Growth and Development

Growth- increase in physical size of a structure or whole. -quantitative change. Two parameters of Growth 1. weight- most sensitive measure of growth, especially low birth rate. Wt doubles months !" 1yr #" $-$ % yrs $. &eight- increase by 1'(mo during 1st months - average increase in ht - 1st year ) *+, stoppage of ht coincide with eruption of wisdom tooth. Development- increase s-ills or capability to function - qualitative &ow to measure development 1. .bserve child doing specific tas-. $. /ole description of child0s progress !. 112T- 1enver development screening test. 3312T 45hil6 3etro 3anila 1evelopmental 2creening Test. 112T measures mental # main rated categories of 112T 1. 7anguage communication $. personal social-interaction !. fine motor adaptive- ability to use hand movement #. gross motor s-ills- large body movement maturation- same with development 8readiness' Cognitive development 9ability to learn and understand from e"perience to acquire and retain -nowledge. To respond to a new situation and to solve problems. :; test- test to determine cognitive development 3ental age " 1++ ) :; <hronological age =verage :; 9 >+-1++ Gifted child- ? 1!+ :; @asic 1ivisions of 7ife :. 5renatal stage from conception- birth ::. 1. $. :::. 1. $. :E. 1. 5eriod of infancy Aeonatal- 1st $B days or 1st # wee-s of life Cormal infancy- $> day 9 1 year Darly childhood Toddler 9 1-! yrs 5re school #- years 3iddle childhood 2chool age- F 9 1$ yrs

E. 1. $.

7ate childhood 5re adolescent 11 9 1! yrs =dolescent 1$ - 1B 9 $1

5rinciples of G G 1 1. GG1 is a continuous process -begins form conception- ends in death - womb to tomb principles 2. not all parts of the body grow at the same time or at same rate. - asynchronism 5atterns of GG1 1. 6renal digestive circulatory musculos-eletal

grows rapidly during childhood

$. 6Aeuromuscular tissue 4<A2, brain, 2. cord6 - grow rapidly 1-$ years of life - brain achieved its adult proportion by * years. !. 67ymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide protection -infection - tonsil adult proportion by * years #. 6/epro organ- grows rapidly at puberty /ates of GG1 1. fetal and infancy 9 most rapid GG1 $. adolescent- rapid GG1 !. toddler- slow G period #. Toddler and preschool- alternating rapid and slow *. school age- slower growth fetal and infancy- prone to develop anemia !. Dach child is unique $ primary factors affecting GG1 =. &eredity / 9 race : 9 intelligence 2 9 se" A - nationality Cemales are born less in weight than males by 1 oz. Cemales are born less in length than males by 1 inch @. Dnvironment ; 9 quality of nutrition 2 9 socio eco. status & 9 health . 9 ordinal pos in family 5 9 parent child relationship Dldest- s-illful in language and social s-ills Hounger- toilet trained self #.GG1 occurs in a regular direction reflecting a definitive and predictable patterns or trends. 1irectional trends- occur in a regular direction reflecting the development of neuromuscular function. These apply to physical, mental, social and emotional development and includes. a. cephalo-caudal 8head to tail'

occurs along bodies long a"is in which control over head, mouth and eye movements and precedes control over upper body torso and legs. b. pro"imo- distal 8<entro distal' - progressing form center of body to e"tremities. c. 2ymmetrical- at side of body develop on same direction at same time at same rate. d. 3ass specific 8differentiation' - child learns form simple operations before comple" function of move from a broad general pattern of behavior. To a bore refined pattern. @. 2equential- involves a predictable sequence of GG1 to which the child no>rmally passes. a. locomotion- creep than crawls, sit then stand. b. socio and language s-ills- solitary games, parallel games <. 2ecular- worldwide trend of maturing earlier and growing larger as compared to succeeding generations. *.@ehavioral in the most compressive indicator of developmental status. . universal language of child- play F. great deal of s-ill and behavior is learned by practice. 5ractice ma-es perfect. >. neonatal refle"es us must be lost before one can proceed. -plantar refle" should disappear before baby can wal-moro refle" should disappear before baby can roll persistent primitive infantile refle"es- case of cerebral palsy Theories of GG1 1evelopmental tas-s- different form chronological age -s-ill or growth responsibility arising at a particular time in the individuals life. The successful achievement of which will ------- a foundation for the accomplishments of future tas-s. Theorists 1. Sigmund Freud 1B* -1>!> =ustrian neurologists. Counder of psychoanalysis - offered personality development 5sychose"ual theory a.6 Oral Phase 0-18 months - mouths site of gratification -activity of infant- biting, suc-ing crying. -why do babies suc-I- enJoyment and release of tension. -provide oral stimulation even if baby was placed on A5.. -pacifier. -never discourage thumb suc-ing. b.6 A A!- 18 months-" #ears -site of gratification- anus -activity- elimination, retention or defecation of feces ma-e ta-e place - principle of holding on or letting go. -mother wins or child wins -child wins- stubborn, hardheaded anti social. 4ana- pupu na, child holds pupu, child wins6 -mother wins- obedient, -ind, perfectionist, meticulous .<-anal phase -help child achieve bowel and bladder control even if child is hospitalized. c.6 Phalli$- "-% #ears site of gratification -genitals activity- may show e"hibitionism -increase -nowledge of a se"es -accept child fondling his(her own genitalia as normal e"ploration -answer <hilds question directly. /ight age to introduce se"uality 9 preschool d.6 !atent- &-12 #ears -period of suppression- no obvious development. -<hilds libido or energy is diverted to more concrete type of thin-ing

-helps child achieve 4K6 e"perience so ready to face conflict of adolescence e.6 Genital- 12-18 #ears -site of gratification -genitals -achieve se"ual maturity -learns to establish relationships with opposite se". -give an opportunity to relate to opposite se". '()C '()C*SO - psychoanalysis theory - stresses important of culture and society to the development of ones personality - environment - culture stages of psychosocial a.6 trust vs mistrust + 0-18 months. -foundations of all psychosocial tas-to give and receive is the psychosocial theme --now to develop trust baby 1. satisfy needs on time - breastfeed $. care must be consistent and adequate -both parents- 1st 1 year of life !.6 give an e"perience that will add to security- touch, eye to eye contact, soft music. b.6 Autonom# vs shame and dou,t 18-" #ears --- independence (self gov0t develop autonomy on toddler 1. give an opportunity of decision ma-ing li-e offer choices. $. encourage to ma-e decision rather then Judge. !. set limits c. initiative vs guilt- --% #ears -learns how to do basic things -let e"plore new places and events -activity recommended- modeling clay, finger painting will enhance imagination and creativity and facilitate fine motor dev0t d. industr# vs in/eriorit# &-12 #rs -child learns how to do things well -give short assignments and proJects e. )dentit# vs role $on/usion or di//usion 12-18 #rs - learns who he(she is or what -ind of person he( she will become by adJusting to new body image and see-ing emancipation form parents -freedom form parents. f. )ntima$# vs isolation 20--0 #rs -loo-ing for a lifetime partner and career focus g. generatively vs stagnation #+- + #*- * yrs h. ego integrity vs, despair +- *

0'A P)AG'1- 2wiss psychologists -develop reasoning power

S1AG'S OF COG )1)2' D'2'!OP3' 1

=-Sensor# motor 0-2 #rs -8practical intelligence'- words and symbols not yet available baby communicates through senses and refle"es. 4sub div.6

2chema 1.6 neonate refle" $.6 primary circular !.6 secondary circular reaction

=ge 1 month 1-# months #-B months

<oordination of secondary reaction Tertiary circular reaction

B-1$ months 1$-1B months

:nvention of new means there mental combination

1B-$# months

@ehavior =ll refle"es -=ctivity related to body -repetition of behavior e". thumb suc-ing -activity not related to body -discover obJ and person0s permanence -memory traces present -anticipate familiar events. -e"hibit goal directed behavior -increase of separateness 4will search of lost toy, -nows mom6 -use trial and error to discover places and events -8 invention of new means' -capable of space and time perception 4hits for-, spoon on table or drops for-6 -transitional phase to the pre operational thought period.

Preoperational thought 2-& #ears

2chema 5reconceptua l age $-# yrs @ehavior -thin-ing basically complete literal and static -egocentric- unable to view others interrupt -concept of dying is only now -concept of distance is only as fat as they can see. -concept of amenism inanimate obJect is alive -not aware of concept of r!eversibility- in every action theories an opposite reaction or cause and effect @eginning of causation

:nitiative

#-F yrs

Con$rete Operational thought &-12 #ears

1. able to find solution to everyday problems which systematic reasoning. $. have concept of reversibility- cause and effect !. have concept of longer uation 9 constancy despite of transformation. #. #. activity recommended- collecting and classifying *. 9stamps stationeries, dolls, rubber band mar-ers. Formal Operational thought 12 and up. 1. <ognition achieved its final form $. can deal with past present and future !. have abstract and mature thoughts. #. can find solutions to hypothetical problems with scientific reasoning. *. activity ------- will sort out opinions and current events. *O4!5'(G- recognized the theory of moral dev0t as considered to closely appro"imate cognitive stages of dev0t -sabay with cognitive devLt

Stages o/ 3oral dev6t

:nfancy 9 premoral, prereligious, amoral stage =GD 5re-conventional $-! yrs #-F 2T=GD 7evel 1 1 $ 1D2</:5T:.A -5unishment( obedience oriented 4heteronymous morality6 child does right cause a parent tells him or her to and to avoid punishment -:ndividualism. :nstrumental purpose and e"ch. <arries out action to satisfy own needs rather than society. -Will do something for another if that person does something for the

child. <onventional F-1+ 1+-1$ 5ost-conventional =bove 1$ yrs 7evel ! # 7evel ::: * -.rientation to interpersonal relations of mutuality. <hild followers rules cause of a need to be a 8good' person in own eyes and eyes of others. -3aintenance of social order fi"ed rules and authority. <hild finds ff. rules satisfying. Collows rules of authority figures. -2ocial contract, utilitarian level ma-ing perspectives. Collowers standards of society. Mniversal ethical principle orientation. Collows internalized standards of conduct.

