PEDIA Part 1  Put under the FLOOR LAMP, drop light or radiant

warmer
NORMAL  Avoid putting crib near the cold wall (Radiation)
 Avoid cold draft: aircon, fan, open window or
IMMEDIATE DELIVERY ROOM CARE door (Convection)
 essential intrapartum NB care  POSTPONE THE BATH until temperature is stable
 In support of the MDG #4 (6hours)
 to reduce childhood mortality

A- irway
B- reathing
CERTIFY BABY’s BIRTH
 Plastic Bracelet (ankle) and crib card
C- ertify the Birth
D- etermine Adaptation to Extrauterine Life: APGAR  Foot Prints- no longer recommended
Score  Most Ideal: DNA
REGISTER
AIRWAY  Local Civil Registrar then PSA (Philippine
 the Band/Bound Intervention Statistics Authority/ NSO) for Birth Certificate
 to prevent asphyxiation
 to prevent aspiration
*accounts for 31% of NB death DETERMINE
WHAT CAUSES ASPHYXIATION? ADAPTATION TO
umbilical cord clamped

No more O2 from placenta

EXTRAUTERINE LIFE
*a crying baby is a breathing baby
HYPOXIA *the louder the cry- good expansion of lungs

Hypercapnia/ Hypercarbia CRITERIA ASSESS 0 1 2

PULSE Cardiac Absent 100 100

Acidosis
Rate
CNS Depression RESPIRATION Cry Absent Weak, slow, Strong
irregular regula
AIRWAY r
 neonates must breath after birth If not:
 Asphyxiation may result ACTIVITY Muscle Limp, Some Well
 neonates breath after birth by CRYING so Tone Floppy flexion, Little flexed,
stimulate NB to cry effectively after birth to prevent tone movement active
asphyxiation
GRIMACE Reflex No Grimace Cry,
 Suction with bulb syringe PRN if (w/ nasal
obstruction/ meconium stain amniotic fluid) to Irritabilit respons gag
prevent aspiration y e cough,
pulls
 Encourage to cry effectively to maximize lung away
expansion
APPEARANCE Color Pale/ Acrocyanosi PINK/
BODY TEMPERATURE Blue all
over
s
(hands+feet
RED
all
 Time Band/Time Bound Intervention are blue) over
 PHYSIOLOGIC HEAT LOSS AFTER BIRTH
 37.2 °C down to 35.5 to 36.5°C *You expect a pink/red baby depends on what continent
 EXTREME HYPOTHERMIA can cause Cold you work
Stress causing ACIDOSIS
 *prone to cold stress due to extreme hypothermia Expect a score of 8/9 at 1st minute

EXTREME HYPOTHERMIA SCORE INTERPRETATION & MGT

non shivering Burns brown fats  SCORE OF 0 to 3

thermogenesis for heat  POOR CONDITION
 Resuscitation Needed/ NICU
O2 consumption Ketones/ fatty acids
 SCORE of 4 to 6
O2, CO2 ACIDOSIS  FAIR CONDITION but guarded
 Closer Monitoring (baby goes to NICU)
Acidosis
 Score of 7 to 10
MANAGEMENT  GOOD CONDITION
 DRY baby immediately after birth (heat loss by  allowed to do “Unang Yakap”
Evaporation)  ROOMING-IN
 Put on TOP of MOTHER’s BODY: Skin to Skin
Contact (Conduction) “Unang Yakap” 1. NON TIME BAND/ BOUND INTERVENTION
  Breastfeeding must be done atleast 8x/day on
DEMAND & EXCLUSIVE (no other milk)
2. EYE CARE (Crede’s Prophylaxis)  Antibody: IgA: PASSIVE NATURAL IMMUNITY
 Prevents OPHTHALMIA NEONATORUM d/t  IgG- placenta
maternal gonorrhea/chlamydia
 done to ALL babies delivered either CS/NSD after RA 9288 – NB Screening Act of 2004
initial bonding/ complete breastfeeding  done to diagnose inborn errors of metabolism
 Tetracycline, Erythromycin, Betadine Eyedrops  Congenital Adrenal Hyperplasia
on the lower conjunctival sac  Galactosemia
 PKU
*don’t wash hands of the NB, let them smell the amniotic  G6PD
fluid on their fingers/ hand, because the nipple of the  Cretinism
mother has the smell of amniotic fluid.  that may cause DEATH/ MENTAL
RETARDATION
3. CORD CARE
 Done by HEEL PRICK when baby is atleast 24h
 Clamp when NO LONGER PULSATING, at 2cm old/ not more than 72 hours (Best time: 48 hours)
& 5cm from the base.
 DON’T MILK *reached 38-42 w- TERM Delivery
42 & above- POST TERM
Count no. of blood vessels
 2 arteries & 1 vein (AVA)- rule out THE RISK NEONATES
 Kidney Agenesis- absence of 1 kidney  the premature infant is defined as baby born
 Cardiac Defect before 37 weeks of pregnancy
 Problems of Prematures= d/t IMMATURE
NEPHRITIS- most common cause of renal failure in ORGANS
children
*surfactant-allows lung to expand
 PREVENT INFECTION  Immature alveoli w/ less amount of surfactants
 clean with soap and water if soiled
 Keep umbilical cord clean and free of infection PROBLEMS: Atelectasis, prolong apnea (more than
to prevent sepsis neonatorum 20s), cyanosis, asphyxia

