UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
PEDIATRIC NURSING
a.
b.

Administrative order of DOH 2009 Unang Yakap

The Neonates 0 age group
a. ABCD of Life - Ladewig
i. Airway - includes breathing
ii. Body temperature
iii. Certify the babies birth identity as a Filipino citizen, tagging with bracelet
iv. Determine adaption to life outside the womb
b. AO 2009- New policies and protocol on essential NC care
i. Ensure quality provision of time-bound interventions
1. Within the first 30 seconds
a. Objective 1: dry and provide warmth and prevent hypothermia
i. Body temp at birth: physiologic heat loss after birth
(37.2C down to 35.5 to 36.5C)
ii. Extreme hypothermia can cause:
1. Increased risk for infections
2. Coagulation defects
3. Brain hemorrhage
4. Acidosis
a. Prone to cold stress due to extreme
hypothermia
b. Extreme hypothermia
i. >> shivers / chills >> increase 02
consumption >> decrease O2 and ^
C02 >> ACIDOSIS can cause CNS
depression coma, stupor, death
ii. >> burns brown fat for heat
abnormal kasi dapat CHO muna >>
Ketones / Fatty Acids >> Acidosis
iii. Management - Traditional
1. Dry baby immediately after birth evaporation
2. Avoid putting the baby near the wall radiation
3. Unang yakap
4. If to be separated from mother, put under the floor
lamp or drop light with safety consideration ( most
ideal radiant warmer most safe source of
external heat)
a. Floor lamp- kung san lang nakatutok, yun
lang umiinit; uneven heat distribution
5. Keep warm while bonding
6. Postpone the bath for 6 hours
7. Use warm water during bathing
iv. Management - AO 2009
1. Double gloves just before delivery
2. Use clean, dry cloth to thoroughly dry the heat
evaporation
3. Do a quick check on BREATHING while drying
a. Tignan mo kung humihinga umiiyak dapat
b. ARIWAY: AA prevent asphyxiation number
one cause of NB death; and prevent
aspiration
i. Umbilical cord is clamped >> no more
02 from placenta >> hypoxia >>
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
hypercapnea >> acidosis >> CNS
depression asphyxiation
c. Neonates must breath after birth! If not..
asphyxiation
may
result
(hypoxia,
hypercapnea, acidosis)
d. A crying baby is a breathing baby kapag
hindi umiyak, tiyanak yun.
e. Neonates breath after birth by crying so
stimulate NB to cry effectively after birth
f. Suction ONLY if nose and mouth is blocked
with secretions or amniotic
fluids is
meconium stained prevent aspiration
greenish; bulb syringe
i. Do not use catheter too deep can
cause bradycardia vagal stimulation
g. Encourage to cry effectively to maximize
lung expansion color of the baby from
blue to red or pink
i. Do not give oxygen automatically
oxygen
can
cause
blindness

retrolental fibroplasias retinopathy of

prematurity
4. Do not put on a cold or wet surface conduction
5. Do not bathe earlier than 6 hours of life
6. If the NB must be separated from the mother, put
baby in a warm safe place close to the mother
a. Kapag walang RW, floor lamp
2. After thorough drying:
a. Objective 2: facilitate bonding between mother and baby
through skin to skin contact to reduce likelihood of infection and
hypoglycemia
i. Place the baby PRONE on the mothers abdomen or chest,
skin to skin up until the hypogastrium lang kasi hindi pa
putol ang UC
ii. Cover babys back with blanket, head with bonnet layat;
if walang bonnet, towel nalang to prevent heat loss kasi
kalbo ang baby
iii. Place ID band on the ankle
iv. Do not separate baby from mother as long as baby does
not exhibit severe chest indrawing, gasping or apnea and
the mother is stable without any medical or surgical
emergency.
v. Do not wipe off vernix if present / delay bath for 6 hours
1. Wag na mag-oil bath kasi vernix is a protective
mantle for the skin
a. Prevent heat loss, moisture and evaporation
3. While on skin to skin contact up to 3 minutes after delivery
a. Objective 3: reduce the incidence of anemia in term NB and
intraventricular hemorrhage in preterm NB by delaying cord
clamp
i. Remove the 1st set of gloves immediately prior to cord
clamping
ii. Clamp and cut the cord after cord pulsation have stopped
1. 1-3 minutes- do not milk the cord towards the NB.
2

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
2. Tie the cord at 2 cm and 5 cm from the NBs
abdomen
3. Cut between the ties with sterile instrument
iii. After cord clamping, give MOM 10IU oxytocin;
b. Objective 4: to prevent ophthalmia neonatorum through proper
eye care
i. Eye acre or Credes Prophylaxis
1. Prevents ophthalmia neonatorum due to maternal
gonorrhea or Chlamydia
2. Done to ALL babies delivered either CS or NSD
ii. Administer erythromycin or tetracycline ointment or 2.5%
povidone iodine drops to both eyes after the NB has
located the breast eyeball to eyeball ; wala ng silver
nitrate
1. Put only half a grain of rice- ointment
iii. Do not wash away the antimicrobials povidone iodine is
left there
ii. Non immediate interventions
1. Interventions given within 6 hours after birth, and should never be
made to compete with time bound interventions
a. Vitamin K administrations
i. Neonates cannot synthesize Vitamin K because of absent
intestinal bacterial flora 0.1cc / 1mg tuberculin syringe
ii. Given IM in the thigh muscle vastus lateralis biggest
muscle mass and most highly developed
iii. Avoid using the gluteal muscle (buttocks) because of the
danger of sciatic nerve trauma causing paralysis
1. If the child is walking for 1 year safe to give in
gluteal muscle
iv. If parents decline IM, offer oral Vitamin K
b. Inject Hepa B and BCG
c. Examine the NB
d. Cord Care
i. No binder- bigkis, No alcohol!
ii. Just expose the cord to air.
iii. Fold diaper below the stump.
iv. If stump is soiled, wash with clean water and soap, dry
thoroughly with clean cloth.
iii. NB resuscitation
1. Start resuscitation immrfistely if NB is completely floppy or is not
breathing or is gasping after 30 seconds of drying
2. Clamp the cord immediately
a. Approximately 3 minutes before pulsations stops
3. Call for help
4. Transfer to clean, dry surface, keep warm
iv. Certify the Babys Birth
1. Identification and registration
2. Plastic bracelet and crib card
3. Foot prints- no longer required; requested by parents
4. Most Ideal:
a. DNA genotyping
b. HLA Human Leukocyte Antigen Test done before bone
marrow transplant check compatibility in bone marrow donors
3

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
5. Local civil registrar then NSO for Birth Certificate only Filipino citizens;
jus sanguinis by blood
v. Determine Adaptation to Extrauterine Life
1. Apgar score done at 1 minute, then at 5 minutes
CRITERIA
PRAGA