D. 1DE0T 3:7D2T.AD2-maJor mar-ers of growth and dev0t 1. Period o/ in/an$#- universal language of child-pla# a.6 Pla#- )n/an$#- solitar# pla#s -solo, mom interactive -facilitate motor and sensory dev0t -safety- important age appropriate solitary play- mobile, teeter, music bo", rattle b.6 fear of infancy- stranger an"iety begin -F months pea- B months diminishes > months 1 month- dance refle" disappears loo-s at mobile 2 months- holds head up when in prone, social smile, baby coos 8doing sound' cry with tears -closure of frontal fontanel $-! months head lag when pulled to sitting position. " months- holds head and chest up when prone follows obJ. past midline grasp and tonic nec- refle" fading hand regard 4loo-s at hand6 - months 9 turns form front to bachead control complete needs space to turn 7augh aloud, bubbling sounds 7 months- turn both ways 8roll over' -teething rings -handles rattle well -moro refle" disappears 4 #-* months6 % months- reaches out in anticipatory of being pic-ed up -sits with support -uses palmar grasp -eruption o/ 1st temp teeth %-8 months 2 lower in$isors -say vowel sounds 8ah', 8oh' -handles bottle well & months- transfer obJ. hand to hand -li-es obJ that are good size 8 months- sits without support -pea- of stranger an"iety -planters refle" disappears B-> months in prep for wal-ing

8 months - creeps or crawls -neat finger grasp refle" - combine $ syllables 8mama' and 8papa' - needs space for creeping 10 months 9 pull self to stand -understands 8no' -responds to own name -pea- a boo, pat a ca-e -can clap 11 months- cruisse - stands with assistance 12 months- stand alone ta-e 1st step -wal- with assistance -drin- from cup, cooperate in dressing -says $ words mama and dada -pots and pans, pull tay, nursery rhymes

1oddler- parallel pla#- 2 toddlers pla#ing separatel#

-provide with similar toys -squea-y frog to squeeze waddling duc- to pull truc-s to push-push pull toy building bloc-s, pounding peg toys to ride on fear- separation an"iety begin > months pea- 1B months ! phases of separation an"iety 4in order6 1. 5- protect $. d despair !. d- denial -don0t prolong goodbye -say goodbye firmly to develop trust- say when ul be bac-

17 months 9 plateau stage wal-s alone lateness in wal-ing- mild mental retardation -puts small pellets into small bowl -holds spoon well - seats self on chair -creeps up stairs - # - words 18 months- height of possessiveness favorite word- 8mine' bowel control achieved 4bowel 1st before bladder6 -no longer rotates spoon -can run and Jump in place wal-s up and down stairs holding railing or persons hand -1-$+ words

-name, body part -puts both feet on 1 step before advancing. 2- months- terrible two -can open doors by turning door -nobs -unscrew lids -can wal- upstairs alone 9using both feet on same step at same time -*+-$++ words 4 $ words sentences6 -daytime bladder control achieved 4 daytime 1st- ne"t nighttime bladder control6 "0 months or 2 9 #ears 9 ma-es simple lines or stro-e for crosses with a pencil -can Jump down from chairs --nows full name - copy a circle - holds up finger to show age - temp teeth complete post molar- last temp teeth to appear how many deciduous teeth -$+ beginning of toothbrush 9 $-$ % yrs tooth brushing with little assistance ! yrs tooth brushing alone 9 yrs right time to bring to dentist- when temp teeth complete "% months or " #rs- trusting ! - unbutton buttons 4unbutton before learn to button6 -draw a K - learns how to share --nows full name and se" 4gender identity6 - spea-s fluently -nighttime bladder control -!++->++ words -ride a tricycle <haracteristic Traits of toddler negativistic- 8A.N' -way to search for independence 9limit questions 9modify questions to a statement $.6 rigid, ritualistic and stereotype ritualism- for mastering !.6Temper tantrums- head banging, screaming, stamping feet, holds breath 9ignore behavior scaffoid abdominal-due to underdeveloped abdominal muscles physiologic anore"ia- due to preoccupation with environment- food Jag that last for short period of time loves rough and tumbling play loves toilet trainingfailure of toilet training- unreadiness <lues of toilet readinessO 1.6 can stand, squat wal- alone $.6 can communicate toilet needs !.6 can maintain dry for $ hours Pre s$hoolers- associative or cooperative play 1.6 bahay-bahayan 9 play house $.6 role playing !.6 fear-body mutilation or castration fear of dar- places witches fear of thunder and lightning fear of ghosts

3ilestones -#ears old- furious # , noisy, aggressive, stormy -can button buttons -copy a square -Jumps and s-ips -laces shoes -vocabulary 1,*++ --nows four basic colors 7 #ears old- frustrating * -copy a triangle -draw a part man -imaginary playmates -$,1++ words <haracter Traits of 5re-schoolerO 1.6 curious, creative imaginative, imitative $.6 $. favorite words- why and how !.6 comple"es- word identification to parent of same se" and attachment to parent of opposite se" e". .edipal comple"- boy to mom Dlectra comple"- girl to dad <ause of incest marital discord 1eath-sleep only @ehavior problems 5reschool 1. $. !. #. telling tall tales-over imagination imaginary friend- to release tension and an"ieties sibling rivalry- Jealousy to newly delivered baby. regression- going bac- to early stage -thumb suc-ing 4should be oral stage only6 -baby tal-bed wetting -fetal position *. masturbation- sign of boredom -divert attention- offer a toy S$hool Age 5lay- competitive play D". Tug of war, trac- and field, bas-et ball Cear. 1.6 school phobia -orient to new environment $.6 displacement from school -teacher and peer of same se" !. loss of privacy -wants bra #.6 fear of death -F->yrs death is personified -death- permanent loss of life 2ignificant 1evelopment a. boys- prone to bone fracture b. mature vision $+($+ % #ears- temp teeth begin to fall perm teeth appear- 1st molar 1st temp teeth- * months 1st perm teeth- yrs

>

-yr of constant motion clensy mou0t recognize all shapes -1st grade teacher becomes authority figure -nail biting -begin interest in God. & #rs- assimilation age -copy a diamond -enJoys teasing and playing alone -quieting down period 8 #rs- e:pansive age -smoother mouth -loves to collect obJects -count bac-wards 8 #rs 9coordination improves -tells time correctly -hero worship -stealing and lying are common -ta-es care of body needs completely -teacher finds this group difficult to handle 10 #rs- age o/ spe$ial talent -writes legibly -ready for competitive games -more considerate and cooperative -Joins orgs. -well mannered with adult -critical of adults 11-12 #rs + pre adoles$ents -full of energy and constantly active -secret language are common -share with friends secrets -sense of humor present -social and cooperative <haracter Traits 2chool =ge 1. industrious$. modest !. can0t bear to lose- will cheat #. love collections- stamps Signs o/ se:ual maturit# G:/72O :-inc size breast and genitalia 4pelarche- 1st sign se"ual mat. W- widening of hips =- appearance a"illary, pubic 4 adrenarch6 3- menarche- last sign se"ual mat. Girls @.H2O =-appearance a"illary, pubic hair 4 1st sign se"ual mat6 1-deepening voice 1- development of muscles :--inc in testes and penis size 5- prod of viable sperm 4 last sign se"ual maturity6 =dolescent Cear

1+

1. obesity $. acne !. homose"uality #. death *. replacement from friends . significant person- opp se". 2ignificant dev0t 1. e"periences conflict bet his needs for se"ual satisfaction and societies e"pectation $. change of body image and acceptance of opp(se" !. nocturnal emission 9 wet dreams #. distinctive odor- due to stimulation apocrine glands *. sperm is viable by 1F yrs . testes G scrotum increase until age 1F F. breast and female genitalia increase until age 1B 5ersonality Traits =dolescents 1. idealistic $. rebellious !. reformers #. conscious with body image *. adventuresome 5roblemsO 1. vehicular accident $. smo-ing !. alcoholism #. drug addiction *. pre marital se"

:33D1:=TD <=/D .C ADW@./A 1st days of life 1. initiation and maintenance of respiration $. establishment of e"tra uterine circulation !. control of body temp #. inta-e of adequate nourishment *. establishment of waste elimination . prevention of infection F. establishment of an infant parent relationship B. dev0t care that balances rest and stimulation or mental dev0t 1.6 :nitiation and maintenance of respiration $nd stage of labor- initial airway -initiation of a (w is a crucial adJustment -most neonatal deaths with in $# h caused by inability to initiate a(w -lung function begins after birth only &ow to initiate a(w a.6 remove secretions bulb syringe @. <atheter 2uctioning 1.6 place head to side to facilitate drainage $,6 suction mouth 1st before nose -neonates are nasal breathers

11

!.6 period of time -*-1+ sec suctioning, gentle and quicprolonged and deep suctioning can lead to hypo"ia, laryngo spasm, brady cardia due to stimulation vagal nerve #.6 evaluate for patency -cover nostril and baby struggles there0s a need for additional suctioning <. :f not effective, requires effective laryngoscopy to open a(w. =fter deep suctioning an endotracheal tube can be inserted and o"ygen can be administered by an 4K6 pressure bag and mas- with 1++, o"ygen at #+- +b(m. Asg alertO 1. Ao smo-ing $. =lways humidify to prevent drying of mucosa !. .ver dosage of o"ygen can lead to scarring of retina leading to blindness 4 retro lentalfibrolasia or retinopathy of prematurity6 #. When mecomium stained 4greenish6 never administer o"ygen with pressure 4 .$ pressure will push mecomium inside6 $.6 Dstablishing e"tra uterine circulation - circulation is initiated by lung e"pansion or pulmo ventilation and completed by cutting of cord.

F'1O P!AC' 1A! C)(C;!A1)O

-5lacenta4simple diffusion6 9o"ygenated blood is carried by the umbilical vein- passes liver-ductus venousus- :E<- /T atrium F+, blood is shunted to foramen ovale- 7T atrium mitral valve 9 7T ventricle- aorta-lower e"tremities. -/emaining !+,- tricuspid valve- /T ventricle- pulmonary arteries- lungs 4for nutrition6 4vasoconstriction of lungs pushes blood to ductus arteriousus to aorta to supply upper e"tremities.

2&MAT2-shortcuts 1uctus venosus- -shunts from liver to :EC Coramen ovale- shunts bet $ atrias 1uctus arteriosus- from pulmonary artery to aorta

1$

What will sustain 1st

1ecrease 5.$, increase 5<.$ acidosis

Will cause 1st breath (cry of baby

1ecrease pulmo artery pressure

:ncrease 5.$

1ecrease blood flow

:ncrease pressure to 7t side of heart

<losure of ductus arteriosus

<losure of ductus venosus G =E=

<losure of foramen ovale

breath- decreased artery pressure What will initiate lung circulation-lung e"pansion What will complete circulation- cutting of cord #.6 $ way to facilitate closure of foramen ovale a.6 Tangential Cootstep- slap foot of baby -never stimulate baby to cry if secretions not fully drained to prevent aspiration -chec- characteristic of cry normal cry- strong, vigorous and lusty cry cri-du-chat syndrome-chromosomal obliteration cat li-e cry b.6 proper position -right side lying pos. -will increase pressure on left and foramen ovale will close Coramen .vale and 1uctus arteriosus will begin to close within $#h

.bliteration-complete closure 2tructure C. .vale 1uctus =ppropriate time of obliteration 1yr 1 month 2tructure remaining Cossa .valis 7igamentum =rteriosum Cailure to close =trial 2eptal 1efect 5atent ductus arteriosus

1!