 PROMOTE DRYING *Normal apnea- <20s

 Expose to AIR
 Do not use abdominal binders MANAGEMENT:
 Should fall-off between 7-10 days  MD inserts ET
 Purpose: Artificial Surfactant given via ET
*In putting diaper, fold down waist band to expose cord  CPAP via mechanical ventilation/ AmbuBag

4. VITAMIN K Administration *premature skin is gelatinous

 to promote synthesis of prothrombin
 Neonates cannot synthesize Vit K because of REGULATION OF BODY TEMPERATURE
absent intestinal bacterial flora (GI is sterile) Problem:
 1 mg IM (in mL it’s 0.1) in the thigh muscle  immature hypothalamus/ poikilothermia
(VASTUS LATERALIS) –biggest muscle mass & (temperature tends to go extreme depends on
most highly developed environment)
 Avoid using the gluteal muscles (buttocks)  less amount of subcutaneous tissues
because of the danger of sciatic nerve trauma
causing paralysis MANAGEMENT
 put in an incubator for maintenance of NEUTRAL
*Allowed to be injected in buttocks: ask mother when did temperature setting
the baby started to walk. If walking already for just a month  KANGAROO CARE
it gluteal muscles is not developed yet, wait for 1 year *KFC- Kangaroo father care, father helps in doing
*Baby should be walking for at least a year for gluteal M Kangaroo Care
to be developed. *temp goes down- shiver
*temp goes up- sweat
5. INJECT HEPATITIS B & BCG
 Right Deltoid Muscle NUTRITIONAL DIFFICULTIES
 prone to aspiration/ gastric distention and
6. INITIAL BATH hypoglycemia
 done best when VS especially temperature is
stable/ 6hours after birth *You cannot BREATHE & SWALLOW at the same time-
 DO NOT remove vernix caseosa epiglottis is closed when swallowing so that the food you
 Vernix has antibodies that protects baby’s skin ate won’t go to lungs
from infection and prevents evaporation of heat.
MANAGEMENT:
7. ROOMING IN (Bonding & Feeding)  Gavage (OGT) feeding
 Provide Optimum Nutrition:  small frequent feeding
 RA 7600 / Rooming In/ Breastfeeding Act of
1992
 EO 51- Milk Code of the Philippines HEMATOLOGIC DIFFICULTIES
 immature liver function
*When Bilirubin goes very very high- Hyperbilirubinemia *Adult: 70-110 (Ph)
80-120 mg/dl (international)
can go to BRAIN Babies: divide by 2
 If lower than normal: 40-60 mg/dl or mg% give
BRAIN DAMAGE glucose (D50W) as ordered

