PEDIATRIC NURSING

ABNORMAL PEDIA Other Manifestations

→ Diplopia (double vision)
NEUROLOGIC DISORDERS • ↑ICP= ↑IOP and this will cause the damage of the
optic nerve→ double vision, blurring of vision, or
INCREASED INTRACRANIAL PRESSURE blindness if not addressed promptly
→ Pressure inside the brain → Pupillary changes
→ Maintained the brain function and development • N: PERRLA (pupils are equally round and reactive
→ N: 5-15 mmHg to light and accommodation)
• >15 mmHg→↑ICP but if >20 mmHg it becomes • Anisocoria- uneven pupils, one is constricted, one
life-threatening is dilated (if this presents, brain damage may be
→ Cushing’s triad suspected)
• ↑systolic BP, ↓RR, ↓PR, and widened pulse • Dilated pupils- shock
pressure (the complete opposite of the shock • Both eyes are constricted- narcotic overdose (d/t
triad- ↓BP, ↑RR, and ↑PR) opioid drugs that are usually given for seizure
• Pulse pressure is the difference between the disorders)
systolic and diastolic pressure (N: 30-40 mmHg) → Sunset eyes
• If only two of the triad are present, it is not • Eyes are pushed downward because of increased
considered as Cushing’s triad but can still be a pressure in the brain
manifestation of IICP because some of the → Anorexia and weight loss
systems may still be able to compensate → Nausea
→ Seizures
Manifestations of IICP • Two reasons why seizure will occur
→ Bulging fontanelles that is aggravated by crying 1. Irritability of the brain will cause erratic
• There are two fontanelles in the pediatric transmission of signals= ↑neuronal impulses
population (anterior and posterior fontanelles) (electrical impulses from the brain is not
• Anterior- diamond-shaped and closes at around properly transmitted to the muscles→ erratic
12-18 months muscle movements
• Posterior- triangular shaped and closes at 2-3 2. Dehydration d/t vomiting, insufficient fluid
months intake→↑temperature d/t insufficient fluids
• For a child with IICP, fontanelles will not close that will regulate the temperature→
because the pressure inside the brain pushes it convulsions
outwards (hydrocephalus)
• Crying will all the more increase the pressure Lack of oxygen in the brain may also induce seizures, ↓O2 in
inside the brain, this may be normally expected in the brain→ cerebral hypoxia→ brain dysfunction, and the
crying children but not as much as children with afferent and efferent nerve fibers→ erratic neural impulses→
hydrocephalus seizures
→ High-pitched cry: considered one of the early signs
• This is a sign that may be d/t pain Management of IICP
Early signs of ↑ICP per each age group → Proper positioning: semi-fowler’s position
→ Infant- high-pitched cry • Promotes venous return and drainage of CSF that
→ Child- irritability and agitation will decrease ICP through the use of gravity
→ Adult - restlessness → Coughing and sneezing is avoided
→ Geriatric- confusion
• This increases the ICP
→ Increase head circumference • If cough cannot be suppressed, cough with an
• The tape measure should be at the bedside for open the mouth→ pressure will be released
monitoring towards the mouth
• This will be used to measure if the head increases → Limit fluid intake (1,200-1,500 mL or as regulated by
or decreases in size (↑size= ↑ICP) the physician)
• Measured every shift • N: 2-3 L
• From the forehead to the occipital area • Increase in fluids, increase in pressure d/t
• N: 33-35 cm retention
→ Headache- the initial sign of IICP
• First to appear Pharmacotherapy
• Compression of the brain and nerve structures→ → Diuretics
pain • Mannitol (osmotic diuretic) to decrease fluids in
• Crying may be the sign of pain in infants the cerebrum
→ Projectile vomiting o Can cross the BBB
• D/t compression of the CTZ (chemoreceptor o Follows the principle of osmosis (pulls fluids)
trigger zone- vomiting center of the brain) in the o The function is more generalized
medulla oblongata→ may be d/t alteration in the • Furosemide (loop diuretic)
brain structure/ cerebral edema o Takes effect in the loop of Henle
o A specific range of function
• Both are potassium-wasting diuretics; monitor the
serum potassium
o WOF: hypokalemia
 • Stop administration when hypokalemia, severe • Never restrain as it may cause fractures
dehydration, severe fluctuations in the FE • Never put a tongue depressor in the mouth it may
→ Decadron (dexamethasone) cause aspiration
• Anti-inflammatory, prevents cerebral edema if the • Clear the area of any object that may cause harm
brain becomes more edematous→ exacerbation • Protect the head of the patient
of symptoms
• Decadron will be stopped depending on the ICP,
If >4-6 minutes it may cause irreversible brain damage
edema, and CT scan results
→ Anticonvulsants (phenytoin)
• Prevents seizure episodes → Petit-mal seizures/ blank or absent seizures
• Low dose anticonvulsants should only be used as • Blank facial expression
they may cause respiratory depression in children • Automatisms (repeated purposeless behaviors)
(at risk for ARDS) • Lip-smacking
→ Antacids o Occurs because it is proximal to the brain
• Indications: o Cranial nerves involved is the facial nerve
1. If increased ICP, ↑HCl production= (responsible for the movements of the face
hyperacidity and lips) that leads to spasms of the lips and
2. Steroids are used, to prevent GI ulcerations face
because steroids are GI irritants (mucosal • Small seizures that include few muscles
barriers are thin in infants) → Jacksonian
• Aluminum hydroxide (ALa poop, constipation) • One small group of muscles will start to seize then
• Magnesium hydroxide (MArami poop, diarrhea) progress to grand-mal
• Maalox or Mylanta is a combination of Al and Mg • Psychomotor
that are not usually given in IICP d/t FE imbalances • Seen in mental clouding and intoxication
o Take note that magnesium tends to o Seen in people who are near death
counteract calcium, if calcium is altered o Hallucinations, delusions, illusions may
because of potassium (inversely proportional) present
administering this combination drug will o Cognition and mental thinking is clouded d/t
further exacerbate fluctuation the intoxication of the brain
• Low doses are also used because drugs are → Febrile
computed according to body weight in kilograms • Most common in children
and age • AKA under five seizure
→ Anticoagulants o Hypothalamus is not well-developed to
• IICP, blood flow in the brain has increased regulate the temperature→ ↑temperature→
vascular resistance→ wounding of the blood seizures
vessels→ bleeding→ clotting→ thromboembolism o Characterized by the temperature of 38.5°C
• Prevents thromboembolism to 39-40°C
• Heparin (IV or SQ); short-term o Never place in cold baths, as it may cause
o Check PTT (partial thromboplastin time) rupture of the blood vessels and may suffer
• Warfarin (oral); long-term from hypothermia
o Check PT (prothrombin time) o A tepid sponge bath may be done
• People above age five may still experience febrile
seizures
Remember
o Persons who are predisposed to enormous
Opiates and sedatives are contraindicated in ↑ICP
These are both depressants, this will exacerbate the amounts of stress→ failure of the
bradypnea and bradycardia leading to respiratory and hypothalamus
cardiac depression o Superinfections
→ Status epilepticus (seizures that can last for 30
minutes)
SEIZURE DISORDER
• The most dangerous type of seizure
→ Alternating contraction and relaxation of the
• (+) Brain damage
muscles→ spasms
• Considered a medical emergency
→ AKA epilepsy
• Triggers: CN damage, underlying disease
condition, untreated and unmanaged seizures,
Types
meningitis
→ Grand-mal seizure (generalized seizure)
• To prevent brain damage in status epilepticus
• From head to toe (+) seizures
emergency drugs will be given hydantoins,
• Has two phases benzodiazepines
• Tonic (mild contraction)- clonic (severe
contraction)
o Period during the seizure Additional notes
o Manifested with dyspnea, salivation, urination
The type of seizure that is going to present is dependent on
o Position them flat or supine
the age and affectations, and comorbidities
o Never place in side-lying during as it may CN affectation- petit-mal
cause bad alignment of the spine and cervical General neurologic problems- grand-mal
fractures Pediatric- petit-mal
• Postictal- exhaustion phase (after the seizure) Meningitis- grand-mal or status epilepticus
o Position after the seizure: side-lying, lateral,
recovery position
 Diagnostics
All of the neurotransmitters are capable of causing seizures,
especially in wide-range imbalances Lumbar puncture (confirmatory test)
But nerves have larger factors in causing seizures → Inserted at L3, L4, or L5 to get a CSF sample
→ Position: C-shape, fetal, genupectoral (knee-chest)
Neurons normalize and compensate after seizures → Normal CSF: clear
• Cloudy- infection
Thrombosis in the brain may also cause seizures especially → This is done even if with increased ICP and can be
when it is located in the corona radiata (bundle of nerve
managed by:
fibers located in the brain), thalamic parts, and spinothalamic
tracts
• Positioning
• Decreased OFI
• Diuretics
Management
→ Seizure is mostly managed by drugs but can be CSF Analysis
managed by surgery also → Cloudy
→ Elevated WBC (triggered release d/t infection)
Hydantoins: Phenytoin → Elevated protein (byproduct of bacteria)
→ WOF: gingival hyperplasia • The combination of elevated WBC and protein
• Use soft-bristled toothbrush causes the CSF to be cloudy
• Meticulous oral care → Presence of causative agent (Neisseria Meningitides)
→ Pinkish red urine (normal)
• Explain/inform the significant other Signs and Symptoms
→ Kernig’s
Benzodiazepines (Anxiolytics) • Flex the knee = pain in the back, hamstring, neck
→ Act as an antidepressant → Brudzinski
→ Relaxation of the muscles, electrical impulses causing • Flex the batok/nape = pain in the neck and back
seizure to disappear
The difference between Kernig’s and Brudzinski is where the
→ -pam, -lam (Diazepam, Midazolam, Alprazolam)
pain is triggered (knee or nape)
→ If the seizure is caused by increased ICP with the
presence of the Cushing’s triad, this is → Nuchal rigidity (stiff neck) d/t nerve irritation
contraindicated. However, if the physician prescribed → Seizures
it after measuring the parameters, this may be given in → Opisthotonos (arching of the back) – late sign
low doses only • Position the client side-lying