=rteriosus 1uctus Eenosus Mmbilical artery

$ months $-! months

Mmbilical vein $-! months 5osition of infant immediately after birthO A21-trendelenberg( T position for drainage contraindication of trendelenberg position - increase :<5 <2- supine or crib level position

7igamentum venosum 1.6 lateral umb. 7igament $.6 interior iliac artery -ligamentum teres 4 round ligament of liver6

Signs o/ in$reased )CP

1.6 $.6 !.6 #.6 *.6 .6 F.6 abnormally large head bulging and tense fontanel increase @5 and widening pulse pressure 1ecreased //, decreased 5/ proJective vomiting- sure sign of cerebral irritation high deviation 9 diplopia 9 sign of :<5 older child #- months- normal eye deviation ? months- lazy eyes &igh pitch shrill cry-late sign of :<5 P! G P# are Cushings triad of )CP

1emp (egulation - goal in temp regulation is to maintain it not less than >F.F, C 4! .* <6 - maintenance of temp is crucial on preterm and 2G= 4small for gestational age6 - babies prone to hypothermia or cold stress =. factors leading to dev0t of &H5.T&D/3:= 1. preterms are born poi -ilo thermic- cold blooded - babies easily adapt to temp of environment due to immaturity of thermo regulating system of body. &ypothalamus $. inadequate 2; tissue !. baby is not capable of shivering #. babies are born wet 5/.<D22 .C &D=T 7.22 1. evaporationbody to air 4T2@6 $. conductionbody to cold solid obJect 4cold compress6 !. convectionbody to cooler surrounding air 4aircon6 #. radiationbody to cold obJect not in contact with body earliest sign of hypothermia- increase in // Dffects of &ypothermia 4 <old stress6 1.6 &ypoglycemia- #*-** mg(dl normal *+- borderline $.6 met acidosis- catabolism of brown fats 4best insulator of newborns body6 will form -etones !.6 high ris- for -ernicterus- bilirubin in brain leading to cerebral palsy #.6 additional fatigue to allergy stressful heart To 5revent &ypothermia 1. dry and wrap baby $. mechanical pressure 9 radiant warmer i. pre-heated first isolette 4or square acrylic sided incubator6 !. prevent an necessary e"posure 9 cover baby #. cover baby with tin foil or plastic *. embrace the baby- -angaroo care A. 'sta,lish Ade<uate utritional )nta=e <2- breastfeeding after # hours A21- breastfeeding asap

1#

5hysiology breast mil- production =s you deliver baby, decrease Dstrogen, decrease 5rogesterone- -=nterior 5osterior Gland 4=5G6 releases prolactin 9 acts on acinar cells 4or alveoli6 9 produce foremil- 9 stored in lactiferous tubules 4 or collecting tubules6 where breast mil- is produced 9 alveoli post-pit.gland 2uc-ing- 55G 9 o"ytocin 9 contraction of lactiferous tubules - mil- eJection refle"- let down refle". Advantages o/ 5reast/eeding 1. Dconomical $. =lways available !. @reastfed babies have higher :; than bottle fed babies. #. :t facilitates rapid involution *. 1ecrease incidence of breast cancer. . &as antibodies- :g= F. &as lactobacillius bifidus- interferes with attac- of pathogenic bacteria in G:T B. &as macrophages 2tore mil-- plastic storage container 2tore mil- 9 good for months from freezer- put rm temp. don0t heat Disadvantages> 1. 5ossibility of transfer &D5 @, &:E, cytomegalo virus. $. Ao iron !. Cather can0t feed G bond as well Stages o/ 5reastmil=> 1. <olostrum- $-# days present contentO decrease fats, increase :g=, dec <&., dec <&.A, inc minerals, inc fat soluble minerals $. Transitional mil-- # 9 1# days contentO inc lactose, inc water soluble vit., inc minerals !. 3ature mil-- 1# G up contentO inc fats 4linoleic acid6 9 resp for devt of brain G integrity of s-in inc <&.- lactose 9 easily digested, baby not constipated. - resp of sour mil- smelling odor of stool. 7actose intolerance- deficiency of enzyme 7=<T=2D that digest 7=<T.2D 1ecrease <&.A- lactalbumin <ows mil- 9 inc fats1ec <&. :nc <&.A 9 casing- has curd that0s hard to digest. :nc minerals9traumatic effect on -idneys of babies. <an trigger stone formation. :nc phosphorus 4ealth 1ea$hings> 1. 5roper hygiene- proper hand washing <are of breast - cotton balls with lu-ewarm water <a-ed colostrum- dry mil- on breast $. @est position in breastfeeding 9 upright sitting -avoid tensionN !. 2timulate G evaluate feeding refle"es a.6 /ooting refle"- by touching the side of lips(chee-s then baby will turn to stimulus. 1isappear by baby can focus. /efle" will be gone - 5urpose rooting- to loo- for food. b.6 2uc-ing 9 when you touch middle of lips then baby will suc- 1isappears by months - When not stimulated suc-ing will stop. c.6 2wallowing- when food touches posterior of tongue then it will be automatically swallowed d.6 D"trusion( 5rotrusion refle" -when food touches anterior portion of tongue then food will be e"truded. 5urposeO to prevent from poisoning 1isappear by # months G baby can already spit out by # months.

wee-s- by wee-s

1*

Criteria '//e$tive Su$=ing a.6 @aby0s mouth is hi-ed up to areola b.6 3om e"periences after pain. c.6 .ther nipple is also flowing with mil-. To prevent from crac- nipples G initiate proper production of o"ytocin. - begin $-! min at Q breast 4 * 9 F min other authors6 to initiate production of o"ytocin - increase 1 min( day 9 until reaching 1+ mins Q breast or $+ mins( feeding. Cor proper emptying G continuous mil- production ( feeding -feed baby on last breast that you feed her with, alternately 4 if not emptied - mastitis6 Pro,lems e:perien$ed in 5reast/eeding > !/1 day changes in breast post partum a.6Dngorged- feeling of fullness G tension in breast. - sometimes accompanied by fever -nown as 3:7R CDED/. 3gt> Warm compress- for breastfeeding mom <old compress 9 for bottle feeding G wear supportive bra. When is involution of breast- # wee-s b.6 2ore nipple 9 crac-ed with painful nipple 3gtO 1.6 e"posure to air 9 remove bra G wear dress, if not, e"pose to $+ Watt bulb avoid wearing plastic liner bra - will create moisture, cotton only c.6 3astitis- inflammation of breast O staphylococcus aureus CactorsO 1. :mproper breast emptying $. Mnhealthy se"ual practices -contraindicated for breast feeding - manually e"press inflamed breast feed on unaffected breast - give antibiotics 9 can still feed on unaffected breast Contra )ndi$ations in 5reast Feeding> 3aternal <onditionsO 1. &:E <3E &epa @ <oumadin Aewborn <ondition - :nborn errors of metabolism Drythrobastosis Cetalis 9 /h incompatibility &ydrops Cetalis 5henyl-etonuria Galactosemia Tay 2achs disease *. Dstablish of waste elimination =. 1iff stools 1. 3econium - physiologic stool - blac- green, stic-y, tar li-e, odorless 42terile intestine6 will pass with in $# 9 ! hrs failure to pass mecomium after $#h- G:T obstruction e". &irschsprungs disease imperforate anus mecomium ileus 9 due to <ystic Cibrosis $. Transitional stool - green loose G shiny, li-e diarrhea to the untrained eye !. @reastfed stool - golden yellow, soft, mushy with sour mil- smell, frequently passed

- recur every feeding #. @ottlefed stool 9 - pale yellow, formed hard with typical offensive odor, seldom passed, $9! "(day - with food added -brown G odorous Saundice baby 9 Mnder phototherapy 9 3ucus mi"ed with stool <lay colored stool 9 <hal- clay stool 9 @lac- stool 9 @lood flec-ed stool <urrant Jelly stool 9 /ibbon li-e stool 9 2teatorrhea stool 9 <ult blood 9 light stool bright green mil- allergy obstruction to bile duct after barium enema G:T bleeding 4melena6 anal fissure. instussusection hirschsprung disease fatty, bul-y foul smelling odor stool - malabasorption syndrome 4 celiac disease or cystic fibrosis6 stool e"am

))) Assessment /or ?ell+,eing APGA( SCO(' 9 1r. Eirginia =pgar 2pecial <onsiderationsO 1st 1 min 9 determine general condition of baby Ae"t * min- determine baby0s capabilities to adJust e"tra uterinely Ae"t 1* min 9 dependent on the * min =- appearance- color 9 slightly cyanotic after 1st cry baby becomes pin-. 5- pulse rate 9 apical pulse 9 left lower nipple G- grimace 9 refle" irritability- tangential foot slap, catheter insertion = 9 activity 9 degree of fle"ion or muscle tone / 9 respiration @aby cry 9 within !+ secs Cailure to cry after !+ secs 9 asphy"ia near the neatorum /esp. depression 9 due mom given 1emerol. =dminister Aalo"one

APGA( S$oring Chart> + -absent -absent - flaccid e"tremities - no response - A/ - blue(pale 1 T1++ - slow, irreg, wea- some fle"ion - grimace - grimace - acrocyanosis 4body- pine"tremities-blue6 $ ?1++ -good strong cry - well fle"ed - cough, sneeze - cry - pin-ish

&/ /esp effort 3uscle tone /efle" irritability <atheter Tangential Cootslap <olor

APGA( result + 9 ! ) severely depressed, need <5/, admission A:<M # 9 ) moderately depressed, needs add0l suctioning G .$ F - 1+ )good( healthy

1F

<5/ 9 cardio pulmonary resuscitation or <5/ <ardio pulmonary cerebral resuscitation 4<5</6 * min no .$ 9 irreversible brain damage 1. sha-e, no resp, call for help $. flat on head !. head tilt chin lift maneuver e"cept spinal cord inJury over e"tension may occlude airway @reathing 4 ventilating the lungs6 1. chec- for breathlessness if breathless, give $ breaths- ambu bag ? 1 yr old- mouth to mouth, pinch nose T 1 yr 9 mouth to nose force 9 different between baby G child infant 9 puff <irculation <hec- for pulslessness Ocarotid- adult @rachial 9 infants <5/ 9 breathless(pulseless <ompression 9 inf 9 1 finger breath below nipple line or $ finger breaths or thumb <5/ inf 1O* =dults $O1* =ssessment tool determines respiration of baby Silvermann Anderson )nde: (espiration 'valuation 9 lowest score 9 best <riteria + 1 <hest movement synchronized 7ag on respiration :ntercostal retraction Ao retraction Sust visible Uiphoid retraction Aone Sust visible Aares dilatation Aone 3inimal D"piratory grunt Aone &eard on stet only :nterpretation resultO + -! 9 normal, no /12 # 9 9 moderate /12 F 9 1+ 9 severe /12 Assessment o/ Gestational Age -5allards @ Do,owitA Cindings 7ess ! wee-s 45reterm6 2ole creases =nterior transverse crease only @reast nodules $mm 2calp hair Cine G fuzzy Dar lobe 5liable Testes and 2crotum testes in lower canal 2crotum 9 small few rugae Signs o/ Preterm 5a,ies @orn after $+ wee-s, after !F wee-s -frog leg or la"ed positon -hypotonic muscle tone- prone resp problem -scarf sign 9 elbow passes midline pos. - square window wrist 9 >+ degree angle of wrist $ 2ee - saw 3ar-ed 3ar-ed 3ar-ed &eard on na-ed ear

