosis
Non projectile
Management
o Banana
o Rice cereal
o Apple sauce
o Toast
Alerts
Vomiting is an initial symptom of GI Obstruction

Vomitus of upper GI can be blood tinged but bile
streaked
Vomitus of lower GI is bilous
Projectile vomiting is either a sign of increased ICP
or GI Obstruction
Abdominal distention is the major symptom of lower
GIT obstruction
Diarrhea
Exaggerated excretion of intestinal contents
Acute diarrhea is associated with the following
o Gastroenteritis/ salmonelliasis
o Antibiotic use penicillin, tetracycline
o Dietary indigestion
Chronic non specific diarrhea
o Food intolerance
o CHO/ CHON malabsorption
o Excessive fluid intake
Assessment
o Frequemcy
o Consistency (best criteria)
o Appearance of green colored stool
Complications
o Mild dehydration 5% weight loss
o Moderate dehydration 10% weight loss
o Severe dehydration 15% weight loss
Signs of dehydration
o Tachycardia earliest sign
o Tachypnea
o Hypontension
o Increase temp
o Sunken fontanel
o Sunken eyeball
o Poor skin turgor
o Absence of tears
o Scanty urine
page17

o Oliguria severe dehydration
o Weight loss
o Prolonged capillary refill time
Management
NPO
IV infusion
KCl given by doctors
Assess child for ability to void before giving KCl may
lead to hyperkalemnia
Normal K Value 3.5 5.5
Order Na Bicarbonate, administer slowly to prevent

cardiac overload
Gastric Motility Disorders
Hirschprungs Disease/ Congenital Aganglionic Megacolon
Absence of ganglion cells needed for peristalsis
Assessment
o Neonatal Period
Abdominal distention
Failure to pass meconium within 24

hours
o Early childhood
Ribbon like stool
Constipation
Foul smelling stool
Diarrhea
Vomitus of fecal materials
Diagnostic Procedures
o Barium enema reveals narrowed portion of
the bowel
o Rectal biopsy reveals absence of ganglion
cells
o Abdominal x- ray reveals dilated loops on
intestines
o Rectal manometry reveals failure of intestinal
sphincter to relax
Therapeutic Management
o NGT Feeding
NGT Measurement
Infant nose-ears middle

of xiphoid process and umbilicus
Adult nose ears xiphoid

process
o Surgery
Temporary colostomy
Anastomosis and pull through

procedure
o Diet
Increase CHON
Increase Calorie
residue diet pasta foods

no raisin/ prunes
Gastroesophageal Reflux Dse (GERD)
presence of stomach content on esophagus
Assessment
o chronic vomiting
o failure to thrive syndrome organic
o esophageal bleeding manifested by melena
and hematemesis
Complications
o esophagitis
o aspiration pneumonia
o esophageal cancer
Diagnostic Procedure
o barium esophogram
o esophageal manometry reveals lower
esophageal pressure
o intraesophageal pH content reveals pH
of distal esophagus
Medications
Anticholinergics
Bathanechol/ urecholine
o esophageal tone and peristaltic activity
Methachlopromide (Reglan)
o esophageal pressure by relaxing pyloric
and duodenal segments
o peristalsis without stimulating secretions
H2 Blocker/ histamine Receptor Antagonist
o gastric acidity and pepsin secretion
Maalox/ Cimetidine (Tagamet)/ Ranitidine (Zantac)
o Neutralizes gastric acid between feedings
Surgery: Nissen Fundoplication
Diet
o Thickened feeding with rice cereal
prevents vomiting
o Feed slowly
o Burp often every 1 oz
o Positioning
< 9 mos infant sit/ infant supine
> 9 mos prone with head on

mattres slightly elevated on a 30
angle
Obstructive Disorders
Pyloric Stenosis
hypertrophy of the muscle of pylorus causing

narrowing and obstruction
Assessment
o Projectile vomiting
o Failure to gain weight
o Metabolic alkalosis
o Peristaltic wave visible from left to right
across epigastrum
o Palpation of olived shaped mass
o ABG
o Serum Electrolyte - Na and K, Cl
o Ultrasound
o X-ray of upper abdomen with barium
swallow
Management
o Pyloromyotomy/ Fredet Ramstedt
Operation
Intussusception
Telescoping or invagination of one portion of the

bowel into the other
Peritonitis danger of intussusception
Emergency for URT epiglotitis
Emergency for GIT peritonitis
Signs and symptoms

page18

Acute paroxysmal abdominal pain
Currant jelly stool caused by inflammation and
bleeding
o Sausage shaped mass
Non congenital
Caused by fast eating and positioning
Management
o Hydrostatic reduction with barium enema
o Surgery Anastomosis
o
o
Inborn Errors of Digestion

