Professional Documents
Culture Documents
- play syringe or stet, security blanket – favorite article. Let baby hold it.
4. Explain procedure and respect their modesty - school age and adolescent
V/S:
Imperforate anus
Earliest sign:
1. no mecomium
2. abd destention
Mgt:
Surgery with temporary colostomy
TA – tronchus arteriosus
Causes:
1. familial
2. exposure to rubella – 1st month
3. failure of strucute to progress
acyanotic L to R
cyanotic R – L
S&Sx 1. systolic murmurs at lower border of sternum and no other significant sign
Nsg Care:
( dorsalis pedis)
Mgt.
1. long term antibiotic – to prevent subacute bacterial endocarditis
2. open heart surgery-
S&SX
3.) endocardial cushion defects - atrium ventricular (AV) - affects both tricuspid and mitral valve
S&Sx
murmurs
Drug:
cardiac catheterization-
1. balloon stenostomy
2. surgery
Duplication of Aortic Arch- doubling of arch of aorta causing compression to trachea and esophagus
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Outstanding Sx:
3. ECG – cardiomegaly
venous return – pulmo vein instead of entering Lt atrium, enters Rt atrium or SVC
3.) Truncus Arteriousus- aorta & pulmo artery is arising fr 1 single vessel or common trunk with VSD
S & Sx 1. cyanosis
1. cynosis
cynosis, polycythemia
P – pulmonary stenosis
V – ventricular SD
R – Rt ventricular hypertrophy
S &Sx:
1. Rt ventricular hypertrophy
2. high degree of cyanosis
3. polycythemia
4. severe dyspnea – squatting position – relief , inhibit venous return facilitate lung expansion.
5. growth retardation – due no O2
6. tet spell or blue spells- short episodes of hypoxia
7. syncope
8. clubbing of fingernails – due to chronic tissue hypoxia
9. mental retardation – due decreased O2 in brain
10. boot shaped heart – x-ray
Mgt:
1. O2
2. no valsalva maneuver , fiber diet laxative
3. morphine – hypoxia
4. propranolol – decrease heart spasms
5. palliative repair –
Aschoff – rounded nodules with nucleated cells and fibroblasts – stays and occludes mitral valve.
Jones Criteria
Major Minor
o titer (ASO)
Criteria:Presence of 2 major, or 1 major and 2 minor + history of sore throat will confirm the dx.
Nsg Care:
1. CBR
2. throat swab – culture and sensitivity
3. antibiotic mgt – to prevent recurrence
4. aspirin – anti-inflammatory. Low grade fever – don’t give aspirin.
S/E of aspirin:
• Reyes syndrome – encephalopathy- fatty infiltration of organs such as liver and brain
Respiration
Newborn resp – 30-60 cpm, irregular abd or diaphramatic with short period of apnea without cyanosis.
Resp Check
Newborn – 40 – 90
1 yr - 20 – 40
2-3yr 20 – 30
5 yrs 20 – 25
10 yrs 17 – 22
1.) VESICULAR – soft, low pitched, heard over periphery of lungs, inspiration longer then expiration
-Normal
2.) BRONCHOVESICULAR- soft, medium pitched, heard over major bronchi, inspiration equals exp.
Normal
3.) BRONCHIAL SOUNDS- loud high pitched, heard over trachea, expiration longer than inspiration.
Normal
4.) RHONCHI – snoring sound made by air moving through mucus in bronchi. Normal
5.) RALES-or crackles – like cellophane – made by air moving through fluid in alveoli.
6.) WHEEZING- whistling on expiration made by air being pushed through narrowed bronchi .Abnormal –
asthma, foreign body obstruction
7.) STRIDOR- crowing or ropster life sound – air being pulled through a constricted larynx. Abnormal –
resp obstruction
Fibrine hyaline
Mgt:
LARYNGOTRACHEOBRONCHITIS
LTB – most common Creup -viral infection of larynx, trachea & bronchi
pathognomonic - stridor
• labored resp
• resp acidosis
• end stage – death
Lab:
1. ABG
2. neck and throat culture
3. dx- neck x-ray to rule out epiglotitis
Nsg Mgt:
1. bronchodilators
Increased RR
< 5 yo – unable to cough out, put on mist tent (humidifier o2) or croupe tie
BP taking begins by 3 yo
SKIN:
Acrocyanosis
BIRTHMARKS:
1. Mongolian spots – stale gray or bluish discoloration patches commonly seen across the sacrum or
buttocks due to accumulation of melanocytes. Disappear by 1 yr old
2. MIlla – plugged or unopened sebaceous gland . white pin point patches on nose, chin or cheek.
3. Lanugo – fine, downy hair – common preterm
4. Desquamation – peeling of newborn, extreme dryness that begin sole and palm.
5. Stork bites (Talengeictasi nevi) – pink patches nape of neck
1. Erythema Toxicum – (flea bite rash)- 1st self limiting rash appear sporadically & unpredictably as
to time & place.