!F - !B .ccasional creases $(! in #mm or !.* mm Cine G fuzzy 2ome cartilage 2ome intermediate

!> and up <overed with creases ? * or Fmm <oarse G sil-y Thic- cartilage Testes pendulus 2crotum full e"tensive rugae

1B

- heal to ear signabundant lanugoSigns o/ Post term ,a,ies> ? #$ wee-s - classic sign 9 old man0s face - desquamation 9 peeling of s-in - long brittle finger nails - wide G alert eyes eonates in urser# Asg responsibility upon receiving baby- proper identification - foot printing, affi"ing mother thumb print - ta-e anthropometic measurement normal length- 1>.* 9 $1 inch or #F.* 9 *!.F*cm, average *+ cm head circumference !!- !* cm or 1! 9 1# 8 &ydrocephalus - ?1#' <hest !1 9 !! cm or 1$ 9 1!' =bd !1 9 !! cm or 1$ 9 1!' 5athing - oil bath 9 initial - to cleanse baby G spread verni" caseosa C" of verni" caseosa 1. insulator $. bacterio- static @abies of &:E K mom 9 immediately give full bath to lessen transmission of &:E - 1! 9 !>, possibly of transmission of &:E Cull bath 9 safely given when cord fall 1ressing the Mmbilical <ord 9 strict asepsis to prevent tetanus " $leans in $ommunit# 1. clean hand $. clean cord !. clean surface betadine or povidone iodine 9 to clean cord chec- =E=, then draw ! vessel cord :f $ vessel cord- suspect -idney malformation - leave about 1' of cord - if @T or :E infusion 9 leave B' of cord best access - no nerve - chec- cord every 1* min for 1st hrs 9 bleeding .? !+ cc of blood bleeding of cord 9 .mphalagia 9 suspect hemophilia <ord turns blac- on !rd day G fall F 9 1+ days Caiture to fall after $ wee-s- Mmbilical granulation 3gtO silver nitrate or catheterization - clean with normal saline solution not alcohol - don0t use big-is 9 air - persistent moisture-urine, suspect patent uracus 9 fistula bet bladder and normal umbilicus d"O nitrazine paper test 9 yellow 9 urine mgtO surgery <redes 5rophyla"is 9 1r. <rede -prevent opthalmia neonatorum or gonorrheal conJunctivitis - how transmitted 9 mom with gonorrhea drugO erythromycin ophthalmic ointment- inner to outer

1>

silver nitrate 4used before6 9 $ drops lower conJunctiva 4not used now6 Eit-R 9 to prevent hemorrhage /(T physiologic hypoprothrombinemia - =quamephyton, phytomenadione or -ona-ion - .* 9 1.* ml :3, vastus lateral or lateral ant thigh - * ml preterm baby Eit R 9 synthesized by normal flora of intestine Eit R 9 meds is synthetic due intestine is sterile ?eight> Aormal wt !.+++ 9 !#++ gms( ! 9 !.# -g ( .* F.* lbs

=rbitrary lower limit $*++ gm 7ow birth wt baby delivered T $*++g 2mall for gestational age 42G=6 T 1+th , ran- or born small 7arge for gestational age ? >+th , ran- or macrosomia ?#+++ g =ppropriate for G= 9 within $ standard deviation of mean 5hysiologic wt loss 9 * 9 1+, wt loss few days after birth 2mall G= T 4less6 1+ 7arge G= ? 4more6 >+ Ph#si$al ':am and Deviations /r ormal 1. if client is new born, cover areas not being e"amined $. if client is infant 9 the 1st yr of life - get E2 9 ta-e // 1st - begin fr least intrusive to the most intrusive area !. if client is a toddler and preschool, let them handle an instrument li-eO - play syringe or stet, security blan-et 9 favorite article. 7et baby hold it. #. D"plain procedure and respect their modesty - school age and adolescent E(2O TempO rectal- newborn 9 to rule out imperforate anus - ta-e it once only, 1 inch insertion :mperforate anus 1. atretic 9 no anal opening $. agenetic 9 no anal opening !. stenos 9 has opening #. membranous 9 has opening Darliest signO 1. no mecomium $. abd destention !. foul odor breath #. vomitous of fecal matter *. can aspirate 9 resp problem 3gtO 2urgery with temporary colostomy <ardiac rateO 1$+ 9 1 + bpm newborn =pical pulse 9 left lower nipple /adial pulse 9 normally absent. :f present 51= Cemoral pulse 9 normal present. :f absent- <.= - coartation of aorta

Congenital 4eart Dse

<ommon in girls 9 51=, =21 atrial septal <ommon in boys 9 T.G= 4 transportation of great arteries6 T= 9 tronchus arteriosus T.C 9 tetralogy of fallot

$+

<ausesO 1. familial $. e"posure to rubella 9 1st month !. failure of strucute to progress acyanotic 7 to / cyanotic / 9 7 A$#anoti$ heart de/e$ts 7 to / 1. ventricular septal defect - opening between $ ventricles 2G2" $. !. 1. systolic murmurs at lower border of sternum and no other significant sign cardiac catheterization reveals increased o$ saturation Q / side of heart D<G reveals hypertrophy of / side of heart

Asg <areO <ardiac catheterizationO site 9 /t femoral vein 1. A5. hrs before procedure $. protect site of catheterization. =void fle"ion of Joints pro"imal to site. !. assess for complication 9 infection, thrombus formation 9 chec- pedal pulses 4 dorsalis pedis6 3gt. 1.6 long term antibiotic 9 to prevent subacute bacterial endocarditis $.6 open heart surgery$.B ASD 9 failure of foramen ovale to close 2G2U 1. systolic murmur Q upper border of sternum $. result of cardiac catheterization G D<G same with E21 3gtO open heart surgery !.6 endo$ardial $ushion de/e$ts - atrium ventricular 4=E6 - affects both tricuspid and mitral valve 1" 9 confirmed by cardiac catheterization 3gtO - open heart surgery =ntibiotics to prevent subacute bacterial endocarditis #.6 51= - failure of ductus arteriosus to close - should close within $# h -complete close 9 1 month 2G2" 1. continuous machinery li-e murmurs $. prominent radial pulse !. D<G- hypertrophy 7eft ventricle 1rugO 1. endomethazine 9 prostaglandin inhibitor - facilitate closing of 51= $. ligation of 51= by !-# yo !. thoracotomy procedure- na-adapa child 7.BPulmunar# Stenosis- narrowing of valve of pulmo artery 2 G2"O 1.6 typical systolic eJection murmur $. 2$ sound widely split !. D<G- 7t ventricular hypertrophy .6Aorti$ Stenosis 9 narrowing of valve of aorta 2 G 2"O 1. inactive, s" sme with angina $. typical murmur !. rough systolic sound and thrill #. D<G- 7eft ventricular hypertrophy cardiac catheterization3gt 5ulmo 2tenosis G =ortic 2tenosis 1.6 balloon stenostomy

$1

$.6 surgery 1uplication of =ortic =rch- doubling of arch of aorta causing compression to trachea and esophagus 2G2" O 1. dysphagia $. dyspnea !. left ventricular hypertrophy 3gtO - close heart surgery B.6 Coartation o/ Aorta 9 narrowing of arch of aorta outstanding 2" O absent femoral pulse @5 increased on upper e"tremities and decreased on lower e"tremities D<G 9 hypertrophy 7ft ventricle 3gtO close heart surgery CCA O1)C 4'A(1 D'F'C1S ( to ! 1. Transportation of Great =rteries 4T.G=6 - aorta arising from /t ventricle pulmo artery arising form 7t ventricle .utstanding 2"O 1. cyanosis after 1st cry 4due no e"ygenation6 $. polycythemia 9 increased /@< )compensatory due to .$ supply)viscous blood )thrombus ) embolus ) stro-e !. D<G 9 cardiomegaly <ardiac cath 9 decreased .$ saturation 5alliative repair 9 rash-ind procedure <omplete repair 9 mustard repair $.6 1otal Anomalous Pulmonar# venous return 9 pulmo vein instead of entering 7t atrium, enters /t atrium or 2E< :ncreased pressure on /t so blood goes to 7ft .utstanding 2"O .pen foramen ovale 3ild to moderate cyanosis 5olycythemia ) thrombus ) embolus ) stro-e asplenia- absent spleen 3gtO restructuring of heart !.6 1run$us Arteriousus- aorta G pulmo artery is arising fr 1 single vessel or common trun- with E21 2 G 2" 1. cyanosis $. polycythemia 9 thrombus ) embolus ) stro-e 3gtO &eart transplant #.6 4#poplasti$ !e/t heart s#ndrome 9 non f" 7eft ventricle 1. cynosis $. polycythemia 9 throm, emb, stro-e 3gtO heart transplant *.6 1ri$uspid atresia 9 failure of tricuspid valve to open 2G2UO open foramen ovale 4/ to 7 shunting 9 goes to 7t atrium6 cynosis, polycythemia 3gtO fontan procedure 9 open tricuspid valve .6 1etralog# o/ Fallot 5 9 pulmonary stenosis E 9 ventricular 21 . 9 overriding or de"troposition of aorta / 9 /t ventricular hypertrophy 2 G2"O 1. /t ventricular hypertrophy

$$

$. !. #. *. . F. B. >. 1+. 3gtO 1. $. !. #. *.

high degree of cyanosis polycythemia severe dyspnea 9 squatting position 9 relief , inhibit venous return facilitate lung e"pansion. growth retardation 9 due no .$ tet spell or blue spells- short episodes of hypo"ia syncope clubbing of fingernails 9 due to chronic tissue hypo"ia mental retardation 9 due decreased .$ in brain boot shaped heart 9 "-ray .$ no valsalva maneuver , fiber diet la"ative morphine 9 hypo"ia propranolol 9 decrease heart spasms palliative repair 9 @7T blaloc- taussig procedure @roc- procedure 9 complete procedure

ACD;)('D 4'A(1 DS'

1. (4D (heumati$ 4eart Disease - inflammation disease ff an infection acquired by group = @eta hemolytic strepto coccus =ffected body 9 cardiac muscles and valves , musculos-eletal , <A2, :ntegumentary 2orethroat before /&1 =schoff 9 rounded nodules with nucleated cells and fibroblasts 9 stays and occludes mitral valve.