KERNICTERUS IV, umbilical cut down/ UV line (umbilical

Management: vein)
 PHOTOTHERAPY/ BILI LIGHT *pusod
 Cover eyes and genitals
 Turn frequently NEONATES WITH CONGENITAL DEFECTS
GROWTH- is an increase in the no & size of cells
LOW RESISTANCE TO INFECTION  Measured in terms of QUANTITY
 Causes: Immature Immune System
DEVELOPMENT- is capacity of the individual to perform a
Problem: SEPSIS NEONATORUM task
MANAGEMENT: PREVENTION  Measured in terms of QUALITY
 strict compliance with nursery aseptic protocol
 Antibiotic as ordered PRINCIPLES OF GROWTH & DEVELOPMENT
1. Unique- individualized
The POST MATURE INFANT 2. Continuous Process- begins at conception &
 Born more than 42 w in gestation ends at death
3. PLAY is essential in a child
*nagdddry out na
 Problem: PLACENTAL DEGENERATION INFANT 1mo-1yr
causing decreased utero placental perfusion  Plays alone- SOLITARY GAMES
 Long but thin, DRY CRACKING SKIN, No Vernix  plays with their BODY & SENSES
& Lanugo, long hair & nails, alert look, possible  TOYS- mobiles, rattles, teething, rings, music
IUFD (stillbirth/ intrauterine fetal death) boxes, squeeze toys

ASSOCIATED PROBLEMS *Ego- selfish, narcissitic

1. Hypoxia d/t placental insufficiency *pleasure principle
2. Hypoglycemia d/t decreased glycogen
3. Fetal Distress- Early Sign: restlessness (keeps TODDLERS 1-3 yrs
moving)  very possessive/ cannot share
4. Seizure Disorders- hypoxia in brain  loves to play BESIDE another child but must have
5. Meconium Aspiration- infection & respiratory each a toy- PARALLEL GAMES
distress *sticky meconium  TOYS- promote skills of walking- push & pull toys
and talking- toy telephone, coordination-blocks.
PREVENT: Regular Prenatal Check Ups (because EDC is *reality principle
given)
*Accurate way to know EDC: UTZ by ultrasonographist PRESCHOOL 3-6 yrs
 loves to share & imitate adults in their role play
BABY OF DIABETIC MOTHER
 COOPERATIVE/ ASSOCIATIVE GAMES
 TOYS- role playing games- play school, play
HPL (secreted by placenta) --- enemy of insulin --- GDM
house, doctor-nurse kit, etc
Glucose (food of cell)- cell opened by insulin (key)
*Stereotyping- outcasting, may gustong laruan
if glucose doesn’t enter cell- it starves- resulting to
polyphagia
SCHOOLER 6-12
glucose then goes to blood—hyperglycemia
 must have a winner at the end of the game-
COMPETITIVE GAMES
*The blood that goes to uterus is high in sugar which the
 TOYS- card games, scrabble, hopscotch (piko),
baby receivers and compensates by producing more
insulin (the baby is not diabetic, it’s the mother who’s skipping rope, etc.
diabetic and lacks insulin)
*The baby absorbs ALL GLUCOSE coming from mother 4. Rate of Growth varies:
resulting to a MACROSOMIC Baby  Rapid Stages (growth spurts)
 infancy & adolescent
EFFECT on BABY  Slow Periods (growth gaps)
 Toddler, preschooler, schooler
INTRAUTERINE more glucose absorption,
HYPERINSULINISM Macrosomia (large fetus) 5. Directional
 Growth- horizontal & vertical
Macrosomia- Preterm Delivery
DEVELOPMENT- Cephalocaudal (Gross Motor)
AFTER BIRTH: HYPOGLYCEMIA Proximodistal (Fine Motor)
(possible death d/t Metabolic Acidosis) *near- far
MANAGEMENT: ASSESSMENT OF GROWTH
 Monitor s/sx of Hypoglycemia- tremors, 1. Physiologic loss of weight days after birth- 5-10%
irritability, RESTLESSNESS of birth weight
 Monitor blood glucose level 2. Most rapid during Infancy
  Doubles at 6 mos, Triples at 1 year &
Adolescent Stages

ASSESSMENT OF DEVELOPMENT
 DDST- Denver Developmental Screen Test
 MMDST- Metro Manila Developmental Screen Test

