PEDIATRIC NURSING (NOMRAL) - Crawling or creeping

- BIRTH LENGTH: supine position, tape measure is used, 10 months old

Development Stages of the Babies when measure centimeter unit upon assessment - Stand with support
1. INFANT - NORMAL VALUE: 45 – 55 cm 11 months old
- Age: 1 month old – 12 months old DEVELOPMENT – process of maturation - CRUISING –hold the baby hands – both hands while
Note: psychiatric (Sigmund Freud) nursing concept range CHANGES: changes in terms of the SKILLS of the baby – considered as walking
extends to the 18 month unique
- Before the infancy, neonatal stage of development ( 0 - OTHER NAMES: Development is Qualitative changes in
-28 days old) nature – still measurable: assessment tools are still
Key concepts to observe: present
- Fastest growth pattern of the child, development - Assessment tools include :
GROWTH: a. DDST – Denver developmental screening test
b. MMDST – metro manila developmental
- changes in the SIZE (WEIGHT, HEIGHT)
screening test
- OTHER NAMES: quantitative changes of the babies –
- PARAMETERS: under the MMDST
measureable
 Motor gross skills – stand, moving, walking and
- PARAMETERS: measure the height (linear growth) and
running
weight (most sensitive parameter)
 Fine motor skills - development of hand
- normal BW: 2000-3500 g or 2 -3.5 Kg
movement and coordination 12 months old
- 3500 or 3.5 Kg, large for gestational age or  Language skill or development - STAND WITHOUT SUPPORT
Macrosomia: GDM is the 1 cause of LGA or  Social skills or development - might have - WALK WITH SUPPORT – one hand only
Macrosomia: DM – hyperglycemia – placental circulation – antisocial tendency 15 months old - WALK WITHOUT SUPPORT
fetal circulation – consumes the glucose excess in the blood – 3 YEAR OLD – RUN
inc. the fetal size. GROSS MOTOR DEVELOPMENT (normal)
- Cephalocaudal pattern development of the baby (head
- can already use the bike: bike with 3 wheels (TRI –
PRIORITY: Check the blood sugar of the newborn – in risk for
BIKE): with support
hypoglycemia due to high insulin production from the uterus to toe development)
hyperglycemic state. 0 month (at birth)
- NORMAL BLOOD SUGAR: 40-60 mg/dl – newborn - HEAD LAG (birth – 1 month) No well develop neck FINE MOTOR DEVELOPMENT (normal)
muscles: support head when hold the neonate, when - proximo- distal (hands)
not supported – head lag occurs 1-3 months: CLOSE FIST
- When head lag extends 1 month, ABNORMAL - might 5 months: CLOSE + OPEN FIST
be due to inc. head weight - hydrocephalus - can hold the rattle, colorful – develops the sense of
2 months old sight and makes sound – develops hearing
- HEAD LIFT: Prone position –baby lifts head 7 months – CRUDE PINCER GRASPS - transfer objects between hands
4 months old 9 months old – NEAT PINCER GRASPS- learns to control thumb and
- CHEST LIFT and HEAD pointing finger – able to pick and may eat object – RISK OF
5 months old ASPIRATIONS/CHOKING/POSIONING
- ROLL OVER – prone: supine movement – RISK FOR
FALL
- 2000-3500 g or 2 -3.5 Kg Less than normal weight is 6 months old:
SMALL FOR GESTATIONAL AGE - SIT WITH SUPPORT – provide support as baby may flip
- Cause: smoking – nicotine – vasoconstrictions – dec. backwards: chair may be given
blood flow – dec. nutrient delivery to the baby 7 months old
- BOUNCING – bouncing of the legs; strengthen the leg
muscle – preparation for standing and walking
8 months old
- SIT WITHOUT SUPPORT
9 months old
12 months old – THROW (ball) – walking a. Infant: Stanger anxiety
- can control SPOON - In terms of bladder control: 2 classification – daytime Onset: 6 -7 months, baby that are less than 6 months
2 years old – vertical lines (draw) – when a child draws circle (first to develop) and night time (second to develop) does not have stranger anxiety
repetitively at this age – might be early indication of autism - TOOTHBRUSHING – 2 and half year old/ 30 months Peak: 8 months most scared
old- at this age the milk teeth is complete End: 9 months
3 year’s old – “C” (can draw circles, curves, crosses)
b. Toddler: separation anxiety
3. PRE- SCHOOLER (4 to 6 years old) – MISY
4 years old – can draw objects with 4 sides (squares, rectangles) c. Pre-schoolers: body mutilation, castration, ghost,
Note: ANYONE CONSIDER 3+ OF AGE IS CONSIDERED A PRE-