Iminostilbenes: Carbamazepine Management

→ For refractory seizures (pabalik-balik) → Series of antibiotics (no specific antibiotic)
→ For maintenance purposes • Depending on the physician
• Depending on the patient’s status
Valproates: Valproic Acid • Depending on the involved causative agent
→ Last resort for pediatric clients • Penicillin, Ampicillin, Erythromycin, Clindamycin
→ Hepatotoxic → Finish the duration of antibiotic therapy to prevent drug
• Pediatric clients have immature liver resistance
→ Do not give to pregnant mothers especially in the first • The same drug cannot be used if the bacteria
trimester because it can cause neural tube defects become resistant
(e.g., hydrocephalus, myelomeningocele) • 10-14 days but can extend of there is
→ Avoid valproates if planning to conceive because it exacerbation or remission
causes stasis in the blood, which can still affect the
fetus when implantation occurs
Bacterial
• It is safe to conceive after taking valproates after Meningitis
Viral Meningitis
checking blood results for remnants of valproates
in the blood, especially for long-term use Both are isolated because both are
→ If all drugs render ineffective, this is given Isolation
communicable

Surgery Antibiotics Antiviral

Treatment
→ Neurectomy: surgical resection of the nerve/cranial
nerve involved in the seizure
→ This is done when all of the drugs are ineffective After recovery, Can recover without
→ The nursing responsibility depends on the cranial there are complications
nerve involved complications
→ Damaged
E.g., Sequelae
nerve
• Facial nerve- pain in the facial area → Movement
• Acoustic nerve- hearing and balance abnormalities
• Vagus- swallowing → Rigid muscles

BACTERIAL MENINGITIS Can be acquired if there

→ Infection of the meninges is myelomeningocele
• The meninges support and nourish the brain because the spinal cord
is exposed and there is a
→ Mode of transmission: direct contact
neural tube defect (direct
inoculation of bacteria)
HEAD TRAUMA ▪ >20ml: pericardial effusion
→ Common in children ▪ >50ml: cardiac tamponade (medical
→ Concussion: jarring of the brain caused by forceful emergency- cardiac arrest)
contact in a rigid skull→ loss of consciousness→ brain
damage (na-alog) Chambers of the Heart
→ Contusion: bruising, extravasation of blood cells
(nabukulan)

Management
→ Safety
• Wear bike helmets during activities/sports that
require it
• Seatbelts
• Safe driving
• Proper use of infant car seats
o <3 years old: rear-facing (for them to have
back support when there is a sudden break or
accident)
→ Right Atrium
o >3 years old: front-facing booster seat (the
→ Right Ventricle
spine is stable and can withstand sudden
→ Left Atrium
brakes or accidents)
→ Left Ventricle
→ Assess for cerebral functioning: GCS, PERRLA (Pupil
→ The flow of blood in the heart is 1 way (normal)
Equally Round and Reactive to Light and
• If 2 way = regurgitation
Accommodation)
→ Unoxygenated blood→ superior vena cava and inferior
• The prognostic indicator for head trauma is the
vena cava→ right atrium→ tricuspid valve→ right
level of consciousness
ventricle→ pulmonary valve→ pulmonary trunk→
• Difficult recovery if coma
pulmonary artery→ lungs for oxygenation→
• Uneven pupils (anisocoria)- brain damage
oxygenated blood→ pulmonary vein→ left atrium→
→ Assess for cervical injury
mitral valve or bicuspid valve→ left ventricle→ aortic
• Do not allow the child to sleep d/t possibility to
valve→ aorta→ different parts of the body system
progress to coma
→ One-way- normal
• (+) CI- immobilize to prevent further damage and
→ Two-way- regurgitation/ valvular problems
rush to the hospital
o Do not move the client
o Apply the splint according to the position in Artery Vein
which the px is found (wag mo na galawin
yung px) Oxygenated blood Unoxygenated
o Move the patient as a unit
From the heart To the heart
• (-) CI- HOBE (head of bed elevated) to decrease
ICP by the use of gravity (to decrease ICP by the Pressurized Non-pressurized
use of principle of gravity)
• If the patient is seen on the road, immobilize first Spurting blood when injured Oozing blood when injured
then move to a safe place