AREAS ASSESSED
 Gross Motor- skills done by the LARGE
muscles *Baby cried using mouth--- ORAL
 Cephalocaudal Mistrust: drinking, drug addiction
 Fine Motor- skills done by SMALL muscles Oral fixation/ residuals: foul mouth
 Proximodistal *Phallic fixated- penis exhibitionist
 Interpersonal- social
 Language

DEVELOPMENTAL
MILESTONES (every 2 mos, pababa)

*Head Lag- No Head Control- CRADLE HOLD

FINE MOTOR SKILLS (every 3

mos, palayo)
NEONATE- STRONG GRASP REFLEX, hands fisted
 3 mos- Grasp Reflex is gone/ hands are held open
 6 mos- PALMAR GRASP; holds feeding bottle with
2 hands- BIG OBJECTS
 9 mos- PINCER GRASP (thumb to finger to hold
SMALL OBJECTS)
 12 mos- can hold BIG & SMALL Objects, throws
objects

DEVELOPMENTAL THEORIES

Erikson
 PSYCHOSOCIAL
 *son is a relationship- social

PERSONALITY
Developmental Task

Freud’s
 PsychoSEXual
U
C Body Part (most important)
K

Genital Stage- Puberty, organs develop

Phallus- means penis
Genital- Latency- Latent means calm

TRUST 1st- to develop before LOVE

*You can never love w/o TRUST TODDLER
FREUD’S ANAL
ERIKSON’S AUTONOMY VS. SHAME & DOUBT  ACHIEVEMENT ORIENTED YEARS

 Pleasure in controlling his eliminatory function ADOLESCENT

 TOILET TRAINING begins FREUD’S GENITAL
ERIKSON’S IDENTITY VS. ROLE CONFUSION
Important facts about TOILET TRAINING
 Recommended to be started @ 18mos with  Resurgence of sexual drives *di na homosexual
BOWEL 1st.  Develops relationships w/ members of the
 MOST IMPORTANT FACTOR is: READINESS OF OPPOSITE sex
THE CHILD (physical & psychological) completed  Identity develops when there is a feeling of
by 4 years old. belongingness and acceptance by others.

*FEELING OF INDEPENDENCE Physical changes in the FEMALE in order of

appearance:
BEHAVIORS TO OBSERVE:
 development of breast buds (THELARCHE)
 growth of pubic (PUBARCHE) & axillary hair
Negativism “NO” stage
(ADRENARCHE)
 Management: Offer acceptable choices
 Menstruation (MENARCHE) *average 11-13
TEMPER TANTRUMS
 Management: Physical changes in the MALE in order of
 IGNORE THE BEHAVIOR/ Time Out appearance:
 Place baby in a corner (safe place) for 1 minute for  increase in the size of genitalia (SCROTUM)
each year of his life (toddler to preschool) 2 to 6  growth of pubic, axillary, facial & leg hair
 voice changes
PRESCHOOLERS (3 to 6)  Production of spermatozoa (NOCTURNAL
FREUD’S GENITAL (PHALLIC) EMISSIONS/ Wet dreams) *Average 14-16
ERIKSON’S INITIATIVE VS GUILT
CONGENITAL HEART DISEASES
 OEDIPAL/ELECTRA PHASE- Child turns
toward the parent of opposite sex ACYANOTIC LEFT TO RIGHT Shunt
 Initiative develops if the child is allowed freedom  Aorta DOES NOT get unoxygenated
to initiate small activities & is appreciated for it. blood
 Stage of “KUSA”
CYANOTIC RIGHT TO LEFT Shunt
*unresolved Oedipal gay  Aorta GETS unoxygenated blood.