2. Harlequin sign – dependent part is pink, independent part is blue
3 types Hemangiomas
a.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh. NEVER
disappear. Can be removed surgically
b.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal
area. Enlarges, disappears at 10 yo.
c.) Cavernous hemangiomas – communication network of venules in SQ tissue that never disappear with
age. - MOST DANGERIOUS – intestinal hemorrhage
White – edema
Grey – inf
INFANT 5-9 yo
Neck 1 1 1 1
Upper arm 2 2 2 2
Trunk 13 13
Back 13 13
Genital 1 1
@ 2.5@ 2.5 @
buttocks
2nd degree – epidermis & dermis- erythema, blisters, moist, extremely painful
o scalds
3rd degree – full thickness- epidermis, dermis, adipose tissue, fascia, muscle & bone
Mgt:
1.) 1st aid a.) put out flames by rolling child on blanket
2.) a/w
c.) tracheostomy
5.) Relief of pain – IV analgesic MORPHINE SO4 – needed for 2nd degree – very painful
7.) skin grafting – 3rd degree – thigh or buttocks (autograft), pigs/ animals – xenograft
Pediculosiscapitis –"KUTO"
• Mgt: proper hygiene – wash soap and H2o, oral penicillin – bactroban ointment
• self limiting infl dis – sebaceous gland comedones – sebum causing white heads
• sebum- lipids causing acne bulgaris
Mgt: - proper hygiene- mild soap or sulfur soap- antibacterial retin A or tretinoi
ANEMIA-pallor
Causes:
Assessment:
Dx test :
HT: avoid contact sport, swimming only, don’t stop immunization – just change gauge of needle
Falls – immobilized , elevate affected part, apply pressure-not more then 10 min
cold compress
S&Sx:
signs of infection
a. fever
b. poor wound healing
c. bone weakness & causes fracture
signs of bleeding
signs of anemia
Dx Tests:
bleeding
TRIAD:
1. surgery
2. irradiation
3. chemotheraphy
4 LEVELS OF CHEMOTHERAPHY
meds: IV vincristine
L- agpariginase
Oral predinisone
4. Reinductin – treat leukemic cells after relapse occurs. Meds – same as induction
S/Effect of Chemotherapy
1. N/V – adm antiemetic drugs 30 mins before chemo until 1 day after chemo
2. Ulcerations / stomatitis / abscess of oral mucosa- (alteration nutrition less body req)
Hirsutism – hair
ABO incompatibility –
Within 24 h
Mgt:
1. Needs phototherapy
2. needs exchange therapy
• bilirubin encephalopathy
• Kemicterus - > 20 mg/dL among full term &
Physiologic jaundice – jaundice within 48 -72 h (2-3 days) expose morning sunlight
Assessment of Jaudice :
Nsg Resp:
¼ of its length
Char:
1. present at birth
2. crosses suture lines
3. disappear after 2-3 days
Char :
1. present after 24 h
2. never cross suture line
3. disappear after 4-6 weeks
4. monitor for developing jaundice
Scaling, greasy appearing salmon colored patches – seen on scalp behind ears and
umbilicus
Mgt:
1. proper hygiene
2. put oil night before shampoo
• baby oil
• cushings triad
• high pitched cry
Nsg Care:
1.) post VP shunt – side lying on non operated site - to prevent increase ICP
SENSES
EYES: Assessment
Globellars test – test for blink reflex. Points near nose – baby should blink
- appearance
- general appearance
Cover testing test – cover 1 eye for 10 – 15 min. Then remove. Test for strabismus
- general appearance
- snellens test
NOSE:
1. flaring alenase – case of RDS
2. cyanosis at rest – choanal atresia - post nares obstructed with bone or membrane
Sx:
Epistasis – nosebleed
EARS:
Sx:
Mongolian slant
Protruding neck
Puppy’s neck
• 45x0
• affected girls
• signs evident during puberty
• has poorly developed 2dary sexual char.