0ones Criteria 3aJor 1. polyarthritis 9 multi Joint pain $. chorea 9 sydenhamms chores or st. vetaus dance-purposeless involuntary hand and shoulder with grimace !. carditis 9 tachycardia erythema marginatum - macular rashes 2; nodules 3inor 1. arthralgia 9 Joint pain $. low grade fever

!. all lab results increase antibody 8 < reactive protein 8 erythrocyte sedimentation rate 8 anti streptolysin o titer 4=2.6 <riteriaO5resence of $ maJor, or 1 maJor and $ minor K history of sore throat will confirm the d". Asg <areO 1. <@/ $. throat swab 9 culture and sensitivity !. antibiotic mgt 9 to prevent recurrence #. aspirin 9 anti-inflammatory. 7ow grade fever 9 don0t give aspirin. 2(D of aspirinO - /eyes syndrome 9 encephalopathy- fatty infiltration of organs such as liver and brain /espiration Aewborn resp 9 !+- + cpm, irregular abd or diaphramatic with short period of apnea without cyanosis.

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T 1* secs 9 normal apnea 9newborn /esp <hecAewborn 9 #+ 9 >+ 1 yr - $+ 9 #+ $-!yr $+ 9 !+ * yrs $+ 9 $* 1+ yrs 1F 9 $$ 1* G above 1$- $+ 5('A14 SO; DS 4'A(D D;() G ASC;!1A1)O > 1.6 ED2:<M7=/ 9 soft, low pitched, heard over periphery of lungs, inspiration longer then e"piration -Aormal $.6 @/.A<&.ED2:<M7=/- soft, medium pitched, heard over maJor bronchi, inspiration equals e"p. Aormal !.6 @/.A<&:=7 2.MA12- loud high pitched, heard over trachea, e"piration longer than inspiration. Aormal #.6 /&.A<&: 9 snoring sound made by air moving through mucus in bronchi. Aormal *.6 /=7D2-or crac-les 9 li-e cellophane 9 made by air moving through fluid in alveoli. =bnormal- asthma, foreign body obstruction. .6 W&DDV:AG- whistling on e"piration made by air being pushed through narrowed bronchi .=bnormal 9 asthma, foreign body obstruction F.6 2T/:1./- crowing or ropster life sound 9 air being pulled through a constricted laryn". =bnormal 9 resp obstruction =sthma- pathognomonic sign 9 e"piratory wheezing 5et 9 fish. 2port 9 swimming 1rugs 9 amynophylline 9 monitor bp, may lead to hypotension 7aryngo Tracheo @ronchitis 7T@ - inspiratory stridor 9 pathognomonic sign /12 respiratory dist synd or hyaline membrane dis <ause- lac- of surfactant 9 for lung e"pansion &ypotonia, 5ost surgery, <ommon to preterm Fi,rine h#aline 2" 9 definite with in 1st of life :ncrease // with retraction :nspiratory grunting 9 pathognomonic F 9 1+ severe /12 4silvermenn =nderson inde"6 cyanosis due to atelectasis 3gtO 1. surfactant replacement and rescue $. pos- head elevated !. proper suctioning #. o$ with increase humidity- to prevent drying of mucosa *. monitor E(2 s-in color , =@G . <5=5- continuous K a(w pressure F. 5DD5 - K end e"piratory pressure 5urpose of P -F- to maintain alveoli partially open and alveoli collapse !A(C GO1(AC4'O5(O C4)1)S 7T@ 9 most common Creup -viral infection of laryn", trachea G bronchi outstanding s" croupy cough or bar-ing pathognomonic stridor - labored resp - resp acidosis - end stage 9 death

$#

7abO 1. =@G $. nec- and throat culture !. d"- nec- "-ray to rule out epiglotitis Asg 3gtO 1. bronchodilators $.increase o$ with humidity !. prepair tracheostomy set 5(O C4O!)1)S- :nflammation of bronchioles 9 tenatious mucus <ausative agaent 9 /2E - /esp sincytial viruses 2"O flu li-e s" :ncreased // 1rugO =ntiviral 9 /ibavirin Dnd stage 9 epiglotitis 'P)G!O1)1)S - infl of epiglottis - emer. <ondition of M/T: 2"O sudden onset Tripod position 9 leaning forward with tongue protrusion - never use tongue depressor prepare tracheotomy set T * yo 9 unable to cough out, put on mist tent 4humidifier o$6 or croupe tie Asg <areO chec- edges tuc-ed on mist tent 5rovide washable plastic material Ao toys with friction due .$ on Ao hairy toys 9 due moist environment medium for bacterial growth @5 9 B+(# mm&g newborn @5 after 1+ days- 1++(*+ @5 ta-ing begins by ! yo <.= 9 ta-e @5 on # e"tremities S*) > =crocyanosis 5)(143A(*S> 1. 3ongolian spots 9 stale gray or bluish discoloration patches commonly seen across the sacrum or buttoc-s due to accumulation of melanocytes. 1isappear by 1 yr old $. 3:lla 9 plugged or unopened sebaceous gland . white pin point patches on nose, chin or chee-. !. 7anugo 9 fine, downy hair 9 common preterm #. 1esquamation 9 peeling of newborn, e"treme dryness that begin sole and palm. *. 2tor- bites 4Talengeictasi nevi6 9 pin- patches nape of nec hair will grow as child grows old . Drythema To"icum 9 4flea bite rash6- 1st self limiting rash appear sporadically G unpredictably as to time G place. F. &arlequin sign 9 dependent part is pin-, independent part is blue 4side lying 9 bottom part is dependent pin-6 B. <utis 3armorato 9 transitory mottling of neonates s-in when e"posed to cold. >. &emangiomas 9 vascular tumors of the s-in " t#pes 4emangiomas a.6 Aevus Clammeus 9 port wine stain 9 macular purple or dar- red lesions seen on face or thigh. ADED/ disappear. <an be removed surgically b.6 2trawberry hemangiomas 9 nevus vasculosus 9 dilated capillaries in the entire dermal or subdermal area. Dnlarges, disappears at 1+ yo. c.6 <avernous hemangiomas 9 communication networ- of venules in 2; tissue that never disappear with age. - 3.2T 1=AGD/:.M2 9 intestinal hemorrhage 2-in color blue 9 cyanosis or hypo"ia White 9 edema Grey 9 inf Hellow 9 Jaundice , carotene

$*

Eerni" <aseosa 9 white cheese li-e for lubrication, insulator @M/A T/=M3= 9 inJury to body tissue caused by e"cessive heat. =ATD/:./ >.* 1 $ 1.* 1! 1! 1! 1 $.*Q $.F* $.* 1.F* :AC=AT 5.2TD/:./ >.* 1 $ 1.* 1.$* =nt *-> yo 5ost .* .* 1 1 $ $ 1.* 1.* 1.$* 1.$* 1! 1! 1 $.* Q # # ! ! 1.F* 1.F*

&ead AecMpper arm 7ower arm &and Trun@acGenital Q buttoc-s Thigh 7eg foot

$.F* $.* 1.F*

D'P14 1st degree 9 $nd degree 9 !rd degree 9 3gtO 1.6 1st aid

partial thic-ness 9 superficial epidermis - erythema, dryness, 5=:A -sunburn, heals by regeneration from 1 9 1+ days epidermis G dermis- erythema, blisters, moist, e"tremely painful scalds full thic-ness- epidermis, dermis, adipose tissue, fascia, muscle G bone lethargy, white or blac-, not painful 9 nerve endings destroyed e". lava burns a.6 put out flames by rolling child on blan-et b.6 immerse burned part on cold &$o c.6 remove burned clothing of with sterile material d.6 cover burn with sterile dressing

$.6 a(w a.6 suction 5/A, o$ with increased humidity b.6 endotracheal intubation c.6 tracheostomy !.6 5reventiuon of shoc- G CGD imbalance a. colloids to e"pand bld volume b. isotonic saline to replace electrolytes c. de"trose G &$o to provide calories #.6 Tetanus to"oid booster *.6 /elief of pain 9 :E analgesic 3./5&:AD 2.# 9 needed for $nd degree 9 very painful .6 1st defense of body 9 intact s-in prevention of wound infection a.6 cleaning G debriding of wound b.6 open or close method of wound care c.6 whirlpool therapy 9 drum with solution F.6 s-in grafting 9 !rd degree 9 thigh or buttoc-s 4autograft6, pigs( animals 9 "enograft frozen cadaver 9 hallow graft B,6 diet 9 increase <&.A, increase calories. A1OP)C D'(3A1)1)S- infantile eczema 4galis6 5apulo vesicular erythematus lesions with weeping G crusting <ause 9 food allergiesO mil-, citrus Juice, eggs, tomatoes, wheat 2"O e"treme pruritus, linear e"coriation, weeping crustingL scaly shiny and white 9 lechenification Goal o/ $areO decrease pruritus 9 avoid food allergens 1ietO 5rosobi or :somil

&ydrate s-in, borow solution 1, hydrocortisone cream 5revent infection 9 proper handwahsing, trim nails )3P'1)GO- s-in disease. <ausative agent 9 grp = beta &emolytic streptococcus - papulovesicular surrounded by localized erythema 9becomes purulent , oozes a honey colored crust Pedi$ulosis$apitis 98RMT.' - 3gtO proper hygiene 9 wash soap and &$o, oral penicillin 9 bactroban ointment <an lead to acute glomerulonephritis =GA AC '- adolescent problem - self limiting infl dis 9 sebaceous gland comedones 9 sebum causing white heads - sebum- lipids causing acne bulgaris 3gtO - proper hygiene- mild soap or sulfur soap- antibacterial retin = or tretinoi

A '3)A-pallor <ausesO 1.6early cutting of cord 9 preterm 9 cut umb cord =2=5 fullterm 9 cut umb cord when pulsation stops $.6 @leeding disorders 9 blood dyscrasias 4'3OP4)!)A 9 deficiency of clotting factor. U lin-ed recessive 9 inherited :f mom 9 carrier, son 9 affected :f father carrier- transmitted to daughter &emophilia = 9 deficiency of coagulation component factor B &emophilia @ 9or christmas disease, deficiency of clotting factor > &emophilia < 9 deficiency of clotting factor 11 =ssessmentO - umphalagia 9 earliest sign - newborn receive maternal clotting factor - newborn growing 9 sudden bruising on bump area- mar-s earliest sign - continuous bleeding 9 hematrosis 9 damage or bleeding synovial membrane 1" test O 5TT. 5artial thromboplastin time 9 reveals deficiency in clotting factor 7ong Term Goal- prevention of inJury Asg 1"increase ris- of inJury &TO avoid contact sport, swimming only, don0t stop immunization 9 Just change gauge of needle Calls 9 immobilized , elevate affected part, apply pressure-not more then 1+ min cold compress -determine case before doing invasive procedure !';*'3)A- grp of malignant disease - rapid proliferation of immature W@< - W@< 9 protection from infection, soldiers of body <lassification O 1. !#mpho 9 affects lymphatic system $. 3#elo 9 affects bone marrow !. a$ute E ,lasti$- affects immature cells #. $hroni$E $#sti$- affects mature cells 3OS1 CO33O CA C'( 9 4=776 9 =cute 7ymphocytic 7eu-emia 2G2"O 1. from invasion of bone marrow signs of infection a.6 fever