straight but finds a girl matured/ ACYANOTIC CYANOTIC

older than her
VSD TRANSPOSITION OF
THE GREAT VESSELS
*unresolved Electra male much older than her to ASD TETRALOGY OF FALLOT
satisfy PDA
mother & father role COARCTATION OF THE
AORTA
doesn’t want a man who isn’t Complication: Complication:
married.
CHF CEREBRAL
MISTRESS Complex (kabet)
THROMBOSIS
Commitment shallow, finds sugar
ASD- Atrial Septal Defect
daddy.
compensates by BEATING FAST
BEHAVIORS TO OBSERVE:
volume = workload
 Very CURIOUS: “WHY” stage
 gets bigger (hypertrophy)
 Curious about gender differences  reaches point of exhaustion
 TOUCHES/ EXPLORES their body VSD
PDA- Ao & Pa connected
 Exhibits FEAR & BODILY Injury Coarctation – DESCENDING AORTA STENOSIS
 changes in pulse rate & BP
“CASTRATION Complex”
*In any surgery don’t use words “cut, remove / fix”  PR & BP in arms
instead gagamutin/ tatanggalin yung sakit sa ex: tonsil”
ACYANOTIC CONGESTION OF CARDIAC
 Very IMAGINATIVE- engages in fantasy play
CARDIAC SPHINCTER
CONDITIONS
SCHOOLER COMPENSATES BY RATE
FREUD’S LATENCY OF CONTRACTION
ERIKSON’S INDUSTRY VS. INFERIORITY Pul. Congestion LSHF (lungs)
CHF
 The sexual drive (libido) is controlled & repressed. Systemic Congestion RSHF (systemic)
 interest on the same sex only (normal
HOMOSEXUALS)
Chief Complaint: EARLY
 Industry develops if the child is permitted to do
things by himself and praised for the results.
  Pulmonary sx: dyspnea, fast breathing, moist ` R- VH
cough, rales, crackles O- pening in Septum
P- ulmonary Artery Stenosis
Dx:
1. CXR (Pulmonary Edema & Cardiomegaly) Sx: usually seen when child is more active because of
*athletes and older person- Normal cardiomegaly increased O2 demand.
2. ECHOCARDIOGRAPHY/ MRI- identifies type & size of  EXERTIONAL DYSPNEA w/ Cyanosis (Central)
defect  Activity Induced “TET SPELLS” relieved by
 not invasive SQUATTING
3. CARDIAC CATHETERIZATION- identifies pressure
inside the heart (CHF) *Squatting venous return

CORRECTIVE SURGERY pressure in R side of

1. if in FAILURE & DEFECT is large (no
possibility of spontaneous closure  KNEE-CHEST position if small baby
 “BOOT-SHAPED” heart
OPEN - defect is inside the (ASD, VSD)  CLUBBING OF FINGERS d/t Peripheral hypoxia
CLOSED - defect is outside the (PDA, Coarctation
of Aorta) additional capillaries are
formed
MEDICAL / NURSING MANAGEMENT: (collateral circulation is
made)
Objective 1: PREVENT CHF
SCHAMROTH SIGN- looking for diamond space in fingers
1. IMPROVE CARDIAC OUTPUT
 Cardiac Glycoside- DIGOXIN  POLYCYTHEMIA d/t CHRONIC HYPOXIA
(increase strength of contraction) -kidneys compensate by producing more
 check for apical pulse/ cardiac rate erythropoeitin
 don’t give if <60bpm if consistency is viscous blood flow slows down
(sluggish)
2. PREVENT Na RETENTION & PROMOTE
ELIMINATION OF EXCESS FLUIDS CLOT FORMATION
 Diuretics- FUROSEMIDE
 fast/rapid- 30 mins Intervention: SURGERY (Priority)
*1g= cc  Palliative Close surgery then corrective Open

3. LOW Na INTAKE Medical/ Nursing Management:

 Low Sodium Formula 1. Decrease O2 demand
 Clarification on SOLIDS Allowed. *bawal maasin*
2. Monitor Hgb & Hct count- detects early
 Not only the salty foods are rich in sodium
POLYCYTHEMIA
Objective 2: DECREASE O2 DEMAND 3. Assist in PHLEBOTOMY as needed to be done
 cluster nursing care (organized)  removal of blood
 Quiet play activity (blocks, story book, puzzle)  replacing amount removed w/ plasma
4. Increase Fluids/ Maintain IVF line as necessary
 Decrease stress & anxiety level
5. POSITIONING during Attacks
*observe distance to child (Stranger Anxiety)
 allow to SQUAT/ KNEE CHEST, give O2
 Small frequent feeding