Assess

Pulse

Cardiac rateapical pulse

Absent

Less than 100

^100

Respiration

Cry

Absent

Activity

Muscle tone

Limp floppy
tone

Grimace test for the

brain

Reflex irritability

No
response

Appearance circulatory

Color

Weak, slow irregular

konti yung hinigop na air
Some flexion; little
movement

Pale or blue
all over

Strong regular
Well flexed
active

Grimace

Cry, gag, cough,

pulls away

Acrocyanosis normal due

to change in temperature
blue extremities

Pink or red all

over
Pink white
skins
Red black
people

a. Score of 0-3 poor condition

i. Resuscitation needed
b. Score 4-6 fair condition but guarded; closer monitoring
c. Score of less than 6 at 5 minutes babies go to NICU or is
prepared for surgery of for transport PRN
d. Score of 7-10: Good condition
i. Baby goes to regular nursery for regular nursery care.
c. Examine the Baby
i. Measurement
1. Take note of threatening abnormalities that require immediate referral
Measurement
NORMAL
ABNORMALITY
IMPLICATION
Birth Weight
3000 grams normal SGA below 10% in *IUGR

lifestyle,
2500 to 3500 grams
the IUGC
poverty, party animal
6.5 lbs normal +- LGA - ^90%
mother,
cigarette
1.5lbs
smoking, drugs
*Maternal
endocrine
problems:DM/
Hypothyroidism
Birth Length
50cm
19-20 inches
Head
33-35 cm
Microcephaly utak Mental retardation
lamok- smoking, on Hydrocephaly
drugs, drinking alcohol
>> Future retarded
Macrocephaly
Chest Circumference- 31-33 cm
barrel chest
Abdomen
31-33 cm
Smaller than chest Diaphragmatic hernia
Circumference
scaphoid or funnel walang laman ang
shaped
abdomen nasa may
chest
ii. Vital Signs
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
1. CR: 120-160 with normal murmurs- foramen ovale and PDA, higher
when crying, lower when sleeping
2. Respiration 30-60 RPM thoraco-abdominal, irregular with periods of
apnea normal if less than 20 seconds per episode
3. BP- by oscillometry (Dinamap) 65/40 elevated in COA acyanotic
4. Temperature: 35.5-36.5C
iii. Color
1. Normal pinkish or reddish
2. Abnormal
a. Gray ash colored- septicemia due to intrauterine infection
b. Green meconium stained due to fetal distress
c. Blue congenital cyanotic cardiac disease transposition of
great vessels
d. Yellow pathologic jaundice due to blood incompatibility ABO
and Rh
i. Physiologic jaundice
1. Term babies- day 3 day 7
2. Preterm 2nd day to 10th day
3. Caused by normal accumulation of bilirubin due to
expected hemolysis after birth
a. Fetal hemoglobin immature get rid of it
siya na gagawa ng sarili niyang hemoglobin
ii. Pathological jaundice
1. If noticed at birth or baby is less than 24 hours old
2. Biliary atresia surgery rerouting of the biloirubin
away from the liver going to the Gi Kassi
procedure palliative surgery
a. Liver transplant corrective procedure
3. Blood incompatibility exchange transfusion
iii. Blood hemolysis: Indirect bilirubin- unconjugated bilirubin
fat soluble- cannot be excreted >> liver >> convert thru
the glucorynyl transferase >> direct bilirubin >> can be
excreted water soluble
d. Provide optimum nutrition: Republic Act 7600 or Rooming In/ Breastfeeding act of
1992
i. EO 51- Milk Code of the Philippines
ii. Breastfeeding the best feeding for all babies (must be done at least 8x/day)
1. ON DEMAND no schedule
2. Exclusive BF- no water in between
iii. If with temporary CI, teach pumping and proper storage
1. Frozen breast milk can stay for 6 months
2. If mother has absolute CI to breastfeeding ---3. Maternal cancer
4. Hepatitis
5. HIV
6. Active TB hindi pa umiinim ng anti Tb drugs
7. Maternal substance abuse
8. Surgical reasons
9. Breast reconctructions pwede magBF mammary glands were not
touched
10.Give mother advice on the use of breast milk substitute:
a. Type infant formula only- BONA, s26
b. Preparation sterilization/ boiling; instead use cups kahit 2 day
old palang
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
i. #1 Morbidity among children diarrhea
c. Feeding method (Do not PROP feeding bottle at risk for otitis
and aspiration, position, burping)
e. RA 922- Newborn Screening Act of 2004
i. Done to diagnose inborn errors in metabolism
1. Congenital adrenal hyperplasia most fatal; can die in about a week
2. Galactosemia
3. PKU
4. G6PD
5. Cretinism
ii. Can cause Death or Mental Retardation
iii. Done by heel prick when baby is at least 24 hours old
iv. If refused: have sign a waiver
f. Discharge instructions
i. Advise mother to return or go to the hospital immediately if:
1. Jaundice
2. Difficulty feeding
3. Convulsions
4. Movement when stimulated
5. Fast or slow or DOB severe chest indrawing
6. Temperature more than 37.5C or less than 35.5 C
ii. Advice mother on routine check up at the ff schedule
1. Post natal visit 1: at 48-72 hours of life
2. PN2: at 7 days
a. UC 7-10 days
b. Check the jaundice
i. Breastfeeding jaundice longer period of time G.
transferase
1. Breast milk contains Pregnanendiole decreases the
production of G. transferase longer jaundice;
higher bilirubin level NORMAL very very yellow
or bronze
3. PN3 first immunization day 6 weeks of life HB2, DPT1, OPV1
g. UNNECESSARY PROCEDURES need to be erased in memory
i. Routine suctioning
ii. Early bathing
iii. Foot printing
iv. Giving sugar water or formula
v. Use of bottles and pacifiers
vi. Application of alcohol, medicine and other substance on the cord
GROWTH AND DEVELOPMENT
I.
Growth increase in the number and size of cells; measured in terms of quantity
II.
Development capacity of functioning or skill; measures in terms of quality
a. No need to be taught: rolling over, sit, stand
III.
Principles of G and D
a. Unique individualized- no 2 persons are exactly the same/ alike.
b. Unified all areas are important
i. Physical
ii. Social a child needs to play universal language of a child
1. Game Children Plays
a. Criteria:
i. Safety
ii. Appropriateness in mental age
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

b.

c.

d.

e.

iii. Functional educational

iv. Based on limitations of condition
1. To increase OFI tea party, beer drinking, water gun,
simon says
Infants
i. Plays alone solitary games
ii. Plays with their body and senses
iii. Toys
1. Mobiles hanging objects at top of crib
2. Rattles colorful and safe; made of foam
3. Teething rings
4. Music boxes
5. Squeeze toys
6. Most important FACE priceless
Toddler
i. Narcissism
ii. Very possessive and cannot share
iii. Loves to play BESIDE another child but must have each toy
PARALLEL GAMES
iv. Toys
1. Promote skills of walking-push and pull toys
2. Promote talking-toy telephone human sounds
a. No talking dolls- robotic sound
3. Coordination blocks
Pre-school
i. Role playing age
ii. Copy adults when in play
iii. Loves to share and imitate adults in their role play
iv. COOPERATIVE / ASSOCIATIVE GAMES
v. Toys
1. Role playing games- play school, play house, doctornurse kit, etc
School Age
i. Competitive games
ii. Must have a winner at the end of the game
iii. Toys
1. Card games
2. Scrabble
3. Hopscotch - piko
4. Skipping rope

iii. Emotional
c. Continuous process.
i. Begins in conception and ends at death.
d. Influenced by factors in the environment
i. Prenatal factors: Genetics and pregnancy care
ii. Post natal: home, school, city, country
e. Rate of growth varies:
i. Rapid stages growth spurts
1. Infancy and adolescents
ii. Slow periods growth gaps
1. Toddler, preschoolers, schooler
f. Directional
i. Growth horizontal and vertical
ii. Development
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

IV.