CARDIOVASCULAR DISORDERS Classification

→ Acyanotic: 1 problem only
Anatomy → Cyanotic “blue babies” (Evidence of ineffective tissue
perfusion): 2 or more problems
Layers of the Heart
→ Endocardium- innermost layer PATENT DUCTUS ARTERIOSUS (PDA) - Acyanotic
→ Myocardium- muscle layer; responsible for the heart’s → The ductus arteriosus did not close after delivery
contraction and cardiac output (amount of blood → The lifespan varies on how the size of patency and the
ejected by the heart per contraction) urgency of treatment
• If destroyed/ affected there is an insufficient beat
of the heart Signs and Symptoms
• One of the strongest muscles in the body (beats at → Machinery-like murmur (pathognomonic sign/ hallmark
the time you were born until death; continuous manifestation)- distinguishing characteristic
contraction) • Banggaan ng mag dugo in the ductus arteriosus
→ Pericardium- outermost layer • Ductus Arteriosus should close after cutting the
• Visceral Pericardium- inner umbilical cord
• Parietal Pericardium- outer o The pressure should close the ductus
• Pericardial Space- contains the pericardial fluid; arteriosus
between the visceral and parietal pericardium → Signs and symptoms of heart failure especially if not
• Pericardial Fluid managed
o Prevents friction rub, prevents the layers of → Poor feeding
the heart to rub together, prevents • Mode of feeding is sucking therefore they need an
inflammatory response in the heart (reduces enormous amount of oxygen but there is a mixing
friction) of blood resulting in insufficient oxygenation
o Normal pericardial fluid: <20ml
 • PDA has decrease in O2 → poor sucking → poor COARCTATION OF AORTA – Acyanotic
feeding → poor weight gain → Narrowing of the aorta (descending aorta)
→ Fatigue • Narrowing aorta → increase pressure → decrease
• Poor feeding d/t easy fatigability in output
• Easily fatigued during crying
→ Poor weight gain d/t poor feeding Signs and Symptoms
• Weight is the primary indicator of health in → Different vital signs in the upper extremities and lower
newborn extremities
• Ideal birth weight • The upper extremities are proximal to the heart
o 6 months: double birth weight which has increased pressure, while the lower
o 1-year-old: triple birth weight extremities (higher VS) are distal to the heart
→ Irritability d/t cerebral hypoxia where the output is decreased (lower VS)
Upper Lower
Management Extremities Extremities
→ Indomethacin- facilitate closure of PDA (DOC)
→ HOBE to promote lung expansion BP Increased Decreased
→ Surgery (bypass) is rare. Only if not managed by
medication Pulse Bounding Weak/Absent

→ Rib notching- the heartbeat can be seen in the rib

SEPTAL DEFECTS - Acyanotic cage area d/t the narrowed aorta which causes the
→ Atrial Septal Defect (ASD) heart to compensate by increasing its workload
→ Ventricular Septal Defect (VSD) • Mas malakas na rib notching, mas narrowed ang
→ The only difference is the area of affectation aorta
→ If the hole appears on upper/lower portion → Mixing of
blood can happen → d/t the abnormal hole, either Management
unoxygenated or oxygenated goes into the other side → Balloon angioplasty with coronary stenting
→ Only one occurs, either ASD or VSD • “Repair of aorta using balloon”
• Stent: scaffold/ support; made up of mesh
Signs and Symptoms (superfine screen)
→ Fatigue - d/t mixing of unoxygenated and oxygenated • Balloon angioplasty: repair of an artery using a
blood balloon
→ Failure to thrive (delayed milestones; Slow progress of • The balloon is deflated while inserting it to the
development) d/t poor feeding narrowed aorta together with the stent→ once in
→ Dyspnea on exertion (e.g., crying, feeding) place, the balloon is inflated to expand the stent
• There is increased demand for oxygen during and dilate the aorta→ once expanded, the
activities but if there is a mixing of blood, there is balloon is deflated for withdrawal while the stent
insufficient oxygen stays in place
• Leading to exercise/activity intolerance • The stent prevents the aorta from narrowing again
• If during breastfeeding: Brow sweats d/t too much because it acts as a support
exertion of effort o Has low probability for rejection; made of
→ Signs and symptoms of heart failure if left unmanaged synthetic plastic or wire
o Only replaced if damaged or dislodged
Management
→ Dacron patch- implantable consumables in cardiac
surgery
• Tissue: decreased rejection rate (commonly used)
o Normal microflora → less inflammatory
response → decreased rejection rate
o Obtained in other parts of the body with the
same tissue integrity (usually from the heart)
▪ A scintillation camera is inserted for
visualization with a fiber optic scope to
disintegrate/scrape the tissue to be used
o If the tissue is rejected, the surgery is
repeated until compatibility
• Plastic: increased rejection rate (a foreign body
that may cause inflammatory response)
o Only used when the tissue type is not effective → The activities are regulated depending on what the
or rejection occurs child can tolerate
• Immunosuppressant therapy is given to prevent → Before surgery: stable VS, no underlying conditions
rejection (the duration depends on the physician)
• If there is no rejection in the dacron patch, s/sx of TRANSPOSITION OF THE GREAT ARTERIES (TOGA)
septal defect should diminish after a few weeks → Cyanotic
• Indomethacin is not used because the abnormal → Mechanism: the right ventricle is connected to the
holes are larger aorta, the left ventricle is connected to the pulmonary
artery
 1. What is the primary problem?
• Pulmonary stenosis
2. What is the compensatory mechanism?
• Right ventricular hypertrophy
• RV has increased in workload to allow passage
through the narrowed pulmonary stenosis→
overworked→ hypertrophy
• Boot shaped heart will be seen in the 2D echo
3. What allows the mixing of blood?
• Overriding aorta
• An anatomical defect
• Normally the aorta should be connected to the end
of the LV, but in this case, it is connected to the
middle that is completely adjacent to the VSD
• UnO2ed blood from the RV→ shunts to the VSD
and mixes with O2ed blood in the LV
4. What keeps the patient alive?
→ PDA is kept open to allow the mixture of blood • Ventricular septal defect
• PDA keeps the patient alive • Somehow relieves the pressure in the right
→ Unoxygenated blood is deposited into the body ventricle, if VSD is closed, the heart (right vnetricle)
→ Detected with a low APGAR score and 2D echo may have the risk of rupturing