SCHOOLER EX: 3 years old and 1 month DEATH (1-6 years old sleeping, 7-9 years old – death is
5 years old – can draw pointed/APEX object – TRIANGLES, DIAMOND, and Magical thinking: exaggerated imagination of the child punishment – bogyman, 10 year old –END OF LIFE,
STAR – imaginary playmate. irreversible)
6 years old – able to draw all shapes  Fear – also excessive, fear of body mutilation – T – Teacher – idolized the significant person – the teacher
manage this fear – in the event wounds may be
2. TODDLERHOOD (1 to 3 years old) – RENT present in a preschooler patient – cover 5. ADOLESCENT (13 – 18 years old) – PBA
R – Ritualistic behaviors among toddlers: favorite wound. P – Puberty: secondary sec characteristics – thelarche,
object/security objects: toys, pillows etc. Imitative: ROLE PLAY adrenarche (hair growth), menarche
- When security objects are misplace or missing are Share: COOPERATIVE/ ASSOCIATIVE PLAY
common reactions temper tantrums. – may occur with Caused by: ESTROGEN (hormone of the puberty)
Y- WHY? : 200/300 day
head banging B – Body Image:
- Management: 4. SCHOOLER(7-12 years old) WAT– according to Sigmund A – Acne: due to increase in hormone production – inc. oil in the
 Promote safety – provide helmet or pillow Freud tis stage is what he refers to as “latency” phase face – bacteria production – increase acne – disrupted body
 Ignore Child develops a decrease in the growth pattern image.
E – Ego centric – self-centered: PARALLEL PLAY – the “rest period”.
N – Negativism – “no mommy” – when asked to do
Psychosexual Stages of Development by Sigmund Freud
something, always say with the “no”
1. Infant: ORAL STAGE - gratify by promoting breast
- Management:
 Options/ choices
feeding – done by one person: the mother
T – Toilet training, tooth brushing – becomes a part of the - When not gratifies: leads to oral fixation – may
ritualistic behavior: hence must be introduce in this age lead to alcoholism, smoking and thumb sucking
range. 2. Toddler: ANAL STAGE – gratify by toileting:
- To be specific, age: can start at 1 and half years old or mother – guilt.
1 year and 6 months or 18 months old and above. a. RIGID MOTHERS: Excessive guilt – leads
- 18 months due to maturation of the anal sphincter to OCD
- First to develop before bladder control b. LAX mothers: under develop guilt
feelings – antisocial behaviors.
3. Pre- schoolers : PHALLIC STAGE (phallus- penis)
a. Infantile masturbation – holds the dick at all
times. – Due to curiosity – exploration –
manage by diversion of activities.
4. School Age – LATENCY STAGE
5. Adolescent – GENITAL STAGE
W – Winner/Loser – in playing there is the concept of winner
and loser: COMPETITIVE PLAY
Ex: tobang presso, luksong baka or luksong tinik, board
games include monopoly and snake/ladder
A- Afraid of something
 - Followed x-ray ( all barium procedures are 1. Air Enema: can be done when NO BLEEDING is still
proceeded by X- ray): string sign present
TX: - using asepto syringe attached to rectal tube: air
1. IVF, no oral fluid – useless due to vomiting administration removes the intussusception
2. Fredet – ramstedt procedure/pyloromyotomy: opening - complication: peritonitis
of the stomach -
2. Resection and anastomosis – for bleeding occurs
- Swenson procedure
PEDIATRIC NURSING (ABNORMAL) INTUSSUSCEPTION
Gastrointestinal Disorders HRSCHSPRUNG’S DISEASE/AGANGLIONIC MEGACOLON

PYLORIC STENOSIS
- Pathology: narrowing of the pyloric sphincter
Anatomy:
- Telescoping or “overlapping” of the small Hirschsprung’s disease, or congenital aganglionic
Stomach: has 2 sphincter – LES/cardiac sphincter (condition on
intestine megacolon, is absence of ganglionic innervation to the muscle
which to affect this portion may include GERD)
- Obstruction of the GI of a section of the bowel—in most instances, the lower portion
- Cardiac sphincter – immature on newborns:
SX: of the sigmoid/descending colon
normal backflow of milk and gastric contents
1. Bile tinged vomitus (when obstuction occurs –
- Minimize this concern through: BURPING  No peristaltic waves in this section (CONSTRICTIONS of
vomiting is always present) – green or yellowish
2nd sphincter is the PYLORIC SPHINCTER the affected large instestine) to move fecal material
2. Dehydration
- Narrowing: compromise the passage of food through the segment of intestine.