V.

1. Cephalocaudal gross motor

2. Proximo distal - fine motor
Assessment of GROWTH
a. Physiologic weight loss a couple of weeks after birth (2 weeks): 5-10% of birth weight
b. Most rapid during infancy and adolescent stages
i. Doubling time
1. 6 months 2x BW
2. 1 year 3x BW
3. 2 year 4x BW
c. Computing for expected weight (BW is unknown)
i. Less than 1 year: age in months /2 + 3 or 4 = weight in kg
ii. ^1 year: Age in years x2 +8 = weight in kg
Assessment of development
a. DDST Denver Development Screen Test
b. MMDST- Metro Manila Development Screen Test
c. Areas assessed
i. Gross motor skills- skills done by the large muscles (cephalocaudal) even
numbers
1. 0 neonate cry
a. Head lag
b. No head control
c. Safe way cradle hold
d. If burping hold the neck or chin
2. 2 months
a. Begins to have head control
b. Lifts head on prone
3. 4 months
a. Full head control
b. Lifts head and chest
4. 6 months
a. Sit with support
5. 8 months
a. Sits alone- without support
6. 9 months- CRAWLING most dangerous time in infant- together with
pincer grasp
7. 10 months stands with support as long as may mahawakan, they can
stand
8. 12 months stands alone; walks with support basta may aakay, they
can walk
9. 14-15 months- walk alone
ii. Fine motor skills skills done by small muscles (hands) Proximodistal odd
numbers
1. Neonate strong grasp reflex
2. 3 monthsa. Grasp reflex is gone / hands are held open
b. Hand regard- plays with hands
3. 6 months
a. PALMAR GRASP
b. Holds feeding bottle with 2 hands
4. 9 months
a. Pincer grasp thumb and finger to hold objects
5. 12 months
a. Put thinks in and out of containers
b. Puts objects inside mouth, throws objects
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
6. Trainer cups- sippy cups
7. Juices should not be given thru a feeding bottle dental caries
iii. Interpersonal social
1. 2 months- social smile
2. 3 months recognizes mother or primary care giver
3. 7 months- begins stranger anxiety nangingilala
4. 8 months- peak of stranger anxiety
5. Infants primary care giver
6. Toddler parents
7. Pre schooler- siblings
8. Schooler teachers and classmates
9. Adolescent - peers
iv. Language
1. Neonate- cries- mabilis sumasagot ang mother
2. 3 months coos / gurgles naglalaro ng laway
3. 4 months- laughs aloud
4. 7 months m-m-m when crying delayed gratification kasi baka umaarte
lang
5. 9 months- mama or dada
6. 10 months responds to own name / understands NO use non verbal
cues
a. Kapag tinawag, then tumingin
7. 12 months 2 words + mama and dada
8. 18 months- uses phrases
9. 2 years old- short sentences
10.Number 1 cause of language deficit deafness
11.Do not teach child 2 languages at the same time agree on one language

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
VI.

Developmental Theories

STAGE

Eriksons relationship > psychosocial

Developmental Tasks important
because it play vital roles in development
of PERSONALITY

Infant
Toddler

Trust VS mistrust
Autonomy VS shame and doubt

Preschool

Initiative VS Guilt

Freuds F word sex > psychosexual

Human Body
Each stage- may body part na itatangi
MOST LIBIDINAL most pleasurable
sexually
Oral
Anal
Phallic introduced to the presence of
genitals
Latency lose of interest in sex parts
Genital puberty

School age
Industry VS inferiority
Adolescent
Identity VS Role confusion
Early
Intimacy VS Isolation
adulthood
Late
Generativity VS stagnation
adulthood
a. Yung body part ang gagamitin in your relationship >> foundation to your tasks
b. Mom <> Baby
c. Paradigm of a strong, reliable relationship
a. See <> Know <> Trust <> Love
d. Oral
a. If cry is answered- trust
b. Ignored mistrust weakness in personality oral frustration or oral frustration
oral fixations
i. Signs: chain smoking, drug addictions, overeating, foul words
e. Infancy
a. Freuds Oral / Eriksons TRUST VS MISTRUST
b. The infant receives stimulation and pleasure through his mouth. Answering their
cry (needs) helps develop trust
c. Trust develops when the needs are met constantly
f. Toddler
a. Freuds anal / Eriksons Autonomy VS Shame and Doubt
b. Finds pleasure in controlling his eliminatory function
c. Toilet training begins psychological readiness
i. Important facts on TT:
1. Recommended to be started at 18 months with bowel first.
a. Oral 0-18 months
b. Anal 18 months- spinal cord fully coated with sheath can
feel
the
urge;
can
hold
it
- with sphincter control
2. Most important factor is READINESS of the child- physical and
psychological
3. Completed by 4 years old
d. Feelings of independence develops
e. Child feels he can do whatever he wants
f. Behaviors to observe:
i. Negativism- NO stage set limits / offer acceptable choices; child does
the opposite
1. Offer acceptable choices- should end up in achieving the goal
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
ii. Ritualistic or stereotype behavior to achieve independence and security
iii. Security object to feel secured
iv. Temper tantrums feelings of child that he is always the boss
1. Expressions of feelings of frustrations
2. TT because they cannot articulate >> non verbal
3. Management: Ignore the behavior bring them in a safe place
where they can express themselves
a. Provide time out
i. One minute in each year of life
g. Preschoolers
a. Genital differences - latency
b. Oedipal or Electra Phase child turns toward the parent of opposite sex, usually
resolved toward the end of this period
i. Electra daddys girl
ii. Oedipal mommys boy
iii. Ambivalence towards parents
c. Initiative develops if the child is allowed the freedom to initiate activities and is
appreciated for it.
i. Stage of KUSA
d. Behaviors to observe
i. Very curious: WHY stage
1. Asks many questions 300/400 per day including repetitions why
most frequently asked
a. A curious child is a intelligent child
2. Exhibits interest in sex (gender) differences
3. Touches / explores their body
a. Exhibits fear of bodily injury baka lumabas yung laman
i. Dont inject if kakakain lang or kakainom lang
b. Very imaginative engages in fantasy play- costume
magical thinking
4. Masturbation private matter- Ignore send him to his room dont
threaten the baby
5. Fully equipped super ego >> memory
6. Phallic fixations can lead to rape, exhibitionism
h. Schooler
a. Latency Industry VS Inferiority
b. Crucial as we achieve the self confidence that we need for our life
c. The sexual desire (libido) is controlled and repressed put it behind and no
interest on it.
d. Interest on same sex only (normal homosexuals)
e. Latency means calm or quiet
f. Industry develops if the child is permitted do things by him and praised for the
result.
g. To show others that you can do it.
h. ACHIEVEMENT ORIENTED YEARS. Want to prove their BEST in school.
i. Reading, writing and arithmetic. Beginning to be intellectual
i. Adolescent
a. Experimentation doing what others do
b. Genital stage puberty preparing self to fulfill task
c. Identity VS role confusion
d. Heterosexual attraction
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
e. Resurgence of sexual drives
f. Develops relationship with members of the opposite sex
g. Identity develops when there is feeling of belongingness and acceptance by
others
i. Others- people outside yourself parents, friends
h. Behaviors to observe:
i. Understanding bodily changes corresponding to puberty
ii. Moody and unpredictable hormonal imbalance
1. Men testosterone
2. Female estrogen and progesterone
3. Both androgen responsible for hair growth pubic hair, armpit
iii. Attempts to make decision for himself
iv. Makes long-range plans for the future (career plans)
i. Puberty
i. First change in BOTH sexes:
1. Increased height and weight (2nd period of growth spurts)
a. Female widening of the pelvis - gynecoid
b. Male- android; broadening of the chest and shoulder
ii. For women only:
1. Thelarche development of the breast buds
2. Adrenarche growth of pubic and axillary hair
3. Menarche menstruation usually unovulatory 6 months after
adrenarche
4. Average 10.5 to 15 years old.
5. Regular menstruation and ovulation 6 to14 months after
menarche
6. Ovarian agenesis Turners Syndrome- by 16 years old no
menstruation primary amenorrhea
7. Hypothyroidism thyroid supplements- secondary amenorrheanagkaroon ka na then nawala
iii. For males
1. Increase in the size of the genitalia scrotum
2. Growth of pubic, axillary, facial and leg hair
3. Voice changes
4. Production of spermatozoa (nocturnal emission)- later by 2 years
than girls
5. If 20-22 then hindi pa nilabasan, you should have gone to a
urologist >> possible cryptorchidism undescended testicles >> at
risk for testicular cancer >> orchidopexy- treatment