$F

b.6 poor wound healing c.6 bone wea-ness G causes fracture signs of bleeding a.6 petecchiae-small, round, flat, dar- red spot b.6 epista"is c.6 blood in urine( emesis signs of anemia a.6 pallor , body malaise , constipation $. from invasion of body organ- hepato spenomegaly 9 abd pain , <A2 affectation, increase :<5 1" TestsO 1. 5@2- peripheral blood smear 9 determine immature /@< $. <@< 9 determine anemia, leu-ocytosis, thrombocytopenia neutropenia !. lumbar puncture 4756 9 determine <A2 involvement. @efore 75, fetal pos.- avoid fle"ion of nec- 9 will cause a(w obstruction.8<' position or shrimp position only. #. bone marrow aspiration 9 determine blast cells, - common site- iliac crest - post @3= s(effect 9 bleeding - apply pressure. 5ut pt on affected side to prevent hemorrhage *. @one scan 9 determine bone involvement . <T scan 9 determine organ involvement Therapeutic 3gtO 1()AD> 1. surgery $. irradiation !. chemotheraphy Cocus Asg <areO prevent infection - !'2'!S OF C4'3O14'(AP4C 1. induction 9 goal of t"L to achieve remission medsO :E vincristine 7- agpariginase .ral predinisone $. 2anctuary- treat leu-emic cells that invaded testes G <A2 giveO methotri"ate- adm intrathecally via <A2 or spine cytocine, =rabinoside, steroids with irradiation !. maintenance- to continue remission giveO oral methotrisate 9 chec- W@< -adm of methotrisate 9 do wee-ly W@< chec#. /einductin 9 treat leu-emic cells after relapse occurs. 3eds 9 same as induction - give antigout agentsO allopurinol or Vyloprim- treat or prevent hyperurecemic nephropathy. .utstanding nsg d"O alteration in nutrition less body requirement. @ased on 3aslow0s heirarchy SE'//e$t o/ Chemotherap# 1. A(E 9 adm antiemetic drugs !+ mins before chemo until 1 day after chemo $. Mlcerations ( stomatitis ( abscess of oral mucosa- 4alteration nutrition less body req6 - oral care 9 alcohol free mouthwash , betadine mouthwash - don0t brush 9 use cotton pledgets - topical "ylocaine before meals diet- soft, bland diet according to child0s preference Temporary 2(D of chemoO =lopecia 9 altered body image &irsutism 9 hair -give emotional support to parents sg mgt>

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A5O in$ompati,ilit# 9 3ost common incompatibility 9 4 mom6 . 9 4 fetus6 = 3ost severe incompatibility 43om6 .9 4Cetus6 @ <an affect 1st pregnancy

4#drops 4h$+6 Fetalis 9 edematous on lethal state with pathologic Jaundice Within $# h 3gtO 1. initiate breastfeeding to get colostrum $. Temp suspension of breastfeeding - content breast mil- pregnanedioles 9 that delays action of glucoronil transferees liver enzymes converts in direct bilirubin to become direct bilirubin !. Aeeds phototherapy #. needs e"change therapy &yperbilirubinemia - ? 1$ mg(d7 of indirect bilirubin among full term Aormal 9 +-! mg(d7 - bilirubin encephalopathy - Remicterus - ? $+ mg(d7 among full term G ?1$ mg (dl of indirect 9 preterm )can lead to cerebral palsyPh#siologi$ Faundi$e 9 Jaundice within #B -F$ h 4$-! days6 e"pose morning sunlight 5athologic Saundice 9 within $#h. Saundice during delivery. @reastfeeding Jaundice 9 caused by pregnanediole =ssessment of Saudice O 1. @lanching neonates forehead, nose or sternum - yellow s-in G sclera - color of stool 9 light stool - color of urine 9 dar- urine 3gtO 5hototheraphy 9 photo o"ygenation Asg /espO 1. cover eyes 9 prevent retinal damage $. cover genitals 9 prevent priapism 9 painful continuous erection !. change position regularly 9 even e"posed to light #. increase fld inta-e 9 due prone to dehydration *. monitor :G. 9 weigh baby . monitor E(2 9 avoid use of oil or lotion due- heat at phototherapy ) bronze baby syndrome-transient 2(D of phototherapy weigh diaper 1gm ) 1cc &ead 9 largest part of baby W of its length Craniostenosis or $raniosinustosis 9 premature closing of fontanel &ydrocephalus 9 ant fontanel open after 1B mos 3icrocephaly 9 small growing brain due- alcohol G &:E mom =nencepahly 9 absence of cerebral hemisphere <raniotabes 9 localized softening cranial bone. <ommon 9 1st born child

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-due early lightening 4$ wee-s prior to D116 /ic-ets of Eit @ deficiency 9 soft cranial bone in older children <aput 2uccedaneum 9 edema of scalp due prolonged pressure at birth <harO 1. $. !. present at birth crosses suture lines disappear after $-! days

Cephalhematoma- collection of blood due to rapture of pericostal capillaries <har O 1. present after $# h $. never cross suture line !. disappear after #- wee-s #. monitor for developing Jaundice Se,orrhei$ Dermatitis 9 Xcraddle cap' 2caling, greasy appearing salmon colored patches 9 seen on scalp behind ears and umbilicus <auseO - improper hygiene 3gtO 1. proper hygiene $. put oil night before shampoo - baby oil 4#dro$ephalus 9 e"cessive accumulation of <2C 1. communicating 9 e"tra ventricular hydrocephalus $. non-communicating- intraventricular hydrocephalus or obstructive hydrocephalus due to tumor obstruction 2" 9 :<5 9 abnormally large head, bulging fontanel - cushings triad - high pitched cry older child 9 diplopia 9 eye deviation, proJectile vomiting - fontanel bossing 9 prominent forehead - - prominent s-ull vein - sunset eyes 3gtO position to lessen :<5 9 low semi-fowlers !+ degree angle =dminister- osmotic diuretic 3annitol( .smitrol , 1iame"- =zetam 1ecrease <2C production 2hunting 9 =E shunt or Ep shunt 4ventriculoperitoneal shunt6 2have hair 9 in ./ 9 to prevent growth of micro org. Asg <areO 1.6 post E5 shunt 9 side lying on non operated site - to prevent increase :<5 monitor for good drainage - sign 9 sun-en fontanel bulging fontanel 9 bloc-ed shunt change fontanel as child is growing S' S'S DHD2O =ssessment 1. chec- for symmetry $. sclera 9 normal color 9 light blue then become dirty white pupil 9 round- adult size coloboma- part of iris is missing signO -ey hole pupil whiteness G opacity of lens congenital cataract cornea 9 round G adult size large 9 congenital glaucoma 1est /or ,lindness common tests 1. newborn 9 general appearance

!+

- can only see 1+ 9 1$ 8 - visual acuity $+ ($++ to $+( B++ 1oll0s eyes test- test for blindness - done 1+th day - pupil goes opposite to direction when head is moved Globellars test 9 test for blin- refle". 5oints near nose 9 baby should blin$. :nfant G children - appearance - ability to follow obJect past midline !. ! yrs 9 school age - general appearance =llen cards 9 test for visual acuity. 2how picture $+ ft away :shiharas plates 9 test for color blindness 5rechool D chart - test for stereopsi of depth perception <over testing test 9 cover 1 eye for 1+ 9 1* min. Then remove. Test for strabismus #. 2chool age 9 adult - general appearance - snellens test /etinobastoma 9 malignant tumor of retina .utstanding sign O oat0s eye refle"-whitish glow of pupil - red painful eye - blindness surgery 9 Dnucliation 9 removal of eyeball put artificial aye OS'> 1. flaring alenase 9 case of /12 $. cyanosis at rest 9 choanal atresia - post nares obstructed with bone or membrane 2"O 1. resistance during catheter insertion $. emer. 2urgery within $# h normal color nasal membrane 9 pin-ish rhinitis 9 presence of creases G pale chec- sense of smell 9 blindfold 9 smell &air in nose 9 cilia =dolescent no hair with ulceration of nasal mucosa suspect cocaine user 'pistasis 9 nosebleed - sit upright, head slightly forward to facilitate drainage - $old compress , apply gentle pressure, epinephrine most developed sense of newborn 9 sense of touch 1st sense to develop G last to disappear 9 hearing 'A(S> 1. 5roperly aligned with outer cantus of eyes low set ear 9 -idney malformation e". /enal aginesis 9 absence of -idney sign in uterus O oligohydramnios sign in newbornO $ vessel cord failure to void within $# h 3gtO -idney transplant

!1

Chromosomal a,errations O -advance maternal age 1. non disJunction 9 uneven division 1risom# 21 - down syndrome - e"tra chromosome #F"" K $1 - related to advance paternal age 2"O 3ongolian slant @road flat nose 5rotruding nec5uppy0s nec&ypotonic 9 prone to resp problem 2imean crease 9 single transverse line on palm. 1risom# 18 9 8endvard syndrome' 1risom# 1"patau syndrome 1urner 9 3onosomy of U synd. - #*"+ - affected girls - signs evident during puberty - has poorly developed $dary se"ual char. - 2terile *line/elters S#ndrome- has male genitalia - #F UUH - poorly devt secpndary se"ual characteristics - no deepening of voice -small testes, penis -sterile Rlinefelter 9 <alvin Rline 9 male Turner 9 Tina Turner 9 female Otitis 3edia 9 inflammation of middle ear. <ommon children due to wider G shorter Dustachian tube <auses 1.6 bottle propping $.6 <left lip( cleft palate 9 2"O .titis 1. bulging tympanic membrane, color 9 pearly gray $. absence light refle" !. observe for passage of mil-y, purulent foul smelling odor discharge #. observe for M/T: Asg <areO 1. position side lying on affected aside 9 to facilitate drainage $. supportive care- bedrest, increase fld inta-e 3ed 3gtO 1. 3assive dosage antibiotic <omplication 9 bacterial meningitis $. =pply ear ointment 2chool age 9 up and down T ! yo 9 down G bac? ! yo 9 up G bac2mall child 9 down G bac- 4 no age6 surgery 4to prevent permanent hearing loss69 otitis media 9 myringotmy with tympanostomy tube post surgery 9 position affected side for drainage both 9 put ear plug