• Sterile
- no deepening of voice
Causes
1. bottle propping
2. Cleft lip/ cleft palate –
Sx: Otitis
Nsg Care:
Med Mgt:
surgery (to prevent permanent hearing loss)– otitis media – myringotmy with tympanostomy tube
Sx.
Refer to PT
Outstanding Sx – Coughing
Choking
Continuous drooling
Cyanosis
Mgt:
Emergency surgery
Epstein pearl – white glistering cyst at palate & gums related to hypercalcemia
Hypervitaminosis
- common in Japan
Sx:
-strawberry tongue ,
Drug: aspirin
Can lead to MI
LIPS- symmetrical
Cleft lip – failure of median maxillary nasal process to fuse by 5-8 wks of pregnancy
• common to boys
• unilateral
• common to girls
• unilateral or bilateral
Sx:
1. evident at birth
2. milk escapes to nostril during feeding
3. frequent colic & otitis media or URTI
Mgt:
1. Surgery
cleft lip repair – Cheiloplasty =done 1-3 months to save sucking reflex (lost in 6 months )
Pre op care
3. assess for bleeding – freq swallowing. 6-7 days after surgery – bleeding
4. proper nutrition
• clear liquids- ( gelatin except red or brown color due may mask bleeding)
• ( popsicle- not ice cream)
full liquid
soft diet
regular diet
Logan bar – wash ½ strength Hydrogen Peroxide & saline solution- Bubbling effect
traps microorganism
NECK-
1. check symmetry
Complication – scoliosis
earliest sign:
1. change in crying
2. change in sucking
3. sleep excessively
4. constipation
5. edema – moon face
late sign
1. mental retardation
Dx:
1. PPI-protein
2. radioimmunoassay test
3. radioactive iodine uptake
CHEST
1. symmetry
2. breast - transparent fluid coming out from newborn related to hormonal changes-
1. inspection I
2. Auscultation A
3. percussion P
4. Palpation P = Will change bowel sounds, so do last
Sx:
1. sunken abd
2. Sx of RDS
3. R to L shunting
Mgt:
umbilicus.
Fx of GIT
3. veg
4. meat
h.) offered new food one at a time – interval of 4 – 7days or 1 week – determines food
allergens
a. chemical buffers
b. renal & resp system involvement
c. dilution of strong acids and bases in bld
• hypoventilation
• RDS
• COPD
• Laryngotracheobronchitis (LTB)
• hyperventilation
• fever
• encephalopathy
• diarrhea
• severe dehydration
• malnutrition
• ciliac crisis
• uncontrolled vomiting
• NGT aspiration
• Gastric lavage
Sx:
1. nausea
2. dizziness
3. facial flushing
4. abd cramping
Types:
• dietary indiscretions
• antibiotic use
Cause:
1. food intolerance
2. excessive fld intake
3. CHO, CHON malabsorption
Complication = dehydration
Earliest sx of dehydration
Severe dehydration:
Mgt:
before adm of K chloride – check if baby can void, if cant void – hypokalemia
Earliest sign
diarrhea
Dx:
1. NGT feeding – measure tube fr nose to ear to midline of xyphoid & umbilicus
2. surgery
a. temp colostomy
b. anastomosis & pull through procedure
Diet:
Esophageal cancer
Assessment :
1. chronic vomiting
2. faiture to thrive syndrome
3. organic – organ affected
4. melena or hematemesis – esophageal bleeding
Dx procedure
Meds of GERD
Anti-cholinergic
Chronic vomiting –
> 9 months – prone with head of mattress slightly elevated 30 degree angle
OBSTRUCTIVE DISORDERS
obstruction.
- vomitus of upper GI can be blood tinged not bile streaked. (with blood)
6.) ultrasound
7.) x ray of upper abd with barium swallow reveal "string sign"
Mgt:
1. Pyleromyotomy
2. Fredet Ramstedt procedure
Sx:
Mgt:
9 amino acids:
lysine phenylalanine
1. fair complexion
2. blond hair
3. blue eyes
Thyroxine – decrease basal metabolism
mixed with pheric chloride, presence of green spots at diaper a sign of PKU
DIET:
Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanuts
Dx:
B- barley
R- rye
O- oat
W- wheat
Early Sx:
Late Sx:
Dx:
Mgt:
1. vitamin supplements
2. mineral supplements
3. steroids