NEUROLOGIC DISORDERS nerve damage > blurring of vision >

INCREASE INTRACRANIAL PRESSURE double vision > if sever = blindness)

 Increase ICP  Pupillary change: PERRLA (pupil equally
 Normal: 5 - 15 mmHg round and reactive to light and
 > 15 = Increase ICP accommodation)
 > 20 = life threatening  pupillary changes
 Infant: 2-7 mmHg  Anisocoria - uneven pupils
 SIGNS (isang maliit, isang malaki) =
 CUSHING’S TRIAD = INCREASE ICP presentation of brain damage
 Hypertension  Dilated - 2 dilated =
 Bradycardia presentation of shock
 Bradypnea  Constricted - 2 small =
 Widened pulse pressure presentation of narcotic
 Difference between systolic & diastolic overdose
pressure  Sunset eyes
 120/ 80 = 120 - 80 = 40
 Normal: 30-40 mmHg
 > 40 = Increase ICP
 180/80 = 180 - 80 = 100
 S/SX  Anorexia
 Bulging fontanels - instead of closing, they  Nausea
pushing the fontanels = bulging  Weight loss
 Aggravated by CRYING  Important indication of health
 MGT: minimize crying especially for PEDIA
(comfort measure)  Normal: weight gain
 Anterior  Seizures
 Diamond shape  Reasons
 Closes 12 - 18 months  Increase firing - erratic
 Posterior transmission of electrical
 Triangular shape impulses (from brain to
 Closes 2-3 months neurons)
 High pitched cry/ Shrill cry = EARLY  Vomiting → dec fluid levels →
SIGNS (distress child) Dehydrated → Inc temperature
= convulsions → seizures
EARLY SIGNS OF INCREASE / AGE GROUP
MANAGEMENT
 Infant: high pitched cry
 Child: irritability & agitation INDEPENDENT
 Adult: restlessness  Position: Semi fowlers
 Geriatric: confusion  Decrease ICP by the use of principle of
 Increase head circumference gravity = CSF drains downward =
 As your head circumference decrease ICP
increases, therefore the ICP CONCEPTS
also increases 1. Where Na goes, water fallows
 MGT: 2. Increase fluid = Increase pressure
 Tape measure - to measure
every shift (8 hrs)  Coughing and Sneezing is AVOIDED
 Headache = INITIAL SIGN  Limit fluid intake 1,200 - 1,500/ Day
 Projectile vomiting - forceful vomiting =  To decrease pressure
because of medulla is compress =
compress CTZ (chemoreceptor trigger PHARMACOTHERAPY:
zone: vomiting center)  Diuretics: decrease fluid = decrease pressure
 Due to:  Potassium wasting diuretics
 Cerebral edema - confirmed  MGT: monitor hypokalemia
through scan Xray & CT scan  Lasix (loop) → (effect) loop of henle
 Diplopia (double vision) = Inc ICP = (localized)
Increase IOP (because of compression of
the brain > cause eye compress >