!$

if tympanous tube falls 9 healed na 5ells Pals#- facial nerve PF paralysis /(T forcep delivery 2". 1. <ontinuous drooling saliva $. inability to open , eye G close either eye 3gtO /efer to 5T TDC 4Tracheoesophageal Cistula6-TD=- no connection bet esophagus and stomach .utstanding 2" 9 <oughing <ho-ing <ontinuous drooling <yanosis 3gtO Dmergency surgery 'pstein pearl 9 white glistering cyst at palate G gums related to hypercalcemia 4#pervitaminosis Aatal tooth 9 tooth at birth. 3ove with gauze Aeonatal tooth 9 tooth within $Bdays of life 3oniliasis 9 oral candidiasis - white cheese li-e, curd li-e patches that coats tongue - oral thrush - Asg <are 9 don0t remove, wash with cold boiled &$o 3eds 9 nystatin ( 3ysnastatin 9 antifungal *awasa=i Dse--strawberry tongue - originated in *orea - 1r. Rawasa-i discovered it - common in Sapan - 8mucocutaneous 7ymphnode 2yndrome' 2"O -persistent fever 9 * days -strawberry tongue , -desquamation of palm G sole - lymph adenopathy ? 1.* cm 1rugO aspirin <an lead to 3: !)PS- symmetrical Cle/t lip 9 failure of median ma"illary nasal process to fuse by *-B w-s of pregnancy - common to boys - unilateral Cle/t Palate- Cailed palate to fuse by > 9 1$ w-s of pregnancy - common to girls - unilateral or bilateral 2"O 1. $. !. evident at birth mil- escapes to nostril during feeding frequent colic G otitis media or M/T:

3gtO 1. 2urgery cleft lip repair 9 <heiloplasty )done 1-! months to save suc-ing refle" 4lost in <left 5alate- uranoplasty ) done #- months to save speech Pre op $are

months 6

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1. $. !. #. *.

emotional support especially to mom proper nutrition prevent colic feed 9 upright seating or prone pos burp frequently $" at middle and after feeding-lower to upper tap orient parents to type of feeding rubber tipped syringe 9 cheiloplasty paper cup( soup spoon( plastic cup 9 urano plasty apply restraints 9 elbow restraints so baby can adJust post op

<ondition that warrants suspension of operation - colds G pharyngitis ) can lead to generalized infection 9 septicemia Post Op sg Care > 1. airway 9 positon post cheilopasty 9 side lying for drainage post uranoplasty 4tonsillectomy6- prone $. assess for /12 s" bleeding !. assess for bleeding 9 freq swallowing. -F days after surgery 9 bleeding #. proper nutrition - clear liquids- 4 gelatin e"cept red or brown color due may mas- bleeding6 - 4 popsicle- not ice cream6 full liquid soft diet regular diet *. 3aintain integrity of suture line such asO 7ogan bar 9 wash % strength &ydrogen 5ero"ide G saline solution- @ubbling effect traps microorganism - prevent baby form crying for pain- analgesic 'C*1.6 chec- symmetry <ongenital torticolis- 8 wrynec-'-burn inJury of sternocleidomsstoid muscle during delivery 9 due to e"cessive traction at cephalic delivery 3gtO passive stretching e"ercise , 2urgery <omplication 9 scoliosis 14C(O)D gland 9 for basal metabolism <ongenial cretinism 9 absence or non functioning thyroid glands reasons for delaying d"O 1. Thyroid glands covered by sternocleidomastoid muscles in newborn $. baby received maternal thyro"ine !. baby sleeps 1 9 $+ h a day earliest signO 1. change in crying $. change in suc-ing !. sleep e"cessively #. constipation *. edema 9 moon face late sign 1. mental retardation prognosis O mental retardation preventable when 1" is early 1"O 1. 55:-protein $. radioimmunoassay test !. radioactive iodine upta-e

!#

3gtO synthroid 9 sodium 7evothyrosine -synthetic thyroid given lifetime - chec- pulse rate before giving synthroid - tachycardia 9 2" of hyperthyroidism C4'S1 1. symmetry $. breast - transparent fluid coming out from newborn related to hormonal changes!. chest has retroactive 9 /12 #. sternum sun-en 9 pectus e"cavation A5DO3' 4in order6 1. inspection : $. =uscultation = !. percussion 5 #. 5alpation 5 ) Will change bowel sounds, so do last Aormal contour of abd 9 slightly protruding 2un-en abd- diaphramatic hernia 9 protrusion of stomach content through a defective diaphragm due to failure of puroperitoneal canal to close. 2"O 1. $. !. 3gtO sun-en abd 2" of /12 / to 7 shunting Dmergency surgery within $#h .mphalocele 9 protrusion of stomach contents in between Junction of abd wall and umbilicus. 3gtvery small surgery :f large 9 suspension surgery Asg 3gtO protect sac- sterile wet dressing Gastro$hisis 9 absence of abd wall Asg 3gtO sterile wet dressing F: o/ G)1 1. assists in maintaining CGD G acid base balance $. 5rocesses G absorbs nutrients to maintain metabolism G support G G 1 !. e"crete waste products from digestive process /ecommended 1aily =llowance <alories O 1$+ cal ( Rbw(day 4-ilo body wt6 ! + 9 !B+ cal( day <&.AY $.$g (Rbw(day Prin$iples in Supplementar# Feeding 2upplementary Ceeding usually 9 mos 2upplementary feeding given 9 # mos. a.6 solid food offered to ff sequenceN 1. cereals 9 rich in iron $. fruits !. veg #. meat b.6 begin with small quantities c,6 finger foods 9 offered months d.6 soft table food 9 8modified family menu' given 1 yr e.6 dilute fruit Juices 9 mos f.6 never give half coo-ed eggs 9 usually causes of salmoneliosis

!*

g.6 don0t give honey 9 infant botulism h.6 offered new food one at a time 9 interval of # 9 Fdays or 1 wee- 9 determines food allergens 1otal 5od# Fluids- comprises * - B*, of body wt of infants G children Where fluids are greater in infants D"tracellular fld 9 prone to develop dehydration =cid @ase @alance dependent on the ffO a. chemical buffers b. renal G resp system involvement c. dilution of strong acids and bases in bld /esp =cidosis 9 carbonic acid e"cess - hypoventilation - /12 - <.51 - 7aryngotracheobronchitis 47T@6 /esp =l-alosis 9 carbonic acid deficit - hyperventilation - fever - encephalopathy 3et. =cidosis 9 base &<.! deficit - diarrhea - severe dehydration - malnutrition - ciliac crisis 3et =l-alosis 9 base &<.! e"cess - uncontrolled vomiting - AGT aspiration - Gastric lavage

P(O5!'3S !'AD)) G 1O F@' )35A!A C' 1. vomiting 9 forceful e"pulsion of stomach content 2"O 1. nausea $. dizziness !. facial flushing #. abd cramping assessO 3gtO amt, freq, force proJectile vomiting) increase :<5 or pyloric stenosis @/=T diet - banana, rice 9 cereal, apple sauce, toast

2. Diarrhea 9 e"aggerated e"cretion of intestinal contents TypesO =cute diarrhea 9 related to gastroenteritis, salmoneliosis - dietary indiscretions - antibiotic use <hronic non specific diarrhea <auseO 1. food intolerance $. e"cessive fld inta-e !. <&., <&.A malabsorption =ssessO freq, consistency, appearance of given colored stool. @est criteria to determine diarrhea O consistency

<omplication ) dehydration 3ild dehydration *, wt loss 3oderate dehydration 1+, wt loss 2evere dehydration 1* , wt loss 'arliest s: o/ deh#dration tachycardia increase temp tachypnea sun-en fontanel G eyeballs hypotension absence of tears Severe deh#dration> .liguria , 5rolonged capillary refill time 3gtO =cute 9 A5. 4 rest the bowel 6 - with fluid replacement 9 :E - prone to &ypo-alemia 9 give R chloride before adm of R chloride 9 chec- if baby can void, if cant void 9 hypo-alemia 1rugO Aa &<.! 9 adm slowly to prevent cardiac overload Gastric 3otility 1isorderO 4)(SC4P(; GS D)S'AS' 9 congenital aganglionic megacolon =ganglionic 9 absence of ganglion cells needed for peristalis Darliest sign 1. failure to pass mecomium after $#h $. abd distension !. vomitus of fecal material early childhood 9 ribbon li-e stool foul smelling stool constipations diarrhea 1"O 1. @arium enema 9 reveals narrowed portion of bowel $. /ectal @iopsy 9 reveals absence of ganglionic cells !. abd "-ray 9 reveals dilated loops on intestine #. rectal manometry 9 revels failure of intestine sphincter to rela" Therapeutic 3gt(Asg care 1. AGT feeding 9 measure tube fr nose to ear to midline of "yphoid G umbilicus $. surgery a.6 temp colostomy b.6 anastomosis G pull through procedure 1ietO :ncrease <&.A, increase calories , decrease residue 9 pasta G'(- Gastroesophageal (e/lu: <halasia 9 presence of stomach contents to esophagus Will lead to esophagitis complication 9 aspiration pneumonia weight loss scanty urine

'sophageal $an$er =ssessment O 1. chronic vomiting $. faiture to thrive syndrome !. organic 9 organ affected #. melena or hematemesis 9 esophageal bleeding

!F

1" procedure 1. barium esophogram 9 reveals reflu" $. esophageal manometry 9 reveals lower esophageal sphincter pressure !. intra esophageal p& content 9 reveals p& of distal esophagus. 3eds o/ G'(D =nti-cholinergic a.6 @etanicol 4 urecholine6 9 increase esophageal tone G peristaltic activity b.6 3etachloporomide 4/eglam6 9 decrease esophageal pressure by rela"ing pyloric G duodenal segments - increase peristalsis without stimulating secretions c.6 &$ &istamine /eceptor =ntagonist 9 decrease gastric acidity G pepsin secretion - Vimetidine, /anitidine 4Vantac6 9 ta-e !+ min before meals d.6 antacid 9 neutralizes gastric acid between feedings - 3aalo" 2urgeryO Aissen funduplication O <hronic vomiting 9 - thic-ened feeding with baby cereals - effective if without vomiting - feed slowly, burp often every 1 ounce - positioning T > months 9 infant sit with infant supine ? > months 9 prone with head of mattress slightly elevated !+ degree angle O5S1(;C1)2' D)SO(D'(S =. 5H7./:< 2TDA.2:2 9 hypertrophy of muscles of pylorus causing narrowing G obstruction. 1.6 outstanding 2"- proJectile vomiting - vomiting is an initial s" of upper G: obstruction - vomitus of upper G: can be blood tinged not bile strea-ed. 4with blood6 - vomitus of lower G: is bilous 4 with pupu6 - proJectile vomiting 9 increase :<5 or G: obstruction - abd distension 9 maJor s" of lower G:T obst $.6 met al!.6 failure to gain wt #.6 olive shaped mass 9 on palpation *.6serum electrolyte 9 increase Aa G R, decrease chloride .6 ultrasound F.6 " ray of upper abd with barium swallow reveal 8string sign' 3gtO 1. $. 5yleromyotomy Credet /amstedt procedure