Signs and Symptoms Manifestations

→ Severe respiratory depression → Cyanosis (blue babies)
→ Cyanosis: A sign of ineffective tissue perfusion • Higher unO2ed blood than O2ed blood
→ Failure to thrive → Squatting
→ Easy fatigability • Two reasons
→ No murmur even if there is PDA d/t incomplete 1. Decreases venous return to the heart→ relax
pressure of the heart because of transposition of the the heart
two major blood vessels (no compression) 2. Conserves oxygenated blood in the upper
body area
Management ▪ Cutting the circulation in the lower
→ Prostaglandin E: maintains/keeps PDA open extremities → decreasing the return flow
→ Surgery: Arterial switch (the connection is corrected to of blood to the heart → giving sufficient
achieve the normal structure of the heart) time for the heart to relax
• Done during the first week of life (performed in a ▪ There will be difficult venous return from
live client) the lower extremities d/t hip flexion
o The child can only live with PDA for only a ▪ The O2ed blood should be concentrated
week or less in the upper body because the vital
• Predisposed to bleeding and shock organs are there– lungs, brain, and heart
• Difficult and risky surgery ❖ Conservation of O2 in the upper
extremities, sufficing blood to the vital
organs
• (+) cyanosis of the lower extremities
• Squatting is a compensatory mechanism
• Tripod position - sitting on a chair and leaning on a
table
• Squatting - knee chest position
• This is not done throughput the day; only when
there's difficulty of breathing
• In infants, position: Lying down with head slightly
elevated
o To promote lung expansion
→ Tet spells
→ Supportive management • Group of signs and symptoms that depicts lack of
• Oxygen therapy oxygenation
• Vitals signs monitoring • Pathognomonic sign/ hallmark manifestation of
• WOF signs and symptoms of heart failure TOF
• Notify the physician if difficulty of breathing occurs 1. Irritability
2. Pallor
TETRALOGY OF FALLOT (cyanotic type) 3. Blackouts (fainting spells)
4. Convulsions (d/t lack O2 in the brain)→
Problems (PROV) cerebral hypoxia
→ Pulmonary stenosis → Cardiomegaly d/t overworking
→ Right ventricular hypertrophy → Clubbing
→ Overriding aorta • One of the main symptoms
→ Ventricular septal defect • Spoon-shaped fingernails d/t compensation of
capillaries (enlargement)
• Represents chronic hypoxia
Common four questions asked in the boards
 • Also seen in IDA d/t lack of iron → RBC have no age. But if the child is already stabilized even without the BT
enough O2 → hypoxia shunt, intracardiac surgery may be done
→ Pansystolic murmur
If BT shunt is done first, then intracardiac surgery follows,
• Every contraction of the heart (+) murmur the shunt (subclavian artery) will not be removed
because of numerous holes in the heart (VSD)
The age of curative surgery will be dependent on when the
Diagnostics child stabilizes
→ 2D echo- boot-shaped heart will be
seen Vital signs, FE balances, and all other aspects should be
balanced first before surgery can ensue
Nursing care:
→ Allow the child to squat RHEUMATIC HEART FEVER
• It is a form of compensation of → An infectious heart disease
the child → Caused by GABHS (group-A beta-hemolytic
streptococcus)
Medical Management • Causes sore throat and AGN (acute
→ Surgery glomerulonephritis)
1. Palliative surgery (Blalock-Tausig shunt)
• Relieve signs and symptoms Criteria for RHF: Jone’s criteria
• The goal is to increase oxygenated blood than → There should be two major symptoms + history of
oxygenated blood GABHS or 1 major symptom + 2 minor symptoms +
• Anastomosis of the pulmonary artery and the history of GABHS
aorta using the subclavian artery
o The subclavian is part of the aorta, it will not
Major Symptoms Minor Symptoms
be harvested it will only be rerouted and
connected Carditis Low-grade fever
• Blood that passes through the VSD may be
allowed to pass through the aorta→ subclavian Inflammation of the walls of
artery connected to the aorta→ lungs the heart d/t the presence of
a bacteria