Objective 3: PREVENT RESPIRATORY INFECTIONS

GIT PROBLEM
 Lung congestion prone to PNEUMONIA CLEFT LIP & PALATE
 Vitamin C CLEFT LIP
 Promote IMMUNIZATION Management: CHEILOPLASTY/ Z-PLASTY

The CYANOTIC CONDITIONS Post Operative:

 Position: NEVER ON PRONE (no head control)
TRANSPOSITION OF GREAT VESSELS  Prevent tension on suture lines
 Ao & Pa switched  Anticipate needs to lessen crying
 Aorta receives pure unoxygenated blood  use of ARM RESTRAINT- doctor’s order
 Clean suture lines after feeding
sx: PERSISTENT CYANOSIS inspite of VIGOROUS
CRYING CLEFT PALATE
*less symptomatic if with Septal Opening Management: URANOPLASTY/ PALATOPLASTY

Management: Post Operative:

 PALLIATIVE:  Position: SHOULD BE ON PRONE (to promote
 Emergency BALLOON ATRIAL natural drainage of secretions
SEPTOSTOMY- To open hole in the atrial *any surgery VASCULAR Prevent
septum that involves (lots of blood swallowing/
 CORRECTIVE OPEN SURGERY mouth/oral vessels) ASPIRATION
of blood.
TETRALOGY OF FALLOT
D- isplaced Aorta (overriding) Feeding Device Post Operative:
  DRINK FROM CUPS
 NEVER USE STRAW adhesion obstruction distention
 prevent NEGATIVE PRESSURE
*sipsip BILE STAINED VOMITUS
EFFECT: BLEEDING

ESOPHAGEAL ATRESIA
TRACHEOESOPHAGEAL FISTULA

Problems: ASPIRATION/NUTRITION

Sx:
 Mom w/ POLYHYDRAMNIOS
 BABY is DROOLING/ very MUCOUSY

3C’s DURING FEEDING

BLOOD VESSEL Blood Supply
C caught between
layers NECROSIS
Dx: X-ray
Mgt: SURGERY (ASAP) PAIN/ BLEEDS

PreOp Care: CURRANT JELLY STOOLS

 PREVENT ASPIRATION
 Suction PRN
 Strict NPO DANGER: PERFORATION bcausing PERITONITIS

 PROMOTE NUTRITION Sx:

 Gastrostomy Feeding  spasmodic abdominal pain
 TPN as ordered (check blood sugar)  blood w/ mucus in the stool- Currant Jelly Stool
 Vomiting of Bile-stained Vomitus
PYLORIC STRENOSIS  SAUSAGE SHAPED MASS

cardiac sphincter –prob:GERD Management:

2 sphincter (open)  IMMEDIATE SURGERY to prevent perforation that
can lead to peritonitis (Bowel Resection)
pyloric sphincter
HIRSCHSPRUNG’s DISEASE
(close)
 Congenital Aganglionic Megacolon
*pyloric sphincter- holds stomach content until it is
nerve supply
mechanically digested
of LI
*sphincter is a circular M --- when pressure build up
inside HYPERTROPHY ---- small exit
 absence of parasympathetic nerve supply
Sx: (ganglion cells) in LI
 ABDOMINAL DISTENTION AFTER FEEDING or  RECTOSIGMOID AREA
(+) peristaltic wave
Sx: Early: in the nursery – DELAYED MECONIUM
 PROJECTILE VOMITING- pressure builds up
Later sx:
inside; Metabolic Alkalosis
 Constipation
loss K
 Frequency: stool <3x/wk Characteristic: HARD
 Dehydration
 Hypokalemia  Pellet like stool/ RIBBON LIKE STOOLS
 Weight loss  Abdominal distention w/ possible fecaloid vomitus
 Weight loss- don’t absorb nutrients the right way
 PALPABLE OLIVE SHAPED mass in RUQ
Dx:
*palpation not a reliable technique
Dx: X-ray- BARIUM  RECTAL BIOPSY
Management: PYLOROMYOTOMY (opening muscle) w/  BARIUM ENEMA- to determine EXTENT
PYLOROPLASTY (repair)
Management:
PreOp
INTUSSUSCEPTION
 FACILITATE ELIMINATION
 small intestines TELESCOPES into the lumen of
 regular caloric irrigation
another
 Palliative Colostomy- TEMPORARY
  prevent COUGHING causing laryngospasm &
 CORRECTIVE SURGERY respiratory distress
 ERPT- Endorectal Pull Through
1. AVOID RESPIRATORY IRRITANTS & sudden
IMPERFORATE ANUS temperature changes
 pollen, dust, dander, smoke, baby powder
Sx: Absence of Meconium 2. FEED & HYDRATE w/ ASPIRATION Precaution
Unable to Insert 3. Decrease O2 demand
4. Administer high humidity w/ MIST THERAPY
Management: during attacks
STEP 1: COLOSTOMY in the nursery (Palliative)  cool mist vaporizer in the hospital- only water
no perfume
STEP 2: Before 1y/o (10 mos):  liquefies secretions
CORRECTIVE SURGERY:  steaming bathroom at home
 ANOPLASTY- opening anus  “tuob/ suob”
 pull through procedure
*Kasi pag toddler na, dapat toilet training na BRONCHIAL ASTHMA
 Avoid high sugar, high fibrous Pedia- Acute and involves only the MAINSTEM
BRONCHI; Prognosis: CURE
PEDIATRIC RESPIRATORY CONDITIONS Adult- bronchi, bronchioles, alveoli