Phenylketonuria/ PKU
Deficiency of the liver in Phenyalanine Hydroxylase

Transferase (PHT)
PHT is a liver enzyme that coverts protein into amino

acid
9 Essential Amino Acids

o Tyrosine / phenylalanine
o Histidine
o Isoleucine
o Leucine
o Lysine
o Methionine/ cysteine
o Threonine
o Tryptophan
o Valine
Tyrosine or Phenylalanine responsible for the melanin

production
Signs and Symptoms

o Fair complexion
o Blond hair
o Blue eyes
o Infantile eczema
o Mousy/ musty odor urine
o Seizure due to Phenyl Pyruvic Acid goes to
brain
o Mental retardation
Guthrie Test
o Specimen Blood
o Preparation Increase Fluid Intake
Management
o Diet
phenylalanine diet indefinitely
Chicken, meat, peanuts, milk,

legumes, cheese contraindicated
Lofenalac special formula
Celiac Disease/ Malabsorption Syndrome; Gluten Induced

Enteropathy
Sensitivity or immunologic response to protein

Assessment
Early signs
o Diarrhea, failure to regain weight following
diarrheal episode
o Constipation
o Vomiting
o Abdominal pain
o Steatorhea
Late signs
o Behavioral changes: irritability and apathy
o Muscle wasting and loss of subcutaneous fats
Celiac Crisis
o Development of infection by a child having a
celiac disease
o Acute vomiting and diarrhea

o Stool analysis
o Serum antiglandin and antireticulin
antibodies
o Sweat test
Therapeutic management
o Vitamin supplements
o Mineral supplements
o Steroid
Poisoning
Common accident in toddlers poisoning
Common accident in infants falls

Principles
Determine the substance taken and assess LOC
Unless poisoning was corrosive, caustic (strong

alkali, such as lye) or hydrocarbon, vomiting is the
most effective way to remove the poison from the
body
o Strong acid poisoning give weak acid to
neutralize strong acid
Syrup of ipecac oral antiemetic to cause vomiting

after drug overdose or poisoning
o 15 ml adolescent, school age and
preschool
o 10 ml infant
Universal Antidote
o Activated charcoal
o Milk of magnesia
o Burned toast
o Charcoal absorbs toxic substance
Never administer the charcoal before ipecac

because giving charcoal first will absorb the effect
of ipecac
Antidote for acetaminophen poisoning :

Acetylcysteine (mucomyst)
Kerosine/ Gasoline poisoning: Give mineral oil to

coat the intestine and prevent poison absorption
Tracheostomy set will be at bed side

Lead Poisoning
Assessment
o Beginning symptoms of lethargy
o Impulsiveness and learning difficulty
o As lead , severe encephalopathy with
seizure and permanent mental retardation
Pencil, paint, crayon Lead
Destruction of RBC Functioning
hyupochromic Microcytic Anemia
Destroys Kidney Function
Accumulation of ammonia
Leading to Encephalitis (Late stage)
Severe mental retardation
Diagnostic procedure
o Blood smear
o Abdominal x-ray
o Long bone
page19
Management
o Chelation binds with the lead and excreted
via kidneys
o Ca EDTA/ BAL/ Dimercapro
Nephrotoxic
ANOGENITAL
Female
Pseudomenstruation
o Slight vaginal bleeding related to hormonal
changes
Rape/ Child Abuse

o If the client came with a laceration and
bleeding at the perineum
o Report rape within 48 hours
o Preschool are proneto rape because of their
innocence
o Report rape cases to barangay chairman
first or bantay bata
Male
Cryptochirdism
o Undecended testes or empty scrotum or
ectopic testes
Common in preterm babies
Testes is palpable at lower quadrant
Surgery: Orchioprexy
Preop warm the room and