Polyarthritis Arthralgia without swelling

Inflammation of various joints Joint pain, if it swells, then it

becomes a major symptom

Chorea ASO titer

St. Vitus dance/ worm-like Antistreptolysin- O titer

movements – especially
seen on fingers GABHS specific only
increases when (+) infection
Involuntary, irregular, of streptococcus
unpredictable muscle
movements Only minor because still
increases in AGN and sore
throat, not only specific to
2. Curative surgery (Intracardiac surgery/ Brock’s
RHF
procedure)
• Treats the disease condition Subcutaneous nodules C-reactive protein
• Involves two surgeries:
o Balloon angioplasty (to widen the pulmonary Usually seen in bony A protein released during an
stenosis) prominences because it has inflammatory response
▪ This will also resolve the RVH d/t few SQ tissue (knees,
↓workload elbows, nodules) An inflammatory marker,
▪ VSD will no longer be needed to relieve even in ordinary
inflammation, is not specific
the pressure
to RHF. Therefore, it is
o Insertion of Dacron patch (closing of the VSD) considered a minor symptom
▪ This will also resolve the overriding aorta
(wala nang katapat na butas na VSD) Erythema marginatum Erythrocyte sedimentation
rate (ESR)
Rashes of the trunk
There is no pharmacologic treatment for TOF, the only
Also released during an
management aside from surgery is to increase the
inflammatory response
oxygenation
An inflammatory marker,
Let the child regulate activities of their own
even in ordinary
inflammation, is not specific
to RHF
For infants, surgery is not done yet for TOF because they are
not stable yet, surgery will be done at toddlerhood or school
Management
side of the heart is → Fluid located inside the
→ DOC: penicillin increased → backflow in lungs are heard
• A broad-spectrum antibiotic that can kill both the jugular vein → → Gurgling sounds
gram-negative and gram-positive bacteria bulging
• Given 5-10 days and duration should be finished,
this is to completely eradicate the streptococcus Hepatomegaly (the liver is Cough reflex
(penicillins are highly effective in streptococcus) proximal to the heart and the → Fluids in the lungs will
• Administered via IV liver is sensitive to changes trigger the cough reflex
in oxygenation)
• If (+) allergy to penicillin, erythromycin, or
→ ↑pressure in the liver→
clindamycin may be given portal HTN→
• If (+) exacerbation and remission (manifestations destruction of the liver
become more severe), treatment is continued for
about 10 years (the physician schedules when the Ascites Tachycardia
antibiotic will be taken within the 10 years), the → Fluid accumulation in → In the early stages, in
only continuous is the monitoring the abdominal area d/t an attempt to
→ Salicylates (ASA- acetylsalicylic acid) fluid retention and portal compensate for the lung
HTN failure and decrease of
• Aspirin
oxygenation
• Four As of aspirin Body weakness → But in the long term,
o Antiplatelet aggregate bradycardia will occur
o Antipyretic Anorexia d/t fatigue and will stop
o Analgesic
o Anti-inflammatory → Nausea d/t bloating→
• Given for pain and swelling ↓appetite to eat that
• Side Effect results to anorexia and
o WOF: s/sx of bleeding body weakness
→ Corticosteroids
• To relieve carditis (inflammation) Diagnostics
→ Chest x-ray- (+) cardiomegaly d/t overworking
HEART FAILURE → 2D echo- hypokinetic heart (slow contraction of the
→ A condition where the heart fails to contract to pump heart that will present in the latter stages)
blood out of the heart → Pulse oximetry- decreased O2 saturation d/t decrease
→ Insufficient ↓CO to oxygenate the different organs in tissue perfusion
→ Has two types: RSHF (right-sided) and LSHF (left- → PCWP (pulmonary capillary wedge pressure)
sided) • Measures the pressure in the left side of the heart
• RSHF- manifestations is systemic • Determines LSHF
• LSHF- manifestations are pulmonary → CVP (central venous pressure)
→ Concept of backflow: • Connected to the RA, therefore, measures
• Damaged left ventricle → blood goes back to the pressure in the right side of the heart
left atrium → lungs → lung manifestations (LSHF) • Determines RSHF
• Damaged right ventricle → right atrium → goes
back to system → systemic manifestations (RSHF) Management (FAILURE)
→ Both can have edema → F- fowler’s position
• To allow maximizing lung expansion that will
Right-Sided Heart Failure Left-Sided Heart Failure enhance circulation and oxygenation
→ A- administer high O2
Symptoms are systemic in Symptoms are pulmonary in • Using venturi mask that delivers precise and
nature nature accurate oxygen delivery
→ I- inotropic drugs
Peripheral edema/ Dyspnea on exertion • Strengthens the heart’s contraction to increase
dependent/ pitting edema (+)
the cardiac output
indentation → Difficulty of breathing
especially during activity
→ L-Lanoxin or digoxin
→ D/t fluid retention, blood
is not circulating well→ Digoxin toxicity
fluids are also not N- nausea
properly circulated→ A- anorexia
extravasation→ edema V- visual disturbances (halos) and vomiting
D- diarrhea
Weight gain d/t fluid Orthopnea A- abdominal cramps
retention
→ Difficulty of breathing If one or two appear, stop administration, and digibind
especially in a lying (digoxin immune fab) will be given as an antidote to digoxin
position→ when lying toxicity
down, lung expansion is
not maximal
→ Should be placed on a → U- urine output and intake monitoring
semi-fowler’s position • D/t fluid retention
→ R- record daily weight
Distended neck veins (JVD) Crackles or rales d/t fluid • To determine if edema worsens
→ The pressure in the right retention
• Same time, clothes, weighing scale, and patient
 • Done early in the morning • Large-brimmed hats
→ E- edminister diuretics (LOL PINILIT) • Sun visors
• To decrease retained excess fluids in the body → Polymorphous rash
• To relieve pulmonary edema • Rashes of different shapes
• This is d/t inflamed vessels that can rupture and
Management for Heart Failure: LISENSYA
extravasate in the skin
→ Lanoxin/digoxin (maximize cardiac output) → Palmar desquamation
→ Inotropic drug • Only localized in the palms
→ Set at bedside: digibind/digoxin immune fab • Shedding of skin on the palms
→ Elevate head of the bed to maximize lung expansion • The blood vessels in the hands are small,
(semi-fowler's position) inflammation will decrease circulation in the hands
→ Note I and O causing the death of cells in the hand leading to
→ Same time, clothes, weighing scale, patient (weight shedding
monitoring)
→ Yes to venturi mask (accurate oxygen delivery) Diagnostics
→ Administer high O2 → Elevated ESR
• This is always elevated when there is inflammation
(multisystemic vasculitis)
KAWASAKI DISEASE
→ Very common in children especially in the newborn
Management
→ Involves two disease conditions:
→ Immunoglobulins to enhance and activate the immune
• Mucocutaneous lymph node syndrome- response
affectation of the immune system
• Children with Kawasaki disease have weak
• Multisystemic vasculitis- inflammation of the blood immune systems
vessels specifically affecting the cardiovascular
→ Aspirin
system
• Low dose only
• To address high spiking fever, inflammation, and
Manifestations
serves as an analgesic
→ High spiking fever d/t affectation of the lymph nodes
→ Clear liquid diet
that alters the immune system (erratic)
• To allow monitoring bleeding in the stools
• A sharp increase in temperature
• Avoid dark-colored foods
• The hypothalamus is having difficulties in
• Clear liquids do not contain milk and are
regulating the temperature
determined according to opacity to light
→ Strawberry red tongue (pathognomonic sign)
o If light passes through it, it is considered a
• D/t multisystemic vasculitis
clear liquid
• The tongue is rich in blood vessels
→ CPR
• Children tend to develop coronary artery
diseases→ at risk for cardiac arrest

GASTROINTESTINAL DISORDERS
→ Cephalocaudal (mouth to anus)

CLEFT LIP AND CLEFT PALATE

→ Photophobia/ photosensitivity
→ They have the same manifestations
• The retina is composed of the minute blood
→ Both are congenital
vessels
• Dark-colored glasses are advised to be worn
CLEFT LIP CLEFT PALATE

MANIFESTATION
Tuwid magsalita

→ aka Ngongo
→ Has speech problems
→ If palate is open → tongue cannot articulate well
(walang tinatamaan yung tongue sa ibabaw na
portion ng bibig)
→ It can also manifest when cleft lip + cleft palate
happens

Deformity/Alteration in appearance
PROBLEM
 Heredity: Transferred genetically; balanced translocation of genes
CAUSE

Maternal smoking → CO2 will go up with the hemoglobin receptor sites → normally hemoglobin carries O2
PROBLEM IN (O2 are nutrients for the fetus) → if CO2 binds to the receptors, it would yield carboxyhemoglobin → O2
PREGNANCY cannot bind anymore → lesser oxygen → lesser development of the baby → deformities in the lip and/or
palate

COMMON ON Males/Lalaki (Lip) Females/Pemales (Palate)

GENDER GROUP

→ Difficulty of Feeding
→ Risk for Aspiration
PROBLEM → Risk for Infection
• URTI (Upper Respiratory Tract Infection) → risk for aspiration → food aspirated in the lung
structure → inflammatory response activated → infection sets in

Should have a lot of patience

Don’t laugh at them (it would decrease their self-esteem)

Provide with large nipples (synthetic nipples) Training cup (made up of rubber) or medicine
→ The larger the nipple the easier/stronger they can dropper
suction → More precise and therefore delivers accurate
→ If small nipple, milk will spill from the mouth fluid flow
→ Cross cut nipples depends on the strength of → Less likely for the baby to be aspirated
NURSING
RESPONSIBILITIES
suction of the infant, also matters with age → If cup and medicine dropper both appears in
the choices, look for the age:
• 3 months or <1 yr old → use medicine
dropper
• >1 year old - cup → because it is more
sufficient to the baby’s needs

→ If not severe, pacifier can be used

• Make sure there is no fluid retention in the mouth because this might put the child at risk for aspiration

Cheiloplasty Palatoplasty
→ Rule of 10 - should be accomplished to undergo Surgical repair of the cleft palate
Cheiloplasty → Rule:
• 10 weeks • Not too early → if early → surgical site might
• 10 lbs reopen d.t growth of the baby
• 10k WBC • Not too late → speech problems had already
SURGERY
• 10g/dL Hgb occurred
• 18-24 months → before 2 years old
because the child is starting to learn to
speak; hence, if the surgery is done within
this period, speech problems will be
prevented.

