Bullets in pediatric nursing

Growth

an increase in physical size. Human growth is orderly and predictable, but not even

Development

an increase in the complexity of function and skill

progression.

Growth and development proceeds in:

Proximodistal Cephalocaudal General to specific

Fast growth periods:

Infancy and Adolescence

Slow growth periods:

Toddler through school-age

BIOGRAPHICAL CHARACTERISITCS WEIGHT

Physiologic weight loss: losing 5 15 % of actual BW Birth weight doubles by 5-6 months. Triples by 12 months.

Length Average birth length: 50 cm, increase by 50% in 1 yr, double by 4 yrs of age

HEAD CIRCUMFERENCE (Occipito-frontal Circumference) Average HC: 34-35 cm HC > CC at birth HC = CC @ 1 yr CC > HC @ 2 yrs CHEST CIRCUMFERENCE Normally about 1 inch (2cm) less than HC. IMPORTANT DEVELOPMENTAL MILESTONES 2 MONTHS:

Posterior fontanelle closes (2-3 mos)

Social smile

4 MONTHS:

Head is steady

Rolls back to side

Brings object to mouth

5 MONTHS:

Birth weight usually doubled

Completely rolls over

Smiles at mirror image

10 MONTHS Cruises Object permanence

11 MONTHS Stroll while holding on to a person or an object

12 MONTHS Stand w/o help and walks 8 teeth by end of 1st year

By By By

Understands simple commands

FEEDING MILESTONES At 1 month - has strong extrusion reflex. By 4-6 months - able to start supplemental feeding. Rice-based cereal vegetables and fruits pureed meat 6-7 months - developmentally ready to chew solid foods. 8-9 months - can hold a spoon 12 months - can drink from cup with some spilling BULLETS PEDIA DISORDERS HYDROCEPHALUS

Enlargement of the head characterized by an increased in the amount of CSF within the ventricle of the brain. Manifestations: (BIDDS)

B-ulging fontanel I-rritability Downward rotation of the eyes D-ecreased level of consciousness S-separation of sutures Shunting

Labs: Serial Trans-illumination; Lumbar Puncture Treatment: Nursing Care: Check neuro status Post-op care

DO NOT flex neck on the side where the shunt is placed

 Observe for signs of infection Observe for signs of ICP

Parental teaching SPINA BIFIDA

Failure of posterior vertebral arches to fuse during embryonic

development Manifestations: OCCULTA: (LACE)

CYSTICA: (HANDS)

L-ateness in walking H-ydrocephalus

A-ssymptomatic

A-lteration of motor function

C-hronic back pain

N-eurogenic bladder and bowel

E-enuresis

D- eformities S-ensory losses

Labs: Physical Exam Treatment:

Antibiotics ; Surgery; Shunt; Immobilization

Nursing Care: Preventing trauma to the sac

Cover with sterile dressing soaked with normal

saline

Prone or side-lying position

Protective barrier drape

Prevent complications

Signs of hydrocephalus, meningitis, joint

deformities

PROM

Sensory stimulation

Adjust objects according to position

Emotional support for parents/family

CONGENITAL HEART DISEASE CHDs are structural defects of the heart, great vessels, or both that are present from birth

2nd only to prematurity as a cause of death in the first year of life PATENT DUCTUS ARTERIOSUS

Failure of the a blood vessel to close after birth.

Manifestations: (M-CRIB)

M-urmur C-ongestive heart failure R-espiratory infection I-rritability B-ounding pulse

Labs: ECG Treatment:

Indomethacin
Nursing Care:

Provide parents education about treatment option. PDAs are

treated either surgically or non surgically VENTRICULAR SEPTAL DEFECT

An opening that communicates between the L and R ventricle.

Manifestations: (MER-C)

M-urmur E-xcessive Sweating R-espiratory infection C-ongestive Heart Failure

Labs: Doppler U/S and ECG

Treatment:

Dacron Patch
Nursing Care:

Provide parents education about treatment option. VSDs are

treated either surgically or non surgically. COARCTATION OF THE AORTA

A defect that involves a localized narrowing of the aorta Manifestations: (BLEED)

B-ounding pulse L-eg cramps E-pistaxis E-elevated UE blood pressure D-decreased LE blood pressure Balloon angioplasty
Nursing Care:

Labs: Electro and Echocardiography Treatment:

Provide parents education about treatment option.