1
  Mannitol (osmotic) → osmosis: - Due to small muscle involvement/ di mo alam
pulling pressure → (effect) may seizure na
generalized  Blank facial expression
 DECADRON (dexamethasone) - prevent cerebral  Automatisms - repeated purposes behaviors (one
edema side)
 ANTICONVULSANTS - prevent seizure episodes  Lips smacking
 ANTACIDS - neutralize acidity
 Reasons 3. JACKSONIAN
 Increase stress level = increase gastric  TONIC CLONIC of a Group of Muscle → grand mal
motility (hydrochloric acid)
 Use of steroids - GASTRIC IRRITANT → 4. PSYCHOMOTOR
pedia has thin gastric mucosal lining (GI)  Mental clouding and intoxication
→ cell easily penetrate GI  Not common in CHILDREN , Common in ADULTS
 Side effects
 Mg: Diarrhea `= Mg tae 5. FEBRILE
 Al: Constipation = Al ang tae  Common in Children (under 5 y/old)
 ANTICOAGULANTS - prevents clumping of blood  Hypothalamus is not yet well-developed (immature)
 Increase ICP → Increase peripheral vascular  Hemoregulatory center
 38. 5 →39 → 40
resistance (too much/ fast blood goes to blood
vessels)
6. STATUS EPILEPTICUS
 Prevents complications of thrombo embolism
 30 mins (on & off) → before brain damage could
 HEPARIN: IV/ SubQ → check pTT (partial
occur
thrombo plastin time)
 EMERGENCY
 WARFARIN: Oral → check pt (prothrombin
time)
MANAGEMENT
*REMEMBER: Opiates and Sedatives (Depressants- Main: Medication
relaxes the system) are contraindicated in Increase ICP Last resort: Surgery - some types are can’t manage by
* Cushing’s (hyper, brady, brady) = RESPIRATORY & medications
CARDIAC DEPRESSION.
 HYDANTOIN: PHENYTOIN
 WOF:
 Gingival hyperplasia
 MGT:
 Soft bristled toothbrush
 Meticulous oral care
 Pinkish red urine
SEIZURE DISORDER
 MGT:
EPILEPSY: Erratic transmission of electrical impulses  Inform the significant other -
avoid confusion (normal side
TYPES OF SEIZURE effect)
1. GRAND MAL SEIZURE (Generalized seizure)
 From head to toe  BENZODIAZEPINES = “pam, lam”
 Relaxes system
2 PHASES  Minimizes seizure episodes
1. TONIC (Mild) CLONIC (Severe) Contractions =
 IMINOSTILBENES: CARBAMAZEPINES
“During” → Dyspnea, Saliva, Urination
 Use for Refractory seizure (pabalik balik na
seizure)
MGT:
 Prevent seizure reoccurrence
 Position:
 During: Supine/ Flat - to protect the head
 VALPROATES: VALPORIC ACID
 Last resort because of side effects
2. POST ICTAL (Exhaustion) = “After”
 Hepatotoxicity - toxic to liver → high
MGT:
chance to destroy the liver
 Position:
 Never given in pregnancy
 After: Side lying/ Recovery position
 Cause Neural Tube Defect
(hydrocephalus)
2. PETITE MAL/ ABSENT

2
  Teratogenic - X especially in the 1st  structural alteration → extravasation of blood
trimester
MANAGEMENT
SURGERY  Safety - MOST PRIORITY
 NEURECTOMY  Wear bike helmets, sear belts, safe driving,
 Surgical resection of the cranial nerve involve in infant car seat
the seizure (Cranial nerve it depends to the  < 3 y/o: rear facing → protect the spine
assessment of the MD)  > 3 y/o: front facing forward facing booster seat
→
BACTERIAL MENINGITIS  Assess for Cerebral Functioning:
 Viral - self limiting  Glasgow coma scale
 Increase probability of having permanent damage  PERRLA
(rather than viral)
 Infection of the meninges (supports & nourishes the * MOST IMPORTANT INDICATOR: Level of
brain) Consciousness (chances of survival)

DIAGNOSTICS  Assess for cervical neck injury

 Lumbar Puncture - L3, L4, L5  (+) DO NOT move the client
 POSITION: C-Shape, Fetal, Kneechest/  MGT: Immobilize - to prevent further
Genupectoral damage
 CSF Analysis:  (-) Head of Bed Elevate 30 degrees = to
 Normal - Clear decrease ICP = Gravity
 Meningitis: Cloudy = infection
(because of Elevated WBC & Protein)
 Protein - by product of the bacteria CARDIOVASCULAR DISORDERS
(waste product)
 Causative agent: Neisseria Meningitides LAYERS OF THE HEART
 Endocardium - Innermost
 Myocardium - Muscle layer→ muscle
SIGNS & SYMPTOMS contraction → Cardiac output (amount of
 Pathognomonic signs blood eject by heart in 1 min = determines O2
 Kernigs: K(nee) → Flex → Pain in the distributed in the body)
Hamstring, Back, Nack = + Kernigs  Pericardium - outermost layer
 Brudzinski: B(atok) ? Nape → Flex → Pain in  Visceral - inner
the Back & Neck = + Brudzinski  Pericardial space - contains
 Nuchal Rigidity = Stiff neck pericardial fluid - to prevents friction
 child move their body as a unit rub
 They cannot Isolate their body movement  Parietal - outer
 Seizures
 Opisthotonus - arching of the back CHAMBERS OF THE HEART
 MGT: One way flow = Normal
 Position: Side Lying  pedia & adult = same circulation
 Fetal = not same
MANAGEMENT Two way flow = Abnormal
 ANTIBIOTIC THERAPY  regurgitation → valvular problems
 Finish duration - to prevent drug resistance  Ductus Arteriosus = intersection of aorta and
pulmonary artery
HEAD TRAUMA
Blood Flow = superior & inferior vena cava → r.a →
 Pedia - Common → due to inadequate balance = tricuspid → r.v → pulmonary v → p.a → lungs →
Risk for Fall p.v → l.a → mitral v → l.v → aortic v → aorta →
body
2 TYPES
 CONCUSSION  RIGHT ATRIUM
 Jarring of the brain → sudden force contact in a  RIGHT VENTRICLE
rigid skull  LEFT ATRIUM
 Transient loss of consciousness  LEFT VENTRICLE
 CONTUSION = Bruising