12

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
THE RISK NEONATES
I.
Most common complication of PIH: abruption placenta premature separation of placenta
that is normally implanted
a. Management: early delivery
II.
The premature pre term
a. Born before the 48th week or before completing 37 weeks of gestation regardless of
the birth weight
b. Focus: immaturity of organs
c. Physiologic handicaps- kung ang bata ay preterm, expect these problems
i. Respiratory Distress immature alveoli with less amount of surfactant>
decrease surface tension > prevents atelactasis
1. Problems
a. Atelactasis
b. Prolong apnea: normal should be less than 20 only
c. Cyanosis
d. Asphyxia
2. Symptoms
a. Nasal flaring- nasal opening is bigger
b. Fast breathing
c. Chest indrawing
d. Grunting most obvious sign expiratory
e. Silverman Anderson index chart to check for respiratory
distress
3. Management
a. Assist MD in inserting ET
b. Artificial surfactant given via ET
i. Survanta / Lquivent
ii. Survanta must be given in the first 15 minutes >> days
after: liquivent liquid oxygen
c. Given 02 by CPAP (Continuous Positive Airway Pressure) /
Ventilator
d. Monitor with pulse oximeter
i. Danger of retinopathy of prematurity (premature) or
retrolental fibroplasias (term)
e. On NPO during respiratory distress
f. Neonatologist MD in NICU
g. Normal urine output- 1-1.5ml/kg
ii. Regulation of body temperature
1. Problem:
a. Immature hypothalamus
b. Less amount if SQ tissues
c. Poikilothermia they take the temperature of the environment
2. Management
a. No radiant warmer
b. Put in an incubator for maintenance of neutral temperature
setting
c. KMC- Kangaroo Mother Care AO 2009
i. Done when the baby is stable already if IVF or NGT
nalang ang contraptions
iii. Nutritional deficiencies
1. Prone to aspiration / gastric distention small stomach
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

III.

2. Hypoglycemia
3. Poor suck, swallowing and gag reflex
a. Gag- most important
4. Management
a. Gavage- OGT feeding
b. Small frequent feeding
c. Upright position during feeding
d. Right lateral after feeding > promotes gastric emptying
iv. Hematologic difficulties
1. Immature liver function
2. Problem:
a. Early and prolong jaundice
b. Prone to kernicterus bran damage due to accumulation of
bilirubin that go to the brain
c. Bleeding
3. Management
a. Phototherapy as ordered - Photoisomerization
b. NR
i. Maximum exposure except the eyes and genitals
ii. Deep penetrating light can cause retinal dryness at risk
for dryness
iii. Cover gentials priapism painful erection
iv. Regular turning to all sides every 30 minutes
v. Check temperature regularly
1. CBE: how to promote elimination of bilirubin when
baby is under the lights: promote feeding >>
promote hydration >> more urination
vi. Promote bonding or BF if allowed
1. BF depends on the level of bilirubin
2. During BF tanggalin sa phototherapy, 15 minutes,
remove eye patch
v. Low resistance to infection most common cause of death
1. Cause: immature immune system
2. Problem: sepsis neonatorum
3. IgG is provided in the last weeks of pregnancy 38-40 weeks
4. IgA breastfeeding kasalanan ng nurse
5. If BF do not put ice or very constrictive bra stop milk production
a. Store it in the freezer FIFO can be stored up to 6 months
b. Prepare: do not abruptly heat the milk destroy the IgA
gradual heating immerse in warm water
6. Management
a. Note for signs of infection
b. Strict compliance with nursery aseptic protocol
c. Antibiotic as ordered.
d. Incubator Isolet mini isolation unit
e. One baby per incubator if twins, can be in one incubator- cobedding
POST TERM BABIES born more than 42 weeks in gestation
a. Primiparas- possible to reach 41 weeks AOG
b. Problem: placental degeneration causing decreased utero-placental perfusion only
up to 41 weeks
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

IV.