Throat Problems: PHARYNGITIS/TONSILLITIS  EXTRINSIC- Allergens Induced (GIT/RT)

 caused by GABHS  INTRINSIC- Idiopathic/ innert on the patient
 if 10yr/more- Tonsillectomy (stress/anxiety)

Management: HISTAMINE
 If (+) GABHS- Antibiotic
 Erythromycin than PCN, for it’s the Mechanisms responsible for sx:
hypoallergenic form 1. Bronchospasm
 Antipyretic PRN (NO ASA) 2. Inflammation & Edema of Airways
 Paracetamol/ Acetaminophen 3. Accumulation of Tenacious Secretions

*reye’s syndrome- go to seizure MANAGEMENT

 ALLERGEN CONTROL
 TONSILLECTOMY if: recurrent, w/ peritonsillar  SKIN TESTING followed by
abscess, w/ massive hypertrophy causing dyspnea HYPOSENSITIZATION (for 3 years)
 CI: <6y/o
Management during EXACERBATION:
PreOp: 1. Administer BRONCHODILATORS/AEROSOL
 Check dental (LOOSE TEETH-pedia, FALSE 2. IVF Drugs (Aminophylline, Steroids)
TEETH-adult) & bleeding status (bleeding DO) 3. Position: “ORTHOPNEIC”
4. Promote Oral fluids w/ ASPIRATION
Post Op: PRECAUTION
1. Position: while Asleep- PRONE/LATERAL
 Limit MILK (thickens secretions) / AVOID VIT C
position to promote natural drainage of secretion
(high doses is an Allergen)
2. Observe for BLEEDING (FREQUENT
5. Promote breathing exercise- PURSE LIP
SWALLOWING & RESTLESSNESS) BREATHING
3. Prevent Bleeding
 ice collar- potential for numbing to decrease
TOYS: flute, whistle, bubble blowing, pin wheel
pain sensation & vasoconstriction
SPORT: swimming
 Avoid suctioning, throat clearing
 Avoid Valsalva maneuver
4. Diet resume ONCE FULLY AWAKE & CAN RHEUMATIC FEVER
SWALLOW  complication of STREPTO INFECTION
 No ice cream- not advisable
 COLD, CLEAR, NON IRRITATING FLUIDS
 cool water, ice cold apple juice, frozen gelatin, JONES CRITERIA OF ASSESSMENT
suck on frozen popsicle, sherbet MAJOR SYMPTOMS
 then SOFT DIET then DAT- (progressive diet)
 Migratory POLYARTHRITIS- joint pains
SPASMODIC CROUP (LTB)  CHOREA (St. Vitus Dance)- involuntary jerks
 Laryngotracheobronchitis
 Erythema Marginatum- rashes on the trunk
 Subcutaneous nodules
Sx:
 CARDITIS- Endocardium (3 layers epi, myo, endo)
 hoarseness (BRASSY SPASMODIC “SEAL-
LiKE” COUGH)
 inspiratory stridor MITRAL VALVE STENOSIS RHD
 Fever
 Possible distress d/t LARYNGOSPASM Diagnosis:
 JONES CRITERIA + ASO titer= Rheumatic
Management: SUPPORTIVE CARE Fever
 Normal Value ASO titer: 0-200 ‘iu’
PRICES TECHNIQUE (instead of RICE)
 ECHOCARDIOGRAPHY- if with valve damage
P- rotect (protective devices)
MITRAL VALVE= Stenosis/ Insufficiency RHD
R- est (immobilize)
I- ce (vasoconstriction)
Management:
C- ompression (apply pressure)
OBJECTIVE 1: Decrease Demand from the Weakened
E- levate (above the heart)
Heart
S- upport (parents, MDs, nurses, dentist, PT,
 CBR/ Modify Lifestyle after discharge nutritionists)
 Cluster care
LEUKEMIA
OBJECTIVE 2: Prevent further Cardiac Damage (RHD)
 most common form of childhood cancer
 Meds: PCN IM once a month x 3-5yrs/ ASA/  IMMATURE WBC’s (lymphoblast) *not
Steroids lymphocytes; not capable of phagocytosis is
formed
OBJECTIVE 3: Safety Precaution for CHOREA
Early Symptom: PRONE TO INFECTION
HEMATOLOGIC DISORDERS
Forms:
IRON DEFICIENCY ANEMIA  LYMPHOCYTIC- good prognosis
 more common to 6mos & older children- Fe  MYELOCYTIC- poor prognosis
from mother has been used up & d/t
3 MAIN CONSEQUENCES
OVERFEEDING of MILK  INFECTION
 ANEMIA
*occupational anemia- x-ray department
*pernicious anemia- Bariatric surgery (obese people)  BLEEDING TENDENCIES