→ Turn to unaffected side → Side-lying (<2 yrs old)

→ Prone position (>2 yrs old)
POST-OP
• To drain secretions and bleeding out of the
POSITIONING
mouth
→ Frequent swallowing → sign of bleeding

GASTROESOPHAGEAL REFLUX DISEASE (GERD)/CHALASIA

→ If the sphincter is incompetent, backflow of food
happens including hydrochloric acid → esophageal
lining will be damaged → chest pains → because LES
is located near the chest
→ Signs and Symptoms:
• Forceful vomiting
o Pressurized vomiting
o Sphincter has no function → backflow is
pressurized
• Heartburn (chest pain)
o d/t hydrochloric acid reflux
• Bitter taste in the mouth
o HCL acid has bitter taste
→ Problem: Incompetent LES (lower esophageal • Dysphagia (difficulty of swallowing)
sphinter/cardiac sphinter) o Occurs hand in hand with odynophagia →
• Responsible for entry of food from esophagus to because of pain, the child will have difficulty
stomach with swallowing
 • Odynophagia (painful swallowing) PYLORIC STENOSIS
o Reflux → HCL acid damages lining → painful
swallowing → d/t pain → difficulty swallowing
• Hoarseness of voice
o d/t laryngeal damage/affection
o “Hindi gagana ang chalasia kung walang
hoarse” O.O
→ Diagnostics - Barium Swallow
• Barium stays within 2 days only
o >2 days → harden → obstruction
o Primary responsible of nurse: Excrete barium
▪ Increase OFI
❖ Assess DHN based on appearance of
the patient and lab results → Narrowing of the pyloric sphincter
▪ Laxatives as ordered (with proper • Food cannot pass → stomach distention → olive
assessment by the physician) shaped mass (distinguishing characteristic)
→ Management: • Possible regurgitation
• Diet: low fat, high fiber • Pyloric sphincter: responsible for gastric emptying
o Fats are hard to digest → stimulate vomiting → Congenital defect
reflux/regurgitation of the infant → Signs and symptoms:
o Fiber enhances digestion • Regurgitation → possibility of laryngeal damage →
o Manggang hilaw → aggravates acid could also cause dysphagia and odynophagia
▪ But does not cause GERD or hyperacidity • Projectile vomiting
▪ Only a risk factor o Vomiting with gastric contents w/o bile
• SFF: Small frequent feedings ▪ Bile is seen in the intestines
o If large frequent feeding → abdominal ❖ If bile is seen in vomitus, it indicates
distention → contraction → reverse peristalsis an intestinal obstruction
→ vomiting ▪ If vomiting is prolonged, bile can be seen
• Avoid: GI irritants ▪ No bile d/t narrowed sphincter
o Especially in adolescents ▪ Metabolic alkalosis
▪ Spicy foods • No anorexia, with good appetite but with vomiting
▪ Tobacco • Weight loss
▪ Caffeine • Upper abdominal distention: Olive shaped mass
▪ Alcohol (excessive) • Malnutrition and dehydration
▪ Apple and bananas → hardest to digest o Malnutrition: d/t the child cannot eat well
• Medications: o DHN: d/t vomiting
o Antacids → Diagnostic: Barium swallow
o H2 Blockers “tidine” → Management:
▪ Cimetidine, Ranitidine • Monitor feeding pattern
→ Proton Pump Inhibitors (PPI) “zole” • Assess vomitus
• Omeprazole, pantoprazole o To check if w/ or w/o bile (greenish-yellowish)
→ HOBE: 6-8 inches during sleeping ▪ If w/ bile - intestinal obstruction
• To prevent food regurgitation • Increase OFI
o To enhance digestion
• Prevent aspiration
Additional Notes:
o Feeding slowly
Adult GERD
▪ If feeding is too fast → rapid distention →
→ Adults tend to consume excessive alcohol d/t peer
contraction → vomiting
pressure
• Burp frequently
→ Stress as a risk factor for GERD is more common to
o To prevent gas formation
occur in adults
▪ (+) stenosis → gas cannot exit the body
• Stress occurs in pediatric clients d/t
→ encourage burping
malnourishment or abuse
o Stimulate burping by positioning or tapping
→ Surgery: the back
• Nissen fundoplication
• High-Fowler’s Position
• Fredet Ramstedt/Pyloromyotomy o Prevent vomiting
→ Diagnostics: Esophageal manometry • Diet: any food that causes digestion
o Avoid gas forming foods → causes abdominal
digestion and colic
• Surgery: Pyloromyotomy
o Cutting the muscle layer of the pyloric
sphincter
o Incision that splits the obstruction
▪ Open → food can pass through (the child
can now eat 🎶 epples and benenes 🎶)
 → Diagnostics:
• Bowel Biopsy: obtaining the actual tissue
o Findings: Flat mucosal surface with
hyperplastic villous atrophy
▪ If a tissue/villi atrophies (not
developed/dysfunctional) → doesn’t carry
out its ability to absorb gluten
(malabsorption of gluten)
o Confirmatory test
• Elevated IgA and IgG
o Congenital disease → autoimmune
complication → elevation for IgA and IgG
→ Management:
• Avoid foods with gluten, such as: (BROW)
o Barley
o Rye
o Oats
o Wheat
o (X) commercially prepared cakes and breads
CELIAC DISEASE/CELIAC SPRUE/GLUTEN SENSITIVE • Allowed foods, such as:
ENTEROPATHY o Meat
o Eggs
o Milk products (milk, cheese, cream)
o All fruits and vegetables (🎶 apples and
bananas🎶)
o Rice, Corn, Cornflakes