V.

c. Long but thin, dry cracking skin, nor vernix and lanugo, long hair and nails, alert
look, possible IUFD Hermits look
d. Associated problems:
i. Hypoxia due to placental insufficiency mentally retarded and seizure
ii. Hypoglycemia due to decrease glycogen
iii. Fetal distress- more fetal movements
iv. Seizure disorders
v. Cold stress due to less SQ fats
1. No need for incubator can be put under radiant warmer
vi. Meconium aspiration respiratory distress and infection
vii. Polcythemia causing hyperbilirubinemia related to Tetralogy
1. Hypoxia >> kidney >> erythropoietic function produces
erythropoietin >> activates bone marrow >> more blood
e. Management
i. Oxytocin tetanic contractions
ii. Close monitoring
iii. If in fetal distress stop the Pitocin possible CS
Drug Addicted Neonates (DANs)
a. Unborn child is passively addicted to the drug
b. Neonates are born SGA and may show signs of withdrawal 12 to 24 hours after birth
i. Microcephaly Drug addicts, smoking, alcoholics > mental retardation
c. Clinical manifestations of withdrawal:
i. GIT irritability
1. Diarrhea
2. Regurgitation
3. Vomiting
4. Anorexia
ii. CNS irritability
1. Tremors
2. Irritability
3. High pitched cry
4. Restlessness
5. Seizure
d. Management
i. Environmental modulation to decrease external stimuli NICU
ii. Provision of adequate nutrition and hydration- no oral feeding
1. Done by parenteral feeding
iii. Drug therapy
1. Phenobarbital decrease CNS irritability
2. Chlorpromazine decrease CNS irritability
3. Diazepam muscle relaxant
iv. Seizure precautions
1. No tongue depressors
2. No teeth biting kasi walang teeth
3. Left side lying position
Fetal Alcohol Syndrome (FAS)
a. Fetal or NB effects
i. Facial features
1. Hypoplastic maxilla
2. Hypoplastic philtrum
3. Short palpebral fissure
15

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

VI.

VII.

ii. Neurologic
1. Microcephaly
2. Mental retardation
iii. Growth
1. Prenatal growth retardation SGA
2. Persistent postnatal growth lag
iv. Irritability and hyperactivity does not extend forever
Baby of Diabetic Mothers
a. Mom with Diabetes hindi kayang gumawa ng insulin
b. Baby can produce her own insulin
c. Effect on baby:
i. Intrauterine hyperinsulinism >> more glucose absorption macrosomia- large
fetus >> macrosomia beyond 8 lbs >> pre term delivery; fractured clavicleshoulder dystocia green stick fracture
ii. IU hyperinsulinism >> after birth hypoglycemia
d. Five cardinal symptoms
i. Polyuria
ii. Polydipsia
iii. Polyphagia
iv. Weight loss
v. Glycosuria
e. Management
i. Monitor s/sx of hypoglycemia tremors, irritability, restlessness
ii. Monitor blood glucose level (BCG)- big toe
iii. If lower than normal (40-60mg/dl or 2-3mMol), give glucose (D50W) IVP, in
vial- as ordered
Blood Incompatibility
a. ABO/RH Erythroblastosis fetalis
i. Mother - Baby
ii. Rh Negative mother <> Rh Positive Baby
iii. Type A mother <>Type B
iv. Type B <> Type A
v. Type O <> Type A or B
vi. Type AB <> No problem
b. First baby is not affected
c. Utero-placental barrier- separates the babys blood and mothers blood; selective
permeable; food, glucose, oxygen, antibodies, some small virus CMV, not AIDS
d. Filipino Orientals- 99% - Rh+ - rare ang Rh problem
e. Westerners 85%- Rh+ ; 15% Rhf. Type O+
i. Have Rh Factor D antigen
g. Oi. Type 0
ii. No D antigen
h. O > A > B > AB most common to least common
i. Management after birth of the second baby if affected
i. Exchange transfusion
1. Removal of babys blood and replacement with fresh whole blood (Rh
Negative) all blood are hemolysed and with high bilirubin content
ii. Phototherapy PRN
j. Management by prevention
16

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

VIII.

i. If mom and baby are not compatible:

1. After 1st baby, Coombs Test (baby)
a. Specimen: cord blood
b. Determines presence of maternal antibody on the babys blood
c. With antigen - +
2. If mother is not compatible with baby and Coombs is negative, then
RHIg (RHOGAM) is given to Mother within 72 hours after delivery or
abortion of an incompatible fetus.
3. If coombs test is positive exchange transfusion before the hemolysis
starts
Neonates with congenital defects
a. Congenital Heart Disease
i. TORCH all can cause CHD; German Measles can greatly cause CHD
ii. When lungs are fully expanded, magiging normal na yung circulation
iii. Anatomical and functional closure functional closure of the formaen ovale
due to increased pressure in LA
1. 2-3 months- closes anatomically
iv. High oxygen level >> spasm of the DA >> closure of DA functional closure
when baby breathes first time
1. Anatomically 1 month
v. Defect >> mixing or shunting of UO and O blood >>
1. >> Left to Right acyanotic (6) aorta does not get unoxygenated
blood
a. PDA
b. VSD- congestion of RV beats faster
c. ASD previous foramen ovale; congestion of the Right chambers
d. PS
e. AS
f. COA LV first to be congested
g. Acyanotic cardiac conditions >> congestion of cardiac chamber
>> heart compensates by ^rate of contraction >> CHF
h. CC: Early: pulmonary symptoms: dyspnea, fastbreathing, moist
cough, rales, crackles
i. Dx: CXR pulmonary edema and cardiomegaly normal for
athletes and elderly
i. Echocardiography identifies type and size of defect
ii. Cardiac catheterization identifies pressure in the heart
(CHF)
iii. Hepato-jugular reflux if dyspneic, do it quick
a. Tanggalin mo unan, flat on bed, press on the
liver >> sumisipa yung neck vein
j. Corrective surgery
i. If in failure and defect is large( no possibility of
spontaneous closure)
ii. Open Heart defect is inside the heart
1. Procedures includes:
a. Induction of asystole (cardioplegia) uses
KCl hyperkalemia causes asystole
b. Induction of hypothermia ice packing
c. Use of bypass machine (ECMO)
i. Extracorporeal Membrane Oxygenator
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
iii. Closed heart defect is outside
iv. PDA- Indomethacin Progstaglandin Inhibitor spasm
then closure of DA
k. Medical or nursing management
i. Objective: Prevent CHF D
1. Drugs
a. Digoxin cardiac glycoside increase the
strength of contraction> Improve cardiac
output
i. Earliest SE: GI NVD before meals
b. Diuretics / ACE inhibitors prevent sodium
retention and promote elimination of excess
fluids
i. Furosemid- Lasix loop diuretics
hypokalemia give potassium drip
side bottle check for patent line;
check for good kidney function 2
good urination for the past 4 hours; If
patient is crashing give combination
of glucose and insulin to let potassium
enter the cells. Hyperkalemia- peaked
T wave
ii. Captopril and Enalapril -ACE
2. Diet low sodium, low cholesterol (adult)
a. Low sodium formula LONALAC
i. Not only the salty foods are rich in
SODIUM
b. Clarification on solids allowed continue
diuretic
3. Decrease cardiac demands
4. Decrease / avoid exposure to Respiratory infections
PNM
ii. Objective 2: decrease oxygen demand
1. Cluster nursing care organized care plan
a. Quiet play activity
b. Decrease stress and anxiety level
c. Small frequent feedings
iii. Objective 3: prevent respiratory infections
1. Vitamin C 500mg/day: RDA
2. Promote immunization
2. >> Right to Left cyanotic aorta unoxygenated blood- TTT
a. TOGV can be seen in delivery room; more rare but fatal
i. The more they cry, the bluer they get
ii. Mas maganda kung bukas pa yung DA, FO, presence of
VSD
iii. Give prostaglandin stop the closure of DA
iv. Septostomy break open the foramen ovale
v. Symptoms
1. Persistent cyanosis inspite of vigorous crying
2. Hypoxia inspite o2 therapy
3. Less symptoms if with septal opening
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
vi. Management
1. Palliative
a. Emergency balloon septostomy
2. Corrective: open heart surgery
b. TOF mixed blood enters the aorta
i. DROP
1. Displaced aorta overriding
2. RVH
a. Boot-shaped heart
3. Opening in the septum (VSD)
4. Pulmonary Artery Stenosis
ii. Symptoms
1. Usually seen when child is more active because of
increase oxygen demand
2. Exertional dyspnea with cyanosis central
circumoral
3. Activity induced TET SPELLS- hypercyanotic
attacks relieved by squatting
4. Clubbing of fingers due to peripheral hypoxia>>
additional capillaries are formed (collateral
circulation is made)- irreversible
a. Clubbed finger: 180 degress angle
b. Normal: 160 degress
c. Shamrock- diamond space
5. Polycythemia due to chronic hypoxia
a. Patient has very thick blood >> sluggishness
>> possibility of thrombus
b. Cerebral thrombosis most common
complication in infants
6. Stunted physical G and delayed D
iii. Treatment
1. Palliative: Close heart (goal: increase amount of
blood going to lungs
a. Blalock Taussig- anastomosis of subclavian
and pulmonary artery, Potts pulmonary
artery and aorta, Glenn Shunt SVC and
pulmonary artery, Waterston descending
aorta and PA
2. Corrective: open heart surgery
iv. Medical nursing management P group
1. Decrease oxygen demand
a. Cluster care
b. Delay anxiety
2. Propanolol dilates artery in the periphery to
decrease TET spells, prophylactic antibiotic for
bacterial endocarditis- PCN
3. Monitor hemoglobin and hematocrit count detects
early polycythemia
a. Normal Hgb: 120-140
b. Pedia Hct: 35-45% soild portion of blood
4. Assist in phlebotomy as needed to be done.
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
5. Increase fluids/ maintain IVF as necessary
6. Position during attacks allow to squat / knee chest
(yung mga kaya lang), give 02
b. GIT Problems exposure to teratogens
i. Cleft Lip
1. Predisposition: heredity
2. Most common in male
3. Problems in nutrition, airway and speech
4. Management: Cheiloplasty or Z-plasty
a. Rule of 10: 10 weeks old, 10 pounds in weight, 10 grams of Hgb,
less than 10000 WBC
b. Post op:
i. Position: NEVER ON PRONE (no head control)
ii. Prevent tension on the suture lines
1. Logans bar: - to hold sutures together even if the
baby cries
2. Anticipate needs to lessen crying
3. Use arm restraint written order, no order to
remove; remove in a scheduled time every 2
hours
4. Clean suture lines after feeding
ii. Cleft palate - congenital
1. At risk for otitis media
2. Speech problems delayed speech
3. Management:
a. Uranoplasty or palatoplasty before speech development begins
b. 10 months old malapit na magtoddler
c. Post op care:
i. Position: should be on prone to promote natural drainage
of secretions
ii. Use ELBOW RESTRAINT to protect suture lines prevents
flexion of the arms
iii. Feeding device post op DRINK from CUPS, no sucking,
never use straw
1. Sucking increases pressure in the mouth
iv. Speech rehabilitation, hearing test- optional
iii. Tracheoesophageal fistula (TEF) - congenital
1. Problems: aspiration and Nutrition
2. Boarder babies yung mommy nakauwi na, yung baby maiiwan sa
bahay
3. Symptoms
a. Drooling of mucus after birth outpouring
b. TEF: 3Cs during feeding
i. Choking
ii. Coughing
iii. Cyanosis turns to blue
4. Diagnostic: insert NGT
5. Confirmatory X ray
6. Surgery ASAP
a. Pre op care
i. Suction PRN
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
ii. Strict NPO
b. Promote NTN
i. TPS as ordered (check blood sugar) builds up caloric
requirements faster
1. Maximum is only up to 72 hours
ii. If preterm breast milk PEG gastrostomy
1. To check for patency: flush with water
a. Infant: 10cc
iv. Pyloric Stenosis not congenital
1. Caused by hypertrophy of the muscles of the pyloric sphincter
narrowed exit in the stomach
2. No problems in feeding; problem begins after feeding
3. Positive peristalsis umaalon alon yung stomach
4. Projectile vomiting
5. Symptoms
a. Abdominal distention (visible peristalsis) right after feeding
followed by projectile vomiting, DHN, metabolic alkalosis,
hypokalemia, weight loss
b. Ppalpable olive-shaped mass in RUQ parang duhat
6. Diagnostic procedure to be done: X ray with contrast medium- Barium
a. NPO for 4 hours
b. Barium to be put in bottle
c. Positive: string sign
7. Management
a. Surgery: Pyloromyotomy with pyloroplasty Fredet Ramstedt
v. Intussusception not congenital
1. Hyperactive portion of the small intestines telescopes into the lumen of
another
2. Cause: some children have more motile GI tract madalas kabagin
3. When intraintestinal pressure increases > reflux to the stomach >
vomiting BILOUS vomitus bitter, greenish, liquid ;
4. CURRANT JELLY STOOL (asado na siopao) blood vessels caught
between the layers >> decreased blood supply >> necrosis >> bleeds
>> CJS
a. Lage intestine vomitus fecaloid brown, thick, fouls smelling,
bits and pieces of feces
5. Complication: Peritonitis cause: perforated appendix
6. Symptoms
a. Spasmodic abdominal pain
b. Blood with mucus in the stool Currant Jelly Stool
c. Vomiting of bile-stained vomitus
d. Sausage shaped mass
7. Diagnostic Test: Barium enema liquid panulak sa invaginated
intestines Barium Hydrostatic Reduction technique high flow
a. Pre: Cleansing to remove fecal materials
b. Barium Enema: Low flow enema- para di mabilis yung pagpasok
sa rectum kasi baka ilabas lang kaagad
c. Coiled spring appearance or staircase some portions of the
intestine adhere >> may perforate
i. Immediately surgery to prevent perforation that can lead
to peritonitis ex lap, bowel resection with anastomosis
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
vi. Hirschsprungs disease
1. Congenital aganglionic megacolon
2. Absence of parasympathetic nerve supply (ganglion cells) on the large
intestine
3. Most common location: Recto-sigmoid colon
4. Reverse peristalsis>> may absorb feces >> weight loss
5. Symptom: In the nursery: delayed meconium PBE
a. Normal: within the first 24-48 hours 48 hours in the BE
b. Later symptoms
i. Constipation defecation is less than 3 times a week
ii. Ribbon like stool
iii. Abdominal distention with possible fecaloid vomitus
iv. Weight loss
v. Pellet like feces butyl butyl
vi. Watery stools seepage of water
vii. Alternating constipation and diarrhea
6. Diagnostic: rectal biopsy and Barium enema
7. Management:
a. Pre op:
i. Promote elimination
1. Regular colonic irrigation isotonic saline solution
2. Palliative colostomy
ii. Promote nutrition
1. High calorie, high CHON, small frequent feeding,
vitamin supplements
2. Low fiber/ low residue
b. Corrective surgery:
i. Pull-through Procedures: Soave, Swenson, Duhamel
vii. Imperforate Anus caused by teratogens
1. Agenetic type no external sphincter
2. Atretic type - may butas but with blind pouch
3. Most accurate diagnostic: passage of meconium
4. More common in women : Capable of making recto-vaginal fistula
5. Male: recto-vesical fistula urinary bladder greenish urine
6. Symptoms
a. Absence of meconium
b. Unable to insert rectal thermometer
7. Management
a. Step 1: colostomy in the nursery palliative
b. Step 2: before 1 year old 10 months (in preparation for toilet
training: Hold it)
i. Corrective procedure surgery
1. Anoplasty
2. Pull through procedure
3. At risk for fecal spillage
4. Toilet training to be enforced
c. Neural Tubes
i. Nutritional deficiency Folic Acid
ii. Multi-factoral in cause infections, teratogens
iii. Posterior lamina of the vertebra did not close - gap or opening >> protrusion
iv. Spinal bifida- leakage of spinal content
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
1. Meningocoele sac containing spinal fluid only
a. Legs are not paralyzed
2. Meningomyelocoele- sac containing meninges, spinal fluid, spinal cord
with its nerves
a. Legs paralyzed, no pain feeling
3. Diagnostics test
a. MRI best
b. CT scan
c. X ray machine
4. Assumes in prone position
5. Intervention
a. Surgical closure preferred within 24-49 hours after birth to
prevent local infection and trauma to the exposed tissues
b. Overall objects of nursing care while waiting for surgery:
i. Protect the sac against pressure, injury, infection
1. Prone
2. Cover with sterile gauze always kept moist
irrigate with sterile saline solution minsan may
antibiotic
ii. Prevent neurologic, orthopedic and urologic complications
1. Orthopedic complication paralysis, loss of
function, muscle atrophy - massages, PROM,
exercises
a. 85% - hydrocephalus meningitis,
encephalitis
i. Bulb shaped
ii. Pear shaped
iii. Sunset
iv. Dilated scalp veins
v. Opisthotonic positions
vi. Decorticate
b. Nursing care for hydrocephalus:
i. Assessment of signs: ^ICP measure
HCOD
ii. Measures to prevent ^ICP avoid so
much crying
iii. Provide sensory stimulation and
encourage parental bonding
c. Surgical management
i. Ventriculostomy to relieve pressure
temporary yung tinatanggal na CSF
tinatapos, it endangers the patient to
more infection
ii. insertion of shunt to bypass best
re-absorption of CSF
d. Post op care shunt insertion
i. Routine post op vital signs monitoring
ii. Position: Flat on the unoperative side
to prevent on the shunt valve and too
rapid drainage and reduction of CSF
that may cause subdural hematoma
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