) S1;SS;SC'P1)O - invagination or telescoping of position of bowel to another <ommon site 9 ilio-secal Junction 5rone ptO person who eats fat <omplication 9 peritonitis 9 emergency 2"O 1.6 persistent paro"ysmal abd pain $.6 vomiting !.6 currant Jelly stool- dye bleeding G inflammation - palpate sausage shaped mass 3gtO 1.6 &ydrostatic reduction with barium enema $.6 =nastomosis G pull thru procedura :nborn Drrors of 3etabolism- deficient liver enzymes P4' C!*'1O ;()A 45RM6 9 deficiency of liver enzymes 45&T6 5henylalaninehydro"ylase Transferase 9 liver enzyme that converts <&.A to amino acid > amino acidsO

!B

valine lysine

isolensine phenylalanine

tryptophase

Thyronine 9 decrease malanine production 1.6 fair comple"ion $.6 blond hair !.6 blue eyes Thyro"ine 9 decrease basal metabolism - accumulation of 5henyl 5yruvic acid #.6 =topic dermatitis *.6 musty ( mousy odor urine .6 seizure 9 mental retardation Test 9 GMT&/:D TD2T 9 specimen 9 blood - preparation increase <&.A inta-e - test if <&.A will convert to amino acid specimen and urine mi"ed with pheric chloride, presence of green spots at diaper a sign of 5RM D)'1> 7ow phenylalanine diet- food contraindicated- meats, chic-en, mil-, legumes, cheese, peanuts Give 7ofenalac- mil- with synthetic protein Gala$tosemia 9 deficiency of liver enzyme - GM5T 9 Galactose Mrovil 5hosphatetranferase - <onverts galactose to phosphate tranferace glucose Galactose 9 will destroy brain cells if untreated 9 death within ! days 1"O @eutler test 9 get blood -done after 1st feeding presence of glucose in blood 9 sign of galactosemia galactose free diet lifetime neutramigen 9 mil- formula C'!)AC D)S'AS' 9 gluten enteropathy <ommon gluten foodO :ntolerance to food with brow @- barley /- rye .- oat W- wheat

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Darly 2"O Gluten 9 glutamine 4 normal absorption6 Gliadin 4 to"ic to epithelial cells of villi of intestines, effects is malabsorption syndrome6

3alabsorption

Cats

<&.A G <&. peripheral edema G malnutrition

Eit 1 calcium

Eit R

:ron folic acid

:nadequate blood

coagulation
2teatorrhea .steomalasia
@leedin

anemia

gg 1. $. !. diarrhea 9 failure to gain wt ff diarrheal episodes constipation vomiting

7ate 2"O 1. abd pain 9 protruberant abd even if with muscle wasting $. steatorrhea <eliac <risis- e"aggerated vomiting with bowel inflammation 1"O 1. lab studies 9 stool analysis $. serum antiglyadin 9 confirmatory of disease gluten free diet 9 lifetime all @/.W 9 not allowed o- 9 rice G corn 3gtO 1. $. !. vitamin supplements mineral supplements steroids

PO)SO ) G- common in toddlers. 4falls- common to infant6 1. determine substance ta-en, assess 7.< $. unless poison is corrosive, caustic 4strong al-ali such as lye6 or a hydrocarbon, vomiting is the most effective way to remove poison. - Give syrup 1 pecac to induce vomiting !. 1 pecac 9 oral emetic - 1* ml 9 adolescent, school age G pre school - 1+ ml to infant #. MA:ED/2=7 =AT:1.TD- charcoal, mil- of magnesia G burned toast *. Aever adm charcoal before 1 pecac . antidote for acetaminophen poisoning 9 acetylsysterine 4 mucomyst6 F. caustic poisoning 4 muriatic acid 6 neutralize acid by giving vinegar . 1on0t vomit prepare tracheostomy set

#+

B.

Gas- mineral oil will coat intestine

!ead poisoning 7ead ) 1estroy /@< functioning ) &ypochornic 3icrocytic =nemia ) 1estroy -idney functioning =ccumulation of anemia ) Dncepalopathy 2"O 1. $. !. 1"O 1. $. !. 3gtO 1. $. @lood smear abd " ray long bones remove child from source if ? $+ ug(d7 9 need chelation therapy ) binds with led G e"creted by -idney )nephroto"ic beginning s" of lethargy impulsiveness, learning difficulties as lead increases, severe encepalopathy with seizure and permanent mental retardation

Amogenital CemaleO 5seudomenstration slight bleeding on vagina related to hormonal changes Tearing of fourchette with blood 9 rape( child abuse /ape- /eport within #B h 2hape pubic hair in inverted triangle 4 female6 3aleO Mndescended testes 9 cyrptorchidism -common to preterm surgery 9 orchidope"y assess scrotum- warm room G hands baby 9 pee within $# h -chec- for arch of urination 'pispadias- urinary meatus located dorsal or above glans penis 4ypospadias- urinary meauts loc ventral or ,elow glans penis &ypospadias with chordee- fibrous band causing penis to curb downward 3gtO 2urgery 5himosis- tight fores-in @alanitis-infection of glands penis 9 due smegma 3gtO <ircusicion 4#droseal 9 fld filled scrotum Tst of 1"O Transillumination with use of flashlight - glowing sign 2ari$oseal 9 enlarged vein of epididimis 4 girls- vulvular varicosities6 (enal Disorder AD5&/.T:< 2HA1/.3D Cause infectious S: 1. =nasarca- gen edema $. massive protenuria !. microscopic or no 1: 5rednisone 1iuretic SG CA(' Cocus of careO monitor edema - weigh daily

#1

=GA 4 acute Glomerulo Aephritis6 "A6sG AG H autoimmuneH Grp A

=utoimmune Grp = beta hemolytic streptococcus

hematuria serum <&.A decreased serum lipid increased fatigue normal or decreased @5 45556 primary peripheral periobital edema $. moderate protenuria !. gross hematuria 4 smo-ey urine6 #. serum R increased *. fatigue . increase @5 <omplication O 1. hypersensive encephalopathy $. anemia #. *. . F. 1.

1. anti &5A drug - hydralazine or apresoline $. iron

1ietO :ncrease <&.A :ncrease R- .S, beef broth, banana 1ecrease Aa 1. weigh daily $. monitor @5 G neurologiuc status !. 1ietO decrease R, decrease Aa

@=<R- chec- for flatness G symmetry Open eural 1u,e De/e$t- decreased Colic =cid inta-e 25:A= @:C:1= .<<M7T=- failure of post laminae of vertebrae to fuse 2"O dimpling of bac- , =bnormal tufts of hair 25:A= @:C:1= <H2T:<=- failure of post laminae of vertebrae to fuse with a sac 1#pes> 1. 3eningocele 9 protrusion of <2C G 3eninges $. 3yelomeningocele 9 protrusion of <2C G 3eninges G spinal cord 4 most dangerous6 !. Dncephalocele 4 <A2 complication 9 hydrocephalus6 9 cranial meningocele or myelomeningocele 3ost common problem - rupture of sac - prone pos - sterile wet dressing 3ost common complication - infection 3yelomeningocele 9 genitourinary complication- urinary G fecal incontinence Asg careO always chec- diaper .rthopedic complication 9 paralysis of lower e"tremities 2urgery to prevent infection 5ost op 9 prone position SCO!)OS)S- lateral curvature of the spine $ typesO 1. structural 9 rye nec$. postural 9 improper posture 1"O uneven hemline bend forward- 1 hip higher 1 shoulder blade more prominent Asg careO 1. conservative 9 avoid obesity, e"ercise $. preventive 9 3ilwau-ee brace - worn $! h a day !. corrective surgery 9 insert &arrington rod post op- how to move log rolling- move client as 1 unit 'I1('3)1)'S> chec- P of digits ) $+ 1. $.

#$

1. $. !. #. *.

syndactyly 9 webbing of digits polydactyly 9 e"tra digits olidactyly 9 lac- of digits =melia 9 total absence of digits pocoamelia- absence of distal part of e"tremities

'rD du$hennes 9 paralysis- brachial ple"us inJury or brachial palsy - birth inJury caused by lateral G e"cessive traction during a breech inJury 2"O 1. unable to abduct arms from shoulders, rotate arm e"ternally or supinate forearm $. absence or asymetrical moro refle" 3gtO 1. abduct arm from shoulders with elbow fle". CO G' )1A! 4)P D)S!OCA1)O 9 head of femur is outside acetabulum 1#pesG 1. sublu"ated 9 most common type $. dislocated 2"O 1. shortening of affected leg $. asymmetrical gluteal fold !. limited movement 9 earliest s" #. 4K6 ortolanis sign 9 abnormal clic-ing sound *. when able to wal- 9 child limps 9 late s"- trendelenburg sign Goal of 3gtO Cacilitate abduction 3gt. 1. triple diaper $. carry baby astride !. CreJ-a splint #. 5avli- harness *. &ip 2pica <ast 1A!)P'S 9 8clubfoot' a.6 Dquinos 9 plantar fle"ion 9 horsefoot b.6 <alcaneous 9 dorsifle"ion 9 heal lower that foot anterior posterior of foot fle"ed towards anterior leg c.6 Earus- foot turns in d.6 Ealgus- foot turns out Dquino varus- most common =ssessmentO 1. 2traighten legs G fle"ing them at midline pos 3gtO 1. <orrective shoe- 1ennis brown shoe, spica cast C"O of $ast 9 - to immobilize - bone alignment - prevent muscle spasm lead pencil 9 mar- area to be amputated cold &$+ 9 hasten setting process hot &$+- slow setting process =fter cast application 9 how to move ptO - use open palm not fingers- fingers will cause indention - dry cast 9 natural air not blower - priority chec- O neurovascular chec<- circulation

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3- motion

2- sensation

<ast 9 with bleeding - mas- with ball pen edge of blood to -now if bleeding is on going sign cast is dry ) resonant sound, cast cold to touch do petaline 9 ma-ing rough surface of cast smooth C(;1C4'S C"O To maintain balance - To support wea-ened leg Prin$iples in $rut$hes - wt of body on palmN - @rachial pulsing 9 if wt of body in a"ila - 1o palm e"ercise- squeeze ball Di//erent $rut$h Gaits> 1. 2wing Through $. 2wing to - no weight bearing are allowed into lower e"t !. Three point Gait - wt bearing is allowed in 1 e"t #. Cour point gait *. Two point Gait - wt bearing allowed in $ lower e"t

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