Management: *Prognosis is GOOD- if early detection and treatment

 Introduction of COMPLEMENTARY
Dx: BONE MARROW BIOPSY
FEEDINGS after 6 mos of exclusive breastfeeding
 ONE AT A TIME ONLY- to rule out allergy Management
1. REMISSION INDUCTION
IRON RICH FOODS
 IV (systemic chemotherapy)
 cereals
2. CNS PROPHYLACTIC THERAPY
 egg yolk not egg white (allergenic part of egg)
 dark green leafy vegetables- SPINACH (very rich  Intrathecal Chemotherapy
in iron) 3. INTENSIFICATION/ CONSOLIDATION THERAPY
 dark meat (organ meat)- liver of Cow  regular systemic & intrathecal chemo
4. MAINTENANCE THERAPY
 Supplemental Fe Preparation (FeSO 4) w/
Vitamin C (enhance absorption) Most Ideal: BONE MARROW TRANSPLANT
CHILD’s CONCEPT OF DEATH
HEMOPHILIA  Below 5 y/o- form of a SLEEP/ REVERSIBLE
 Deficiency in Factor VIII (anti-hemophilic factor)  6-9 y/o- person- Grim Reaper, Bogeyman, Devil,
 transmitted as X-LINKED from carrier MOM Monster/ “KAMATAYAN”, REVERSIBLE
to AFFECTED SON (symptomatic)  Above 9y/o- END OF LIFE on EARTH/
 daughter gets it as a TRAIT from carrier MOM IRREVERSIBLE
(asymptomatic)

EARLY Sx in the NURSERY

 PROLONG BLEEDING FROM THE UMBILICAL CORD

LATER SX:
 EASY BRUISING (hematomas)
 EASY EPISTAXIS & GUM BLEEDING

*epistaxis- balinguyngoy

HEMARTHROSIS- bleeding in between the ball joints (pain

& swelling)
*bone absorbs blood in synovial fluid

DEATH d/t INTRACRANIAL HEMORRHAGE

Management:
 MEDICAL: Transfusion of Factor 8,
cryoprecipitate, platelet concentrate
 Prevent BLEEDING (AVOID TRAUMA)
 soft bristled toothbrush, electric razor, no
tattoo, no contact sport