TETRALOGY OF FALLOT

A disorder consisting of 4 abnormalities in the structure of the

heart. Manifestations: (MEET-C)

M-urmur E-pisodes of hypercyanosis

 E-xertional dyspnea T-ransient cerebral ischemia C-lubbing

Labs: Electro and Echocardiography Treatment:

Blolock-Taussig shunt, morphine sulfate, O2, NaHCo3, IV fluids

Nursing Care:

Monitor the status of the child during tet spells Provide parents education about treatment options. Provide pre-op and post-operative care
RHEUMATIC HEART DISEASE / RF

A pancarditis that follows after exposure of a child to

an infection caused by Group A Beta-hemolytic organisms

Repeated bouts with permanent scarring of the valves RHD

Manifestations: JONES CRITERIA (2 MAJ OR 1 MAJ & 2 MIN + STREP INFECTION) MAJOR: (SPEC) MINOR: (FACE)

S-ubcutaneous Nodules F-ever P-olyarthritis A-rthralgia E-rythema Marginatum C-reative protien positive C-arditis E-levated ESR
Treatment:

Aspirin for 4 weeks, Corticosteroids, penicillin, Phenobarbital

or Haldol, digoxin and diuretics Nursing Care:

 Obtain baseline pulse

Avoid situation that increase cardiac demand nausea, vomiting, arrhythmias Maintain accurate input and output LEUKEMIA

Administer digoxin and WOF s/s of toxicity like anorexia,

Malignant disorders of blood forming cells characterized by UNCONTROLLED proliferation of WHITE BLOOD CELLS in the bone marrow- replacing marrow elements.

Types: ALL and AML Manifestations: (BRAILE)

B-leeding R-RBC decreased /Anemia A-activity intolerant / Fatigue I- mmunosupression L-arge organs E-asy bruisability
Labs: Bone Marrow aspiration Treatment: Nursing Care:

Chemotherapy and Bone marrow transplantation

Assess for signs of infection Be alert if the neutrophil count drops below 1,000 cells/mm3 Maintain skin integrity

Provide pain relief Provide Adequate hydration, electrolytes Manage bleeding with transfusions and ice packs Provide Oral care and mucosal care (no rectal thermometer) Provide information as to therapy- chemo and bone marrow transplantation

INTUSSUSSCEPTION

Invagination of a section of the intestine into the distal bowel

Manifestations: (CBC)

C-olicky abdominal pain Bile-stained fecal emesis C-urrant jelly stools

Labs: Barium Enema Treatment:

Hydrostatic reduction
Nursing Care:

Monitor for signs of perforation and shock Prepare for hydrostatic reduction e.g. antibiotics, IV fluids and
NG decompression

Monitor normal return of bowel sounds after the procedure Administer clear fluids and advance the diet gradually
HIRSCHSPRUNGS DISEASE

A congenital anomaly that occurs as a result of an absence of ganglion cells in the rectum and upward in the colon.

Results in mechanical obstruction from inadequate motility in an intestinal segment. Manifestations: (DRIVE)

D-elayed growth R-efusal to suck I-nability to pass meconium V-omiting E-Enlargement of abdomen
Labs: Barium Enema Treatment: Nursing Care:

Surgery Double Barrel Colostomy

Daily rectal irrigations with normal saline to promote adequate elimination and prevent obstruction Provide pre-operative and post-operative care NEPHROTIC SYNDROME

A set of clinical manifestation arising from protein wasting secondary to diffuse glomerular damage

A massive proteinuria, hypoalbunemia, hyperlipidemia and

edema Manifestations: (DHAWP)

D-ark frothy urine H-ematuria A-anemia

 W-eight gain P-roteinuria

Labs: Urinalysis Treatment: Corticostroids, Immunosupressants, Diuretics, Plasma expanders, Antibiotics Nursing Care:

Monitor vital signs and I and O Monitor urine specific gravity and albumin Maintain bed rest during periods of edema Administer the prescribed medications Instruct the parents about the side effects of corticosteroid therapy GLOMERULONEPHRITIS