IX.

iii. Monitor for signs and symptoms of

increased ICP baby vomits every
time he is fed
iv. Observe for abdominal distention
peritonitis or abdominal ileus- HCOD,
ACOD
v. Family support
2. Urologic UB does not empty completely
intermittent catheterization; urinary stasis; manual
pressure to the abdomen Crede manuever
iii. Prepare client for possible surgical correction
v. Arnold Chiari malformation neck location respiratory function to be
affected
Pediatric Respiratory conditions
a. Throat problems: Paryngitis or Tonsillitis
i. Caused by GABHS (Group A Beta Hemolytic Streptococcal infection)
ii. Criteria for tonsillectomy: - plan required surgery
1. Causing respiratory obstruction
2. Abscess or pus
3. History: frequent; 5x per year or more developed resistance with all
antibiotics given
a. After 24 hours of first dose of antibiotics- infection under control
iii. Management:
1. Tonsillectomy / Adenoidectomy
a. Before the surgery, full course antibiotics
b. In patient treatment; in US, out patient
c. Pre op:
i. Dental visit loose teeth and bleeding status bleeding
disorder
1. Loose teeth risk for aspiration
d. Post op:
i. Position: while asleep- PRONE (pedia) or LATERAL (adult)
position to promote natural drainage of secretion
ii. Observe for bleeding frequent swallowing or signs of
restlessness
iii. Prevent bleeding
1. Ice collar
2. Avoid suctioning only to be done PRN,
a. When suctioning insert catheter in the
cheek pockets
3. Avoid throat clearing
4. Avoid valsalva maneuver give papaya (papein)
iv. Diet resumes once fully awake and can swallow:
1. Cold, clear, non-irritating fluid
a. Cool water, ice cold apple juice(not red),
frozen gelatin, suck on frozen popsicle,
sherbet- buko sherbet
b. Ice cream is not advisable
i. If given, make sure child drinks lots of
cold water after
2. Then soft diet then DAT
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
v. Effective pain management can cause bleeding
vi. Bleeding precaution until 7-10 days post op. (More prone
to bleeding)
b. Spasmodic Croup / LTB laryngotracheobronchitis
i. Etiology: Virus
ii. Symptoms
1. Hoarseness- brassy spasmodic seal like cough
2. Inspiratory stridor
3. Fever
4. Croaky frogs- characteristic hoarseness
5. Possible respiratory distress due to LARYNGOSPASM
iii. Supportive care
1. Prevent coughing causing laryngospasm and respiratory distress
a. Avoid respiratory irritants and sudden temperature changes
baby cologne, baby powder, lotion, smoke, dust, insect
repellants
2. Feed and hydrate with aspiration precaution
3. Decrease oxygen demand
4. Administer high humidity with MIST THERAPY during attacks
a. Bring child inside steamy bathroom
b. Suob or tuob
c. Croupette or croup tent
i. Change beddings PRN
ii. Toys are allowed except those who produce spark > fire
c. Epiglottitis
i. Cause: Haemophilus influenza
ii. Symptoms
1. 3D
a. Drooling
b. Dysphonia
c. Dysphagia
d. Distress
2. Child sits upright leaning forward with chin thrust out Tripod or
sniffing position
3. Irritable, restless
4. No spontaneous cough**
iii. Management
1. Hospitalization ASAP
2. Do not insert anything into the mouth stimulates gag reflex spasm
of the throat increase blood supply to the part complete swelling
3. Diagnostic: lateral neck x ray
4. Airway bu tracheostomy
5. IVF for hydration
6. Antibiotic for 7-10 days 2nd generations cephalosporins
7. Corticosteroids PRN more rapid effect than antibiotics
8. Prevention: immunization H influenza type B (Hib) vaccine kasabay
ng DPT 6,10,14 weeks
d. Bronchial Asthma
i. Child: acute only bronchial only; cure is possible - reversible
ii. Adult: chronic- COPD emphysema and bronchitis; irreversible
iii. Extrinsic allergens induced GIT and RT allergologist >> histamine
25