3
  via bypass not open heart
ACYANOTIC  Only use if the defect (hole) in the septum is
 Absence of cyanosis SMALL
 1 problem  DACRON PATCH
 Use is the defect (hole) is LARGE
 Patch the defect
CYANOTIC  TISSUE
 Presence of cyanotic  Made of cardiac tissue (not foreign body)
 2 or more problems  Decrease rejection rate
 Most common use/favorable
PATENT DUCTUS ARTERIOSUS (PDA)  PLASTIC
 Ductus Arteriosus remain open  made of foreign body
 ACYANOTIC  Increase inflammation (foreign body)
 Increase rejection rate
 Used when tissue is already worn out
SIGN & SYMPTOMS
(napunit)
 PATHOGNOMONIC SIGN
 Machinery like murmur - when 2 ventricle COARCTATION OF THE AORTA
contracts yung blood magbabanggaan
(intersection)  ACYANOTIC
 S/sx of heart failure - Looks normal upon birth →  Narrowing of aorta (descending)
detected when HF s/sx are presented already  Increase pressure, decrease output
 Poor feeding
 CO is with unoxygenated blood & sucking (for SIGNS AND SYMPTOMS
feeding) needs oxygen upper extremities lower extremities
 easily gets fatigued from sucking = poor BP increase decrease
feeding pulse bounding weak/ absent
 Poor weight gain
 6 months - doubled - RIB NOTCHING
 12 months - tripled  narrowed aorta → heart compensate →
 Irritability increase pumping = deformed rib
 sign of cerebral hypoxia

MANAGEMENT MANAGEMENT
 Drug of Choice: INDOMETHACIN (Prostaglandin  SURGERY: BALLOON ANGIOPLASTY WITH
inhibitor) CORONARY STENTING (scaffold/ support)
 Facilitates closure of PDA  stenting - scaffold/ support
 Secondary drug: IBUPROFEN  scaffold - made of mesh - super fine
 less effective screen specifically made for the
vessels
SEPTAL DEFECT * stent is forever = will adjust to teh vessels as a times
 ACYANOTIC goes by
 Present of hole in the septum  Artery (aorta) repair
ATRIAL SEPTAL DEFECT (ASD)
 Upper TETRALOGY OF FALLOT
VENTRICULAR SEPTAL DEFECT (VSD) PROBLEMS : CYANOTIC = 2 or moe problems
 Lower  > unoxygenated blood
 Alter tissue perfusion
SIGNS & SYMPTOMS
1. Pulmonary stenosis
 Fatigue → poor feeding
2. Right ventricular hypertrophy
 Dyspnea on exertion (activity intolerance)
3. Overriding of aorta
 they cannot tolerate regular activities
4. Ventricular septal defect
 Failure to thrive (delayed milestones)
 S/sx of heart failure
QUESTIONS:
1. What is the primary problem?
 Pulmonary stenosis - narrow pulmonary area
MANAGEMENT  Blood from the r.v can’t easily pass through
 SURGERY by suture (by pass)