Additional Notes: Lactose intolerant

→ AVOID: milk, eggs and milk products

• In a birthday party, bring own cake (gluten-free)

o Children anticipates cake but these are
commercially prepared which contains gluten
:<
• Gluten-free diet FOR LIFE
• Allow the child to vomit and have diarrhea
→ Problem: Malabsorption of gluten o To excrete the gluten (compensation)
• Intake of gluten → Body cannot process gluten → o (x) antidiarrheals, antiemetics
body will compensate → gluten will be forced to o If signs and symptoms became severe,
exit the body antidiarrheals may be given
→ Irreversible/Incurable but easily manageable o Supportive fluids during vomiting episodes:
→ Congenital ▪ Check electrolytes first before giving
• Elevated IgA and IgG drinks such as gatorade / pocari sweat
→ Signs and symptoms: it occurs once the child has ▪ Some electrolytes may be retained → inc
eaten gluten-containing food/s of electrolytes → imbalance
• Acute diarrhea ▪ (❌) erceflora (✅) pedialyte
o Characteristics: Steatorrhea → fats are not ▪ ORS → for electrolyte imbalance
emulsified → lipase did not perform its
function HIRSCHSPRUNG'S DISEASE
▪ FFF (foul fatty feces)
• Anorexia
• Vomiting
o As compensatory mechanism to excrete
gluten
• Severe abdominal distention
o Body cannot process gluten → gas formation
→ abdominal distention
• Body wasting (pumapayat)
o AKA Cachexia/johnis octubris 💀
o Gluten is needed → to develop muscles
• Retarded growth
o AKA archieris alvized
o Gluten is needed for muscle building → → Megacolon / Aganglionic / Ribbon-like Stools
malabsorption of gluten → slows growth and → AKA Congenital Aganglionic Megacolon
development → Cause: Absence of ganglion → the affected part of the
• Failure to thrive intestine has no peristalsis → accumulation of feces →
o Delayed development intestinal distention → megacolon → forceful
o AKA ejnis flaminianonosis
 contraction happens d/t stretch → feces has no shape • Descending
(pellet-like stool) o Proximal to the anus
• Ganglions - cells/nerves responsible for peristalsis o Solid in nature
→ Problem: Failure to pass meconium for the first 24-48 o With odor
hours o Needs irrigation: NSS (depending on the
• Imperforated anus or hirschsprung disease electrolyte levels, other solutions may also be
→ Diagnostics: used; hypotonic, hypertonic)
• Barium enema o Continuous appliance of the bag:
o Findings: megacolon ▪ YES, because pediatric clients has no
• Rectal biopsy control in bowel
o Findings: absence of ganglionic cells ▪ For adults, not necessary, because the
o Confirmatory test patient has control and therefore can put
→ Pathognomonic Sign: Meconium/Stool - Ribbon like the bag when they feel the urge to move
stool bowels
→ Management: → Assess the Characteristics of the Stoma:
• Surgery: Swenson Pullthrough with temporary • Color:
Colostomy o Normal: pinkish
o Brick red/cyanotic
▪ Notify the physician!
▪ d/t lack of circulation → gangrene
formation → infection
• Moist:
o Normal: Moist
o If dry: the child is dehydrated (insensible water
loss)
▪ Notify the physician!
• Elevated/Protruded
o Normal: slightly protruded
o If depressed, the ostomy not healing
▪ Notify the physician!
→ Avoid foods that can obstruct the stoma:
• Gas forming foods (cabbage, sweet potato)
• Seeds
→ Foods to allow: SPYB
• Spinach
• Parsley
• Yogurt
• Broccoli
→ 🏊 The client can swim
• It is the only non-contact sport that develops the
abdominal muscles
o End to end anastomosis → aganglionic part is o Developing abdominal muscles → faster
only removed and the remaining parts are healing
reconnected (cut cut reconnect) • The bag will not leak, as long as it is properly
o With temporary colostomy to facilitate the placed and sealed
recovery of the stoma → Stool softeners
o Inflammatory response is activated when both • To prevent obstruction
sides of the aganglionic colon is cut → if both
are connected immediately while it is INTUSSUSCEPTION
inflammed → there will be gangrene formation
→ no wound healing / recovery → one side is
connected to the stoma → the other is still in
the abdominal cavity → (X) inflammation in 1-
3 months maximum of 6 months recovery →
that is the time to reconnect → normal
pooping activity
→ Colostomy care:
• Habang lumalapit sa pwet bumabaho/tumitigas
ang poop
• Ascending
o Stool is liquid in nature without odor (kasi
malayo sa pwet)
o Irrigation (NSS) is not needed because stool is
liquid → less likely for obstruction/s to happen → Telescoping of the colon → obstruction → intestinal
o Continuous appliance of the bag: distention → sausage-shaped mass
▪ YES, since the stool is liquid, there is → Could be congenital and or acquired later on
continuous flow of stool → Location affected: Descending colon
• Transverse → Signs and Symptoms:
o Stool is mushy in nature with slight odor • Colicky pain
 o Gas-formed pain Manifestations
o Kabag → Barking seal-like cough (pathognomonic sign)
• Pathognomonic/Hallmark Sign: Sausage-shaped → Inspiratory stridor (constriction of the upper airways)-
mass and Currant Jelly-like Stool (bloody mucoid passage of air through narrowed airways
stool) → Dyspnea
• Bile-stained fecal emesis → Cyanosis d/t ineffective tissue perfusion
o Vomit with stool and bile d/t intestinal → Low grade or no fever
obstruction (pressurized) • The virus causes low-grade fever
• Dance Sign: d/t obstruction → there would be → WOF: drooling/grunting
rhythmic contractions or increase peristalsis in the • If (+) drooling/grunting this may indicate
proximal area → high pitched bowel sounds respiratory distress syndrome/epiglottis/
→ Diagnostics: bronchospasms (an emergency situation) if not
• Barium Enema addressed this will lead to total closure of the
o Introduction of barium → area of obstruction airways
→ determines sausage-shaped mass
• Guaiac’s test Management
o Test for occult blood → Increase humidity in the room
▪ Hidden blood in the stool • Through the use of cool mist (mixed with the
o Considerations: humidifier) for easier respiration
▪ 24 - 48 hours before the procedure, dark- → Inhale cool night air and warm bathroom air
colored foods and vitamin c should not be • Cool night air can bring comfort to breathing
taken • Warm bathroom air will cause bronchodilation and
▪ Avoid dark colored food: will open the airways
❖ Dark colored food → Black tarry stool → Tracheostomy set should always be at the bedside
→ masks the bleeding → blue ring • Anytime the airways may close, the only
will not be identified → false (+) result management to address the child is to create a
▪ Avoid vitamin C rich food: tracheostomy
❖ Normal: Hydrogen peroxide is used in • Time is of the essence!
guaiac test → formation of blue ring
→ indicative of bleeding Medical Management
❖ Vit. C oxidizes the hydrogen peroxide → Antibiotics and antivirals
→ blue ring will not form → bleeding • Antibiotics are given for prophylaxis and
will not be identified → false (-) result complications caused by croup (susceptible for
→ Nursing Care/Management: infections)
• Auscultate bowel sounds • E.g., aspiration- pneumonia
o High pitched bowel sounds d/t increased • Antivirals: -vir
peristalsis → Bronchodilators
• Assess for abdominal distention • To dilate the bronchioles (open the airway) to
o Presence of gas formation → abdominal enhance oxygenation
distention • Side effect: tachycardia
• NGT insertion: functions are: FID Me o Never give with caffeine-containing products
o Feeding (cause dysrhythmias)
o Irrigation
o Decompression - used as management for CYSTIC FIBROSIS
intussusception
o Medications
• Increase OFI
o Minimize obstruction
o Hasten digestion
→ Surgery: Swenson pull through