Assessment:
- Complications include:  OBSTRUCTION IS STILL PRESENT
- Fontanels: sunken
SX:
- Skin turgor: (+) 2 sec. (done in the abdomen) for  symptoms of aganglionic megacolon generally do not
1. Projectile vomiting – buildup of food
geriatric: sternum become apparent until 6 to 12 months of age
2. Dehydration: vomiting, can be fatal
3. Metabolic Alkalosis SX:
Assessment:
4. SAUSAGE SHAPE – palpation 1.
Vomiting – Fecaloid
- Fontanels: sunken
5. Currant jelly stool – red colored stool (due to 2.
Chronic constipation
- Skin turgor: (+) 2 sec. (done in the abdomen) for
bleeding) 3.
Ribbon like stools (passing through small narrow
geriatric: sternum
6. Colicky pain or intermittent pain is felt segment look like ribbon) and Pellet like stools
3. Metabolic Alkalosis
DX: 4. Portion of the bowel proximal to the obstruction
4. Increase appetite
1. Barium ENEMA dilates, distending the abdomen
5. OLIVE SHAPE – palpation, CONFIRMATORY DX and
Followed x-ray (all barium procedures are proceeded by Factors/Causes:
Hallmark
X- ray): staircase sign  higher in the siblings of a child with the disorder
DX:
TX:  occurs more often in males than in females
1. Barium swallow  caused by an abnormal gene on chromosome 10
  The incidence is approximately 1 in 5000 live births 2. Hair color: blonde 5. AKI is present – oliguria as its early manifestation
Assessment 3. Bluish eyes DX:
4. Mental retardation - Newborn screening test
1. meconium cannot pass (infants fail to pass meconium - Beutler test – confirmatory test for the condition
by 24 hours of age and have increasing abdominal 5. Seizures
TX:
distention) 6. Urine: musty order urine –
1. HALT BREASTFEEDING
2. History of constipation or intermittent constipation and HALLMARK/confirmatory order of the patient - Formula feeding is done instead: NUTRAMIGEN
diarrhea. urine
3. Gloved finger is inserted into the rectum, the rectum is
empty because fecal material cannot pass into the DX:
rectum through the obstructed portion 1. Newborn screening Test: PKU screening test – collected
DX: CLEFT LIP
in the heel of the baby.
1. A barium enema is generally ordered to substantiate - Taken in 24-72 hours of the birth
the diagnosis. 2. Guthrie Blood test – confirmatory test for PKU
- X- ray: pigtail sign TX:
Note: The barium will outline on x-ray film the narrow, nerveless 1. Newborn with PKU – breastfeeding is NOT ALLOWED –
portion and the proximal distended portion of the bowel. A formula is used: LOFENALAC
barium enema must be used cautiously, however, because
children cannot expel this afterward any more effectively than
they can stool
2. Definitive diagnosis is by a biopsy/anorectal
manometry
TX
1. Resection of the affected section, with anastomosis of
the intestine (termed a pull-through operation) The maxillary and median nasal processes normally fuse
2. Newborn by two-stage surgery: between weeks 5 and 8 (first trimester) of intrauterine life.
2.1 first a temporary colostomy is established
2.2 bowel repair for 12-18 months of age CLEFT LIP is where fusion fails to occur, causing to range from a
2.3 In the few instances in which the anus is small notch in the upper lip to total separation of the lip and
deprived of nerve endings, a permanent facial structure up into the floor of the nose, with even the upper
colostomy will be established. teeth and gingiva absent
 deviation may be unilateral, bilateral and medial type
Metabolic Disorders  nose is flattened because the incomplete fusion of the
upper lip has allowed it to expand in a horizontal
dimension
PHNENYLKETONURIA  Sucking problem
GALACTOCEMIA
- Inc. phenylalanine or TOXIC LEVELS in the
- Inc. galactose – more fatal
blood stream - Affects the CNS, eyes, liver and the kidneys Cleft lip is more prevalent among boys than girls
- CNS is affected: brain damage – mental Manifestations: Causes
retardation 1. CNS: mental retardations  familial tendency/transmission of multiple genes
- Newborn screening test detection 2. CNS: seizures  Teratogenic factors (second month of pregnancy is
SX: 3. Eyes: congenital cataracts MOST DAMAGING FOR teratogenic factors) present
1. Melanin lvl is low (light or white or fair skinned 4. Skins: increase bilirubin release results in the jaundice: during weeks 5 to 8 of intrauterine life
due to its absence) “GOLDEN BOY” o viral infection
 o deficiency of folic acid Therapeutic Management  one of the first types of congenital heart disease
o TORCH: Toxoplasmosis, Other agents ex. 2. early repair described
Hepatitis, syphilis, Rubella (small viral dimensions - (Increases speech development, results in a  children with this disorder show a deletion abnormality
hence teratogenic compared to Rubeola) , necessary second-stage repair as the child’s of chromosome 22 (22q11.2)