4
2. Compensatory mechanism?  Blalock taussig shunt: anastomosis of
 Right ventricular hypertrophy - will compensate the pulmonary artery and the aorta
by providing more forceful contraction (pagdu dugtungin) by using subclavian
 2D Echo = BOOT SHAPE HEART = artery
3. Allow mixing of blood?  blood from the right ventricle has a
 Over riding of aorta - anatomical defect time to go to the lungs by subclavian
 Normal: the hole of the aorta is at the end of the artery = to oxygenate the blood
left ventricle  Curative surgery
 Abnormal: the hole of the aorta move at the  Cures the condition/ resolves the problem
middle  Intracardiac surgery/ Brock’s Procedure
 aorta malapit sa septum where VSD also 1. Balloon angioplasty
present (which is also a defect = may hole  Insert it to the pulmonary stenosis = X
din) pulmonary stenosis and RVH
 over riding aorta = vsd = mixing of blood 2. Dacron Patch
(oxy & unoxy blood)  X VSD = patch = X overriding of the aorta
4. What keeps the pt alive?
 VSD - relieves the pressure on the right TRANSPOSITION OF THE GREAT ARTERIES
ventricle (by some of the blood from the right MECHANISM
will go to left side)  Right ventricle - connected to the aorta
 X VSD = all the pressure is in R.V =  Left ventricle - connected to the pulmonary artery
rupture  PDA = WHAT KEEPS THE PT ALIVE
 because even though arteries exchange
SIGNS AND SYMPTOMS their position , PDA remain = still have
 Cyanosis mixing of blood → nakakakuwa pa rin ng
 ineffective tissue perfusion = unoxy> oxy oxygenated blood
 Squatting *weak contraction = no murmur
 Allow the child -
 Decrease venous return SIGN & SYMPTOMS
 will promote slow return = promote cardiac  Severe respiratory depression & Cyanosis
rest  Failure to thrive
1. Decrease cardiac workload - by promoting  delayed milestones
cardiac rest  Fatigue
2. Conserves oxygenated blood in the upper  No murmur
body area - where the vital organs are
 squatting = promote cutting the flow of the
MANAGEMENT
blood from upper to lower = more blood to the
vital organs (lung & heart)  PROSTAGLANDIN E
 PATHOGNOMONIC SIGN: TET SPELLS  Maintains PDA/ Keeps the PDA open
 group of s/sx → Decrease oxygenation  SURGERY
 Irritability  JATENE PROCEDURE (ARTERIAL SWITCH)
 Blackouts  Open heart surgery - done during the first
 Pallor - hypoxemia (blood level) week of life -
 Convulsions  Usually the baby only lives for 1 - 2 weeks
 Cardiomegaly - hyperthopy  If successful = 95% survivability
 Clubbing of fingernails: chronic hypoxia
 Pan systolic murmur - in every hearts contractions RHEUMATIC HEART - INFECTIOUS HEART DISEASE
CAUSE: GABHS (Group A beta-hemolytic streptococcus )
DIAGNOSTICS  Sore throat/ AGN (acute
1. 2D ECHO: BOOT SHAPED HEART glomerulonephritis)
JONES CRITERIA
 to confirm RH heart
MANAGEMENT
 2 MAJOR SX + HISTORY OF GABHS or 1
 Allow the child to squat MAJOR + 2 MINOR SX + HISTORY OF
 Childs compensation GABHS
 SURGERY
 Palliative surgery = only relieves the sign and MAJOR MINOR
symptoms
Carditis Low grade fever
 GOAL: oxygenated blood > unoxygenated
= Lumaki because of
blood