RESPIRATORY DISORDERS

CROUP (LARYNGOTRACHEOBRONCHITIS)
→ Narrowing of the areas d/t viral inflammation; self-
limiting
→ Priority: airway
→ Blockage of the exocrine glands d/t mucus
obstruction
→ Organs affected:
• Lungs, pancreas, intestines, and sweat glands
• When the organs are wrapped with mucus, it loses
their functions

Manifestations
→ Dyspnea/ DOB
→ Pancreatitis (which makes cystic fibrosis deadly;
Pancreas is covered with mucus → pancreatic
leakage → pancreatitis)
→ Meconium ileus- meconium is retained in the ileum • Common allergens:
and has not moved d/t decreased peristalsis d/t o Pollen
blocking o Molds
• Ileum is covered with mucus → no peristalsis → o Dust
feces accumulate in the ileum → meconium o Weeds (seaweeds - rich in iodine e.g., iodized
remains in the ileum salt)
→ Increase salty sweat d/t clogged sweat glands ▪ Iodine is a common allergen
• Cystic fibrosis is the only condition that can cause o Pet danders - pet fur
this o Eggs - has albumin
▪ Albumin is a common allergen
Diagnostics o Seafoods
→ Sweat chloride test- ↑chloride levels in the sweat → Factors that causes exacerbation of asthma:
• Sweat naturally has sodium and it comes out with • Air pollutants
sweat, with the addition and increase of chloride in • Cold heat weather changes
the sweat→ Na+Cl→ salty sweat • Strong odors (perfume, smoke)
• White crystals in sweat: normal sodium • Extreme emotions
• Sweat glands → semi porous membranes → → Signs and Symptoms
selectively permeable → clogged → excretes, • Wheezes: expiratory
which it doesn’t normally do o During an asthmatic attack → if there’s
absence/decrease of wheezing (A DANGER
Management SIGN!) → represents complete obstruction of
→ CPT (chest physiotherapy) to address dyspnea the airway → Status Asthmaticus
• Percussion, vibration, postural drainage ▪ During emergency: Administer
• Done to loosen the retained secretions in the bronchodilators, corticosteroids,
lungs epinephrine, opening of airway
• Postural drainage uses gravity to expectorate (tracheostomy)
mucus (head is lower than the extremities) → Management:
• Done before meals, on an empty stomach to • Bronchodilators
prevent vomiting or 2 hours after meals (food is • Corticosteroids
already in the intestines) o For inflammatory responses
o Combi Drugs are now used (Bronchodilators
Medical Management + Corticosteroids)
→ Pancreatic enzymes • O2 therapy
• For digestion, because the pancreas is blocked → Avoid Allergens (best way to prevent asthma)
• Given with meals, never give it without meals as it
may cause autodigestion of the pancreas and
ulcerations
• Never double the dosage as it can also lead to
autodigestion
• Pancreatic Enzymes:
o Amylase - digests CHO
o Lipase - digests fats
o Trypsin - digests proteins (CHON)

ASTHMA

→ Most common childhood illness

→ Reversible (if no allergens, no asthma)
→ Can be inherited
→ Hika
→ Cause: Allergens - substances that causes allergic
reactions
• Presence of allergens → hyper responsiveness
(severe allergic reaction) → bronchospasms
(dangerous - might cause complete closure of
airway)
 NORMAL PEDIA
→ Growth and development theories
→ The age of the child is important to determine milestones

Erikson Freud Piaget Kohlberg

Age
(Psychosocial) (Psychosexual) (Cognitive stages of development) (Moral development)

Infant (0-18 Trust vs. mistrust Oral stage, the center Sensorimotor
months/ 0-12 So long as you give of gratification is the
months) the needs: food, mouth Learning through the sense
warmth, care trust
will be developed Breastfeeding, Toys given should be toys that would
teethers, pacifiers stimulate the senses (mobile toys,
lighting toys)
(+) risk for aspiration
because everything is
put in the mouth

Fear: stranger anxiety, those who are unfamiliar to them will stimulate fear

Play: solitary play (plays alone) since they are still in the sensorimotor stage, they learn still through the senses

Toddler (18 Autonomy vs. shame Anal stage, the center Preoperational Preconventional
months- 3 and doubt of gratification is the
years old) anus Egocentric, inability to understand the Punishment and
Offer the child point of view of others obedience
choices Most important is the
toilet training Best punishment and
obedience: timeout
Criteria for (remove all stimuli from
readiness for toilet the child)
training:
1. Can sit and squat Place the child in a non-
2. Ability to remain stimulating environment
dry for about 2 hours (face the wall)
3. Ability to verbalize
the need to defecate Rule: should be timed (1
and urinate minute per year of age)
4. Show willingness e.g., The child is 3 y.o.,
to please parents face the wall for 3
5. They want to minutes
immediately change
their soiled diapers

Fear: separation anxiety, they do not want to be separated from their guardians or parents

Play: parallel play (side-by-side play), two kids play side by side but does not play with one another, no sharing or interaction this will
cause fights because both of them are autonomous

Preschooler Initiative vs. guilt Phallic stage→ Preoperational (Highest imagination, Preconventional
(3-6 years complexes can understand symbols/
old): symbolizations) Still egocentric
1. Oedipal- the baby E.g., leaves are imagined as money
boy is close to the
mother
2. Elektra- the baby
first is close to the
father

Loves the opposite-

sex parent, but hates
the same-sex parent

Fear: body mutilation (scared of being injured or wounded)

Play: associative/ cooperative play (plays of children are related with one another) E.g., role-playing, make-believe plays

School-age Industry vs. inferiority Latent stage (same- Concrete operational Conventional (believes
(6-12 years sex orientation- in authority)
old) boys vs girls, no Understand the theory of conservation
mixing of sexes) and reversibility

Conservation- being able to conserve

means knowing that a quantity doesn't
change if it's been altered (by being
 stretched, cut, elongated, spread out,
shrunk, poured, etc.)

Reversibility- reverses a sequence of

events or restores a changed state of
affairs to the original condition. It is
exemplified by the ability to realize that
a glass of milk poured into a bottle can
be poured back into the glass and
remain unchanged

Fear: death, they know that death is irreversible and it is final

Play: competitive play (more on indoors- board games, a little on sports)

Adolescent Identity vs. role Genital stage (sexual Formal operational Post conventional
(12-18 years confusion curiosity)
old) Already hypothetical, can rationalize Already knows morals,
Body image is Unwanted, laws, and is already
important at this unexpected responsible
stage pregnancies usually
occur here Knows what is good and
what is bad

Fear: rejection, that is why body image is the focus, peer pressure usually occurs here (nakikisama)

Play: interactive/ competitive (more on outdoors- sports)