hands
Epispadias
o Urinary meatus is located at the dorsal or
above the glans penis
Hypospadias
o Urinary meatus is located at the ventral or
below the glans penis
o Hypospadias is usually accompanied by
Chordee ( A fibrous band causing penis to
curved downward)
o Both are manage by surgery
Phimosis
o Tight foreskin
o This will cause infection
o Circumcision as management
Hydrocele
o Fluid filled scrotum
o Flashlight/ transillumination test to determine
Varicocele
o Enlarged vein opf the epididymis
RENAL DISORDERS
Renal
Disorder
Nephrotic
Syndrome
Acute
Glomerulo
nephritis
Causes
Infection
Autoimmun
e
Group A
beta
hemolytic
streptyococ
Assessment
Findings
Anasarca
Massive
proteinuria
Microscopic or
no hematuria
serum
CHON
serum lipid
Normal or
BP
Fatigue
Primary
pheripheral
perioprbital
edema
Moderate
Proteinuria
Treatment
Nursing Care
Prednisone
Skin Care
Weigh the client
saily with the
same clothing
CHON(Normal
Diet)
Na
K
AntiHPN
Hydralazine
Apresoline
Complication
Hypertensive
Monitor weight
Skin Care
Monitor BP and
neurologic status
K
Fe
cus
BACK
Goss
hematuria
(smokey urine)
serum K
Fatigue
HPN
Encephalopa
thy
Na
Check for flatness and symmetry of the back
Spina Bifida Occulta
Failure of the posterior lamina or vertebral to fuse
Sampling of the lower back
Abnormal tufts of hair
Spina Bifida Cystica
With Sac
Types
o Meningocele protrusion of CSF and
Meninges
o Myelomeningocele CSF, Meninges and
Spinal cord
o Ecephacele
cranial meningocele - CSF and

meninges
Myelomeningocele - brain, CSF ,

meninges
Common Complication
o Infection
o Rupture of Sac
Treatment
o Surgery to prevent infection: post op
prone position
Scoliosis
Lateral curvature of the spine, common in school

age because of heavy bags
Uneven hemline
Tell the child to bend forward, one hip higher than

athe other and one shoulder is most prominent
Types
o Structural
o Postural
Management
o Conserbvative
Exercise
Avoid obesity
o Preventive
Milwaukee Braces worn 23 hours

a day
o Corrective: Surgery
EXTREMITIES
Count the number of digits

Digits
Syndactyl webbing of the digits (foot ginger

like foot)
Polydactyl extra digits
Olidactyl lacks digits
Erb Duchennse Paralysis/ Brachial Plexus Injury
Birth injury of breech delivery
Signs
page20

Inabiluity to abduct the arm fronm the shoulder,
rotate the arm extremely and supinate the
forearm
o Assymetrical oor absence of moro reflex
Management
o Abduct the arm from the shoulder with the
elbow flexed
o
Congenital Hip Dislocation
Congenital hip dysplacia
When the head of the femus is outside the scetabulum
2 types
o subluxated most common
o dislocated
Signs and Symptoms

o Shortening of the affected leg
o Assymetrical gluteal fold
o Limited movement earliest sign
o + ortolanis sign abnormal clicking of during
abduction
o when able to walk the child limps
(Trendelenburg sign) late sign
Management facilitate abduction

o Triple the diaper
o Carry the baby
o Frejka Splint
o Pavlik Harness
o Hip Spica Cast
Talipes
Club foot
4 types
o Equinos plantar rotation/ horse foot (most
common)
o Calcenuous dorsiflexion/ the heel is held lower
than the foot/ the anterior portion of the foot is
flexed towards the anterior leg
o Varus foot turns in
o Valgus foot turns out
Assessment
o Make a habit of straightening the legs and flying it
to the midline position
Management
o Corrective shoes : Dennis Brown Shoes
o Spica Cast
For immobilization
Maintain bone alignment
Prevent muscle spasm
If there is a blood mark on the cast mark

a pen to det. if hemorrhage
Neurobvascular check
Circulation
Motion
Sensation
CRUTCHES
Wait is on the palm not the axilla
Exercise squeeze ball

Different Crutches and Gait
Swing Through
Advance both crutches
Lift both feet/ swing forward/ land feet in front of

crutches

Lift both feet/ swing forward/ land feet in front of
crutches
Swing To
Lift both feet/ swing forward/ land feet next to

crutches
Lift both feet/ swing forward/ land feet next to

crutches
Three point gait
Advance left foot and both crutches
Advance right foot
Advance left foot and both crutches
Advance right foot

Four Point Gait
Advance right crutch
Advance left foot
Advance left crutch
Advance right crutch

Two Point Gait
Advance left foot and right crutch
Advance right foot and left crutch
Advance left foot and right crutch
Advance right foot and left crutch