5
inflammation Arthralgia veins (JVD: (fluid deposition in
= without swelling (if Jugular vein the lungs)
swelling = arthritis distention)  Cough
major)  Hepatomegaly →
Polyarthritis - Portal HPN/ HTN
= multiple joint  Ascites
inflammation  Esophageal
Chorea ASO (Antistreptolysin varices
= St. Vitus dance - O titer)  Hemorrhoids
worm-like dance = Gabhs specific (not - because of
RH specific) increase
SubQ nodules Elevation of pressure to
= bony prominence - Inflammatory Markers the pelvic
knees, elbows, area
knuckles = ESR (Erythrocytes  Body weakness
sedimention rate)  Anorexia
 Nausea
Erythema marginatum = CRP (C reactive * Most sensitive to circulation, perfusion, & oxygenation =
= trunk CHON) LIVER
- because of insufficiency and low co → liver will
compensate → portal vein will compress
MANAGEMENT *body malaise - feeling of weakness
 DOC: PENICILLIN - Broad spectrum → kills gram & *body weakness - actual weakness
(-) bacteria → (5-10 days)
 IF ALLERGY TO Penicillin: ERYTHROMYCIN/ DIAGNOSTICS
CLINDAMYCIN  Chest X-RAY
 Exacerbation and Remission: Treatment is  To rule out Cardiomegaly
continued up to 10 years  2D ECHO
 Follow up check up  LATE SIGN: Hypo kinetic heart
 SALICYLATES (ASA): for pain and swelling  Pulse oximetry
4As  measure of the oxygen to the blood
 ANTIPLATELET - bleeding  Decrease O2 Saturation = HF
 ANTIPYRETIC  NORMAL: 95-100%
 ANALGESIC - For swelling  PCWP (Pulmonary caopillary wedge pressure):
 ANTI-INFLAMMATORY - For swelling LSHF
 Monitor for Bleeding  NORMAL: 4-12 mmHg
*analgesic & anti-inflammatory = specific for Rheumatic  CVP (Central Venous Pressure: RSHF
Heart  NORMAL: 8-12 mmHg
 CORTICOSTEROIDS: relieve carditis
MANAGEMENT
Fowler’s position
HEART FAILURE  HOB = maximize lung expansion = increase O2
 Insufficient Cardiac Output Administer high O2
 RSHF (right sided) = Systemic  Venturi mask = precise and accurate
 LHSF (left sided) = Pulmonary symptoms Inotropic drugs
 strengthens contractions = increase CO
CONCEPT OF BACKFLOW Lanoxin/ Digoxin
=  monitor sign for digoxin toxicity
Nausea
RSHF: SYSTEMIC LSHF: PULMONARY Anorexia
EARLY SIGN: TACHYCARDIA Visual disturbances
= for compensation Diarrhea
 Peripheral/  Dyspnea on Abdominal cramps
dependent, ppitting exertion  ANTIDOTE: DIGIBIND (Digoxin imnate fab)
edema (fluid  activity
retension) intolerance *1 S/SX OF DIGOXIN TOXICITY = STOP IMMEDIATELY
 Weight gain  Orthopnea
 Distended neck  Crackles/ Rales Urine output & intake monitoring

6
Record daily weight Maternal smoking (carbon monoxide)
 same time, clothes, weight scale, patient - need of the fetus: oxygen
Edminister DIURETICS PROBLEMS
 release fluid retention Risk for Infection
Risk for Aspiration
KAWASAKI DISEASE Difficulty of feeding
 RARE DISEASE Risk for URTI (upper respiratory tract infection)
 Mucocutaneous lymp node syndrome - food products that goes to the lungs
 altered immune system MALE FEMALE
 Multisystemic vasculitis lip - lalake Palate = pemale
 inflammation of blood vessels affecting → - tuwid magsalita SPEECH PROBLEM
cardiovascular system NURSING RESPONSIBILITIES
 large  Cup, medicine
SIGN & SYMPTOMS nipple-criss-cross cut dropper
 easier to suck  precise/
 High spiking fever (hyperpyrexia)
accurate fluid
 PATHOGNOMONIC SIGN: STRAWBERRY RED
flow
TONGUE
 Ribber tipped
 Photophobia
SURGERY
 photosensitivity
Monitor: Frequent swallowing = sign of bleeding
 Extreme sensitivity to light - hyperemia of
conjunctiva → blood pooling CHIELOPLASTY PALATORRHAPY/
 RULE OF 10 PALATOPLASTY
 MGT: Dark colored glasses, large brim hats/
sunvisors  10 weeks  RULE
 Polymorphus rash  10k wbc  Not too early =
 10 lbs re-open
 Rash in different shapes
 10g/dl hgb  Not too late =
 Palmar desquamation
speech
 death of skin cells
POST-OP POSITION: problems
*skin desquamation = whole body Unaffected side
FOR BILATERAL: Head 18-24 months
of bead elevated (recommended)
DIAGNOSTIC - where the child learn to
 Elevated ESR talk