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit

X.

iv. Intrinsic idiopathic/inert on the patient stress and anxiety >> histamine
v. Mechanism responsible for symptoms
1. Bronchospasm
2. Inflammation and edema of the airways
3. Accumulation of tenacious secretions
vi. Management
1. Allergen control
a. Skin testing followed by Hyposensitization for 3 years
2. Promote airway with drug therapy bronchodilators
vii. Supportive management during exacerbation
1. Administer bronchodilator / aerosol oral
2. IVF for hydration and drugs aminophylline, steroids for status
asthmaticus asthmatics who do not respond to bronchodilators
3. Position: upright Orthopneic 30 to 40 degrees forward tilt
4. Allay anxiety- if in distress, more histamine
5. Promote oral fluids with aspiration precautions
a. Limit milk and avoid vitamin C allergen
6. Promote breathing exercise pursed lip breathing
Kidney Problems

Nephritis
Etiology: GABHS

Hematuria
Periorbital edema
HPN

Diagnostic:
- ^BUN, ^creatinine, ^ASO titer
(0-200IU), RBC in the urine,
Renal Biopsy
Management:
- CBR in acute stage HPN and
bleeding in the kidney
- Anti HPN, Diuretics
- Penicillin
- Low Na, Low CHON if ^
creatinine
- As soon as the crea is normal
increase CHON
- Skin care- additional pillow in
the night
XI.

Nephrosis / Nephritic Syndrome

Etiology: unknown auto immune; with remission and
exacerbations
Proteinuria basement membrane of kidneys
enlarged pores
Hypoproteinemia
Decrease plasma osmotic pressure > more edema
(ascites), anasarca - hypotension
Hyperlipidemia as a compensatory mechanism by
the liver
Diagnostics:
- Protein in the urine
- Decrease serum CHON
Management:
- Ambulate as tolerated as much as they can
- Diuretics
- Steroids prednisone- immunosuppresants
- High CHON, low Na, low fat
o Egg yolk- high fat; egg white- high Na
- IV albumin
- Skin care

Rheumatic Fever
a. Complication of streptococcal infection
b. Jones criteria of assessment
i. Major symptoms
26

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
1. Migratory polyarthritis joint pain
2. Chorea St. Vitus Dance involuntary jerks most bothersome
symptom
3. Erythema marginatum rashes on the trunk
4. SQ nodule extensor surface of extremities
5. Carditis endocarditis chest pain or palpitation
a. Mitral valve stenosis > reflux > pulmonary congestion
b. Mitral valve insufficiency does not close completely

XII.

c. Diagnosis
i. JONES CRITERIA + ^ASO titer = RF
1. ASO anti streptolysin O titer
ii. Echocardiography if with valve damage
1. Mitral valve: stenosis and insufficiency = RHF
d. Management
i. Objective 1: decrease demand from the weakened heart
1. CBR/ Cluster Care
2. Modify lifestyle after discharge no PE
ii. Objective 2: prevent further cardiac damage (RHF)
1. Medications: PCN IM once a month for 3-5 years / Aspirin / Steroids
a. Crystallized benzathine PCN
b. Do not give in Deltoid too much volume
c. Minimum diluents: 5cc
iii. Objective 3: safety precaution for chorea
1. Phenobarbital muscle relaxant
Hematologic Problems
a. IDA- most common
i. Weaning stage
ii. More common to 6 months and older children Fe from mother has been
used up and due to overfeeding of milk
iii. Also to adolescent females due to weight reduction diet and heavy menstrual
loss
iv. Management:
1. Introduction of supplementary / complementary feeding at 6 months
a. One at a time only to rule out allergy
b. Iron rich foods
i. Cereals complete, hypoallergenic, Fe rich
ii. Egg yolk do not give egg whites to a baby below 1; do
not gives if they are only half cooked cause of
salmonella; serve hard boiled egg
iii. Dark green leafy vegetables more darker, more Fe
1. Role modeling- best way to encourage children
iv. Dark meat organ meat beef and liver
v. Supplemental iron preparation (FeSO4) with Vitamin C
1. Dark colored stool- Fe absorption
vi. Mebendazole- anti helminthic
b. Hemophilia
i. Deficiency in factor VIII antihemophilic factor
ii. Transmitted as X-linked from carrier MOM to AFFECTED DON (symptomatic)
1. X linked: premature baldness, color blindness
iii. Daughter gets it as a trait from carrier mom (asymptomatic)
iv. Early symptom in the nursery:
27

UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
1.
v. Later
1.
2.
3.

Prolong bleeding from the UC

symptoms
Easy bruising
Easy epistaxis (balinguynguy) and gum bleeding
Hemarthrosis bleeding in between the ball joints pain and swelling
can result to loss of function
vi. Management
1. Medical: transfusion of Factor VIII, cryoprecipitate, platelet concentrate
a. Hematologist
2. Prevent bleeding avoid trauma
a. Supply of toothettes or toothies > foam edged toothbrushes
b. No flossing
c. No aspirin
d. Visit dentist- good dental hygiene
e. No contact sport
i. Swimming, golf, badminton, billiards, table tenninsallowed
3. PRICES TECHNIQUES
a. Protect protective devices
b. Rest immobilize
c. Ice vasoconstriction
d. Compress- apply pressure
e. Elevate- above the heart
f. Support- parents, MDs, RN, dentist, PT, Nutritionist, etc
c. Leukemia
i. Most common form of childhood cancer
ii. Immature WBCs (lymphoblast) not capable of phagocytosis is formed
iii. Forms
1. Lymphocytic leukemia pediatric clients; better prognosis 80%
survival rate
2. Myelocytic leukemia / non lymphocytic adults 40% survival rate
bone marrow is affected 6 months prognosis
iv. Three main consequences
1. Bleeding consequences
2. Infection
3. Anemia
v. Diagnosis
1. Bone marrow biopsy, lumbar puncture to determine CNS involvement
2. Bone marrow biopsy
a. PRONE position
b. Local infiltration of Xylocaine
c. Sedate
3. Lumbar puncture to know if there is CNS involvement
vi. Management
1. Remission induction IV- systemic chemotherapy
2. CNS prophylactic therapy intrathecal chemotherapy direct access in
CSF Sanctuary therapy
3. Intensification or consolidation therapy regular systemic and
intrathecal chemotherapy
4. Most ideal: Bone marrow transplant
a. Compatibility HLA
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
Michael John M. Vallarit
XIII.

5. Protect from infection

Childs concept of Death
a. Infant, toddler, preschoolers = 1-5 years old
i. Form of sleep and reversible
ii. Based from stories told by their parents
b. 6-9 years old
i. Person Grim reaper
ii. Bogey man - europeans
iii. Devil
iv. Monster
v. Kamatayan
vi. Reversible
c. Above 9 years old
i. End of life on earth
ii. Irreversible

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