Other Crutch Maneuvering Technique
To Sit Down
Grasp the crutches at the hand pieces for control
Bend forward slightly while assuming a sitting

position
Place the affected leg forward to prevent weight

bearing and flexion
To Stand Up
Move forward to the edge of the chair with the strog

leg slightly under the seat
Place both crutches in the hand on the side of the

affected extremity
Push down on the hand piece while raising the

body to a standing position
To Go Downstairs
Walk forward as far as possible to the step
Advance the crutches to the lower step. The

weaker leg is advanced first and then the stronger
leg. In this way, the stronger extremity shares the
work of raising and lowering the patients body
weight with the arms
To Go Upstairs
Advance the stronger leg first up to the next step
Then advance the crutches and the weaker

extremity ( strong legs goes up first and comes
down last.)
A memory device for the patient is UP WITH THE

GOOD, DOWN WITH THE BAD
WALKER
A walker provides more support than cane andf

crutches
The patient is taught to ambulate with a walker as

follows
o Patient must hold the walker on the hand grips
for stability
page21

o Lift the walker, placing it in front of you while leaning
your body slightly forward
o Walk into the walker, supporting your body weight on
your hands while advancing the weaker leg,
permitting partial weight bearing or non weight
bearing leg as prescribed
o Balance yourself on your feet
o Lift the walker and place it in front of you again and
continue the pattern of walking.
CANE
Used to help patient walk with greater balance and

support and to relieve the pressure on the weight
bearing joints by redistributing the weight.
Quad Cane (four footed cane) is hold on the hand of
affected extremity.
METHODS OF TRANSFERRING A PATIENT FROM THE BED

TO A WHEELCHAIR
Weight bearing transfe4r from bed to chair. The patient

stands up, pivots his back is opposite the new seat and
sits down.
(Left) Non weight bearing transfer from chair to bed.

(Right) With legs braced.
(Left) Non weight bearing transfer combined method.

(Right) Non weight bearing transfer, pull up method.
THERAPEUTIC EXERCISE
Exercise
Passive
Active
Assistance
Active
Resistive
Isometric/
Muscle
Setting
TRACTION
Description
carried out by the
therapist or the
nurse without
assistance from
the patient
Carried out by the
patient with the
assistance of the
therapist or the
nurse
Purpose
To retain as
much joint
range of
motion as
possible
To maintain
circulation
To
encourage
normal
muscle
function
Accomplished by
the patient without
assistance,
activities include
turning from side
to side and from
back to abdomen
and moving up and
down in bed
To increase
muscle
strength
An ective exercise
carried out by the
patient working
against the
resistance
produced by either
manual or
mechanical means
To provide
resistance
to increase
muscle
power
Alternately
contracting &
relaxing a muscle
while keeping the
part in fixed pos.;
performed by the
pt
To maintain
strength
when a joint
is
immobilized
Action
Stabiolize the proximal
joinyt, and support the distal
part. Move the joint
smoothly, slowly and gently
through its full rang of
motion
Avoid producing pain.
Support the distal part and
encourage the patient to
take the joint actively
through its ROM. Give no
more assistance than is
necessary to accomplish
the action. Short periods of
activity should be followed
by adequate rest periods.
When possible, active
exercise should be
performed against gravity.
The joint is moved through
full ROM without
assistance. (make sure that
the patient does not
substitute another joint
movement for the one
intended)
The patient moves the joint
through its ROM while the
therapist resist slightly at
first and the progressively
increasing resistance.
Sandbagws & weights can
be used & are applied at the
distal point of the joint
involved. The mvmt should
be performed smoothly.
Contract or tighten the
muscle as much as possible
wi/o moving the joint. Hold
for several seconds, and
then let go and relax.
Breath deeply.
Use to reduce dislocation
Principles of Traction
The client should be in dorsal or supine position
For every traction, there is always a counter traction
Line of pull should be in line with deformity
For traction to be effective it must be continuous
Weight must be freely hanging

Types of Traction
Straight traction weight of the body serves as

counter pull
Skin traction applied directly to the skin

o Bryants Traction
use to immobilize for < 2 years

old at a 90 angle with buttocks
off the bed
o Bucks extension
For > 2 years old
Halo traction immobilize the spine
Skeletal traction
o Nursing responsibilities
Assess for circulatory and

neurology impairment
It can lead to HPN
Be careful to carry out nursing

functions by not moving the
weights
AUTOIMMUNE SYSTEM
Types of Immunity
1. Passive Natural - developed via exposure to a disease
2. Active Natural - transplacental transfer, IgA from
breastmilk
3. Passive Artificial vaccination
4. Active Artificial - anti Rabies Serum
NEUROMUSCULAR SYSTEM
Reflexes
Blink reflex
Rapid eye closure when strong light is shown to

protect the eyes; never disappears
Palmar Grasp Reflex
When a solid object is placed on the palm then the