MANAGEMENT POST OP POSITION:

 IMMUNOGLOBULINS as ordered Prone - to drain secretion
 enhances/ stimulate immune responses to prevent aspiration
 ASPIRIN as ordered for VASCULITIS
 only the antiplatelet can’t use GASTROESOPHAGEAL REFLUX DISEASE (GERD)/
 monitor for bleeding CHALASIA
 Clear liquid diet  MAIN PROBLEM: Incompetent Lower Esophageal
 determine by ruminate the drinks (clear = Sphincter (LES) / Cardiac Sphincter
ruminated)  LES / Cardiac sphincter = prevent vomiting
 Water
 Orange juice
SIGN AND SYMPTOMS
 Carbonated drinks
 Coffee  Forceful vomiting
 black coffees - simpliest  Heartburn (chest pain)
 CPR  Esophageal lining is damage
 prone in developing Coronaryy artery disease  HCL reflux → damage linings = pain
(CAD)  Bitter taste in the mouth
 MGT: Oral care after vomiting
GASTROINTESTINAL DISORDERS  to avoid poor feeding
 Cephalocaudal approach  Dysphagia - difficulty of swallowing
 mouth to anus  Odynophagia - painful swallowing
 Hoarseness - laryngeal affectation
CLEFT LIP CLEFT PALATE  damage voice box
Both can be caused by HEREDITY

7
 DIAGNOSTICS  Malnutrition and Dehydration = Electrolyte
 Barium swallow (if > 2 das = obstruction) imbalances → Metabolic alkalosis
 should not remain in the body >2 days
 FOCUS: Excretion *Site for absorption - small intestine
 Increase oral fluid intake *stomach is located at the right side
 Laxative as ordered

MANAGEMENT MANAGEMENT
 Diet modification  Monitor feeding patterns
 low fat  Assess vomitus → should be w/o bile
 High fiber  Increase oral fluid intake (hasten digestion)
 increase peristalsis  Prevent aspiration by feeding slowly
 mas okay na itae compared sa isuka  Burp frequently - prevent gas retention
 Small frequent feeding (SFF)  Position: HIGH FOWLERS → prevent regurgitation
 to lessen the contraction = decrease vomiting  SURGERY: PYLOROMYOTOMY
 Avoid  Incision that splits the obstruction
 spicy food  Cutting
 Alcohol
 Caffeine *OTOMY = CUT
 Tobacco PLASTY = Repair using plastic
= GI IRRITANTS Ostomy = opening

MEDICATIONS CELIAC DISEASE

 ANTACIDS
CELIAC SPRUE - Gluten sensitive enteropathy
 Neutralize acidity
 Extreme sensitivity to gluten
 H2 Blockers = “tidine”
 Congenital - from birth to death
Ranitidine
 Irreversible - can’t be cure
 blocks HCL
 Cause: malabsorption of gluten
 Proton pump inhibitor (PPI)= “prozole”
 blocks HCL production and leaves protective
SIGN AND SYMPTOMS
coating
 Acute diarrhea
 Most effective
 because defense mechanism = ilalabas niya
yung hidni niya kayang idigest
POSITION: HOB 6-8 in during sleeping → to prevent  Steotorrhea: foul fatty feces
regurgitation of foods  Anorexia
 Vomiting
 Severe abdominal distention → gas retention
PYLORIC STENOSIS  Body wasting “cochexia”
 Narrowing of pyloric sphincter - Regulates gastric  Retarded growth
emptying  Failure to thrive (delayed milestones)
 cause abdominal distention
 OLIVE SHAPED MASS DIAGNOSTICS
 VOMITING W/O BILE  Bowel biopsy
 Flat mucosal surface with hyperplastic villous
* VOMITING WITH BILE = INTESTINAL OBSTRUCTION (villi) atrophy
 cell & tissue → shrink = not functional
cell & tissue
SIGNS AND SYMPTOMS
 villi - hair like structure → normally
 Vomiting: blood tinged, with gastric contents (w/o should absorb food, but with celiac villi will
bile) remain flat & can’t absorb foods
 Regurgitation  Other diagnostics: Elevated IgA & IgG
 NO anorexia, with good appetite but with vomiting
 Weight loss = no absorption
MANAGEMENT
 Upper abdominal distention = OLIVE SHAPED
MASS  Avoid BROW
 Visible peristalsis movement from left to right  Barley
 Rye
 Oat