Cytomegalovirus, Herpes simplex palate arch grows)  the disorder can result from a documented
Assessment 3. two-stage palate repair (Malek Protocol)
chromosome disorder
 Inspection (needs good lighting) - (Soft palate repair at 3 to 6 months; hard palate
It is called a tetralogy because four anomalies are present:
 sonogram repair at 15 to 18 months)
4. follow-up treatment by a pedodontist, or a dentist 1. pulmonary stenosis – narrowing
TX: - (For extractions or realignment of teeth to detect 2. VSD (usually large)
 Parents of a child should be referred for genetic if speech or hearing difficulty occurs) 3. Dextroposition (overriding) of the aorta
counseling to ensure they understand that they NX for post - op: 4. hypertrophy of the right ventricle
have about a 4% chance of having another child 1. DO NOT LET THE PATIENT OR THE BABY CRY – ruined NOTE: ASD may be present as the 5th condition
with a cleft lip or palate or future children are at a sutures Pathology:
greater risk than usual for this problem - Attend to needs of the baby ex. Food Because of the pulmonary stenosis, pressure builds up
 Fetal surgery (for cleft lip discovered while the - Racking, cuddle – to minimize the cry of the baby in the right side of the heart. Blood then shunts from this area of
infant is still in utero) Note: DO NOT USE PACIFIER TO THE INFANT – pre-op is allowed increased pressure into the left ventricle and the overriding
 Surgical repair (between 2-10 weeks of age which is since patient is NPO aorta. The extra effort involved to force blood through the
a better age for surgical risk) – cheiloplasty: side 2. NO straw and NO use of spoon stenosed pulmonary artery causes the fourth deformity,
lying 3. Use breck feeder, dropper is used most commonly in
hypertrophy of the right ventricle.
 nasal mold apparatus applied before surgery to the Philippines.
shape a better nostril 4. Elbow restrained may be used – tongue depressor, or
mommy restraint SX:
 nasal rhinoplasty to straighten a deviated nasal
1. HYPOXIA
septum (4 to 6 years of age)
2. may not exhibit a high degree of cyanosis immediately
 Early repair helps infants experience the pleasure
of sucking after birth, becoming more active, however, their skin
CLEFT PALATE acquires a bluish tint as cyanosis begins -
The palatal process closes at approximately weeks 9 to 12 of HYPERCAPNIA
intrauterine life. 3. polycythemia
CLEFT PALATE is considered an opening of the palate usually on Complication:
the midline; may involve the anterior hard palate, the posterior  thrombophlebitis
soft palate, or both  embolism
Degree: It may be a separate anomaly, but as a rule it occurs in  cerebrovascular accident
conjunction with a cleft lip 4. If the condition is not corrected: development of
 tends to occur more frequently in girls than boys severe dyspnea, growth restriction, and clubbing of the
 speech problem fingers
Causes
5. Assume a squatting or a knee–chest position when
 polygenic inheritance
resting (provides physiologic relief, if not done the
 environmental influences
heart can be overwhelmed)
Assessment
 Inspection (must have good lighting)  Develop syncope (fainting) and hypercyanotic
 depressing the newborn’s tongue with a tongue blade episodes (sometimes called Tet spells).
 must be assessed for other congenital anomalies
TETRALOGY OF FALLOT
 6. A loud, harsh, widely transmitted murmur or a soft,
scratchy localized systolic murmur in the left second,
third, or fourth parasternal interspace may be present
Note: Follow prolonged crying or exertion. They can be so extreme, if long term,
that children develop cognitive challenge
DX:
 history
 physical symptom
 2D echo/ echocardiography: BOOT SHAPED HEART
 ECG
 cardiac catheterization
 laboratory findings: polycythemia, increased Hgb, Hct,
and total RBC as well as reduced oxygen saturation
TX:
1. If a baby begins to have a hypoxic episode:
 administering oxygen
 placing the baby in a knee–chest position
2. Administering morphine sulfate generally reduces
symptoms.
3. If not, propranolol (Inderal, a beta-blocker) may be
given orally to aid pulmonary artery dilation.
4. A temporary or palliative surgical repair, called the
Blalock-Taussig procedure, can create a shunt between
the aorta and the pulmonary artery (creating a ductus
arteriosus)
 This will allow blood to leave the aorta and
enter the pulmonary artery, oxygenate in
the lungs, and return to the left side of the
heart, the aorta, and the body
 When a Blalock-Taussig procedure is done, a
child will not have a palpable pulse in the
right arm after this procedure. For this
reason, blood pressure and venipuncture
should be avoided in the affected arm
5. Brock’s procedure – curative procedure
- Widening of the pulmonic valve, Dacron patch is
inserted