A variety of disorders caused by an immunological reaction Results in proliferative and inflammatory changes within the glomerular structure

Loss of kidney function may develop Manifestations: (PHEWSS)

P-roteinuria H-ematuria (Gross) E-dema W-eakness Scanty Urine

 S-mokey / Cola-colored urine

Labs: Kidney Function Test Treatment: Antibiotics, Diuretics, and Anti-HPN Nursing Care:

Rest Diet: high calorie, low protein Monitor VS, I and O, daily weight Administer diuretics, antihypertensive, antibiotics as prescribed Monitor for signs of renal failure, cardiac failure NEPHROBLASTOMA / WILMS TUMOR

A tumor of the kidney. It could be unilateral or bilateral. Peak incidence is 3 years old
Manifestations: (ALPHA)

A-bdominal pain L-ethargy P-allor H-ypertension and Hematuria A Abdominal mass

Labs: Biopsy Treatment:

Nephrectomy ; chemotherapy with radiation or without radiation Nursing Care:

Monitor V/S especially BP Avoid palpating abdomen Measure abdominal girth Monitor for signs of hemorrhage Monitor intake and output JUVENILE RHEUMATOID ARTHRITIS

An autoimmune inflammatory disease affecting the joints.

Occurs most in girls before 16 years old. Manifestations: SYSTEMIC: Fever Salmon pink rash

Affects 5 or more joints PAUCI-ARTICULAR: Mild joint pain and swelling iridocyclitis Affect no more than 4 joints

POLY-ARTICULAR:

Morning stiffness Low-grade fever

Affect 5 or more weight-bearing joints Labs: X-ray Treatment: Aspirin, Nsaids, cytotoxic drugs and corticosteroids Nursing Care: Monitor the child for aspirin toxicity Assit with ROM exercises and encourage perfroamce of ADLs Instruct on the use of hot or cold packs, splinting and positing during painful episodes Instruct on the importance of eye care and reporting visual disturbances Refer to the physical therapist

Diabetes Mellitus

A chronic disorder of impaired glucose, protein and fat metabolism due to lack of insulin CLASSIFICATION OF DM 1. Type 1 DM Insulin dependent Diabetes Mellitus 2. Type 2 DM

Non-insulin dependent Diabetes Mellitus 3. Gestational DM Diabetes Mellitus diagnosed during pregnancy 4. DM associated with other conditions or syndromes ASSESSMENT FINDINGS 1. Classic 3 Ps 2. Fatigue 3. Body weakness 4. Visual changes 5. Slow wound healing 6. Recurrent skin and mucus membrane infections LABS:

FBS equal to or greater than 126 mg/dL (7.0 mmol/L) OGTT value 1 and 2 hours post-prandial equal to or greater than 200 mg/dL RBS of equal to or greater than 200 mg/dL PLUS the 3 Ps Glycosylated Hemoglobin Urine test

Four main areas for insulin injection are- ABDOMEN, UPPER ARMS, THIGHS and HIPS Insulin reaction Hypoglycemia

Assessment

Headache, dizziness, restlessness Hunger, visual disturbances Slurred speech, altered gait Decreased LOC

 Pallor, cold, clammy skin

UNANG YAKAP

A call to action by the DOH to implement the Essential

Newborn Care protocol. GOAL: To save newborn lives thereby reducing newborn mortality

rate by at 50% from preventable causes 3 BASIC COMPONENTS OF ESSENTIAL NEWBORN CARE PROTOCOL: Time-bound care / procedures

Non-time bound care / procedures

Unnecessary care / procedures

4 SUB-COMPENENTS OF TIME-BOUND CARE: Immediate and thorough drying

Early skin-to-skin contact with the mother

Properly-timed cord clamping and cutting

Non-separation of the mother and newborn for early

breastfeeding 4 SUB-COMPENENT OF NON-TIME BOUND CARE Immunization

Eye care

Vitamin K

Weighing and washing

Screening

4 SUB-COMPONENTS OF UNNECESSARY CARE:

Footprinting Routine suctioning Adminsitration of prelactals Routine observation and assessment