baby will grasp the object
To cling to the mother for safety
Disappears at 3 months
Step in/ Walk in Place Reflex/ Dance Reflex
Neonate placed on a vertical position with their feet

touching on hard surface will take a few quick
alternating steps
Placing reflex almost the same with the dance

reflex except that is when you are touching the
anterior surface of newborns leg
Plantar Grasp Reflex
When an object touches the sole of the newborns

foot at the base of his toes, the toes grasp in the
same manner as the fingers do
Disappears @ 8 9 months in preparation for

walking
page22
Tonic Neck Reflex/ Fencing/ Boxing reflex
When the newborn lies on its bact, their heads usually

turns to one side, the arm and the leg on the side to
which the head turns extend to the opposite arm and
legs contract
Moro Reflex/ Startle Reflex
With a loud voice or by a jarring the base of the crib, the

baby will assume a c position
Test for neurologic integrity

Magnet Reflex
When there is pressure at the sole of the foot, the baby

pushes back against the pressure
Crossed extension Reflex
While supine and the sole of the foot is stimulated by a

sharp object, it causes the foot to raise and the other
foot to extend
Test for spinal nerve integrity

Trunk Incurvation Reflex/ Galant Reflex
While in prone position and the parabvertebral area is

stimulated, it causes flexion of the trunk and swing his
pelvis towards the touch
Landau reflex
While the infant is placed on a vertical position with the

hand underneath supporting the trunk the baby exhibit
some muscle tone
Present at 3 months
Test for muscle tone

Parachute Reflex
When the infant is placed on a vertical suspension with

the change in equilibrium, it causes the extension of the
hands and legs
Present at 6 9 months
Babinski Reflex
When the sole of the foot is stimulated by inverted j, it

causes fanning of the toes
Disappears by 2 months but may persist till 2 years old
page23

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PEDIATRIC NURSING <reviewer rabe>

IMMEDIATE CARE OF THE NEWBORN

8 PRIORITIES OF THE NEWBORN

Projectile Vomiting surest sign of cerebral

High pitched, shrill cry

Cushing Triad of ICP

Establish and maintenance of Airway patency

I. ESTABLISH & MAINTENANCE OF AIRWAY PATENCY

Expulsion is @ 2nd stage of labor

Lung function begins only after birth.

I. Suction secretions properly:

II. PROMOTE ADEQUATE CIRCULATION

Circulation is initiated by LUNG EXPANSION and

Completed by cutting the cord

Assess characteristics of cry

Hypoglycemia/ Increased ICP high pitched, small

Feto Placental Circulation

Placenta O2 carried by vein liver Inferior Vena Cava

Support head and remove secretion, place babys

Evaluate patency: OCCLUDE ONE NOSTRIL AT A

If not effective requires effective LARYNGOSCOPY to

Scarring Retina results Retinopathy (O2 overdose)

Diplopia normal in newborns, sign of ICP in

Must be humidified prevent drying of mucosa

Right side-lying best position for NB less than 3

Abnormal large head

Bulged & tensed fontanel

Ways to facilitate closure of Foramen Ovale

Proper positioning of the Baby

CS supine, crib level position

PEDIATRIC NURSING <reviewer rabe>

Physiology of Breastmilk Production

III. CONTROL OF BODY TEMPERATURE/ TEMPERATURE

The goal of temperature regulation is to maintain

Factors leading to the development of Hypothermia

Preterm are born POIKILOTHERMIC (easily adapt the

Contains LACTOBACILLUS BIFIDUS interfere

Helps in early involution of uterus oxytocin

Incidence of breast cancer

Process of Heat Loss

Evaporation body to air

Radiation body to a cold subject not in contact with the

Conduction body to solid objects (cold compress)

Effects of Hypothermia (COLD STRESS)

RR first sign of hypothermia

Average/ borderline 40 mg/ dl

Metabolic Acidosis due to the catabolism of BROWN FAT

High risk for KERNICTERUS (bilirubin in the brain)

Possibility of transfer of Hepa B, HIV, CMV (13

Father cant bond with the mother and baby

Freezer good for 6 mos./ dont reheat

Pre Colostrums 6 weeks

Prevention of Cold Stress

Dry and wrap the newborn

Mechanical measures (radiant warmer, acrylic sided

Prevent unnecessary exposure cover areas not being

IV. ESTABLISHING ADEQUATE NUTRITION

Lactose Intolerance deficiency in enzyme

PEDIATRIC NURSING <reviewer rabe>

Linoleic Acid responsible for the

fats almost similar to mature milk

Problems experience in Breastfeeding

SORE NIPPLE/ CRACK NIPPLE