8
  Wheat  With odor
 Allow meat, eggs, milk, products → cheese/ cream,  Continue appliance of the bag: yes
all fruits & vegetable, rice, corn, corn, flakes  Irrigation: yes
 in pedia = yes
**Bday party = bring own cake  In adult = no
**GLUTEN FREE diet FOR LIFE  Assess the characteristics of the stoma
HIRSCHSPRUNGS DISEASE  COLOR
 Pinkish → Bluish → lack of circulation
 CAUSE: Aganglionic - absence of ganglion →
= inform MD
cells/ nerves responsible for peristalsis
 MOIST
 Megacolon - distended colon
 Yes: dry → dehydration = notify MD
 RIBBON LIKE STOOL: PELLET LIKE/ PECIL LIKE
 AKA: Congenital aganglionic megacolon  ELEVATED:
 PROBLEM  Yes, slightly - concave/ depressed =
 Failure to pass meconium for the first atrophy →. Notify MD
24-48 hours  Avoid food that can obstruct the stoma (gas foring
 Either: Imperforated anur or food)
Hirschsprungs disease  FOOD TO ALLOW = spy b
 Spinach
DIAGNOSTICS  Parsley
 Yogurt
 Barium enema
 Broccoli
 You will see megacolon
 Can the client swim? YES
 Location of obstruction
 sports that can enhance muscle
 Not confirmthe diagnostic
 Stool softener as ordered
 Rectal biopsy
 Confirmatory procedure
INTUSSUSCEPTION
 Absence of ganglionic cells
 Telescoping of the colon
MANAGEMENT  isang part ng colon pumasok sa kabila
 out pouching colon
SURGERY
 SWENSON PULL THROUGH
 End to end anastomosis → cut the SIGN AND SYMPTOMS
affected part and connect unaffected part  PATHOGNOMONIC SIGN: SAUSAGE SHAPED
 Present of inflammation because of the MASS
procedure  Bile stained fecal emesis - vomiting
 Need temporary colostomy  Colicky pain (gas formed pain)
 WITH TEMPORARY COLOSTOMY →  CURRANT JELLY LIKE STOOL (bloody mecooid)
Wait 1-3 months till inflammation is gone
(6 monsths maximum) DIAGNOSTICS
 then connect end to end  Barium enema
 determine the obstruction
 Colostomy care  Guaiac’s Test: Occult blood test
 habang lumalapit sa pwet BUMABAHAHO/  agent use: hydrogen peroxide → blue ring
TUMITIGAS presentation (+) bleeding
 Dark colored food = NO → FALSE
1. Ascending POSITIVE
 Liquid  Vitamin C rich food: NO → FALSE
 W/o odor NEGATIVE
 Irrigation: no need
 Continue appliance of bag: yes
MANAGEMENT
2. Transverse
 Mushy  Auscultate bowel sound
 Slight odor  Assess abdominal distention
 NGT Insertion
 Irrigation: depends
 function
 liquid> solid = no
 Feeding
 Solid > liquid = yes
3. Descending  Irrigation
 Solid  Decompression - to release gas
 Specific use for intussusception

9
  Medication DIAGNOSTICS
 SWEAT chloride test
SURGERY  Increase chloride levels in the sweat
 SWENSON PULL THROUGH  Normally, sodium only
 With CF = sodium + chloride = sodium chloride
= salt
RESPIRATORY DISORDERS
CROUP MANAGEMENT
 Chest Physiotherapy
 Narrowing of airway due to viral inflammation  process of removing mucus in the lungs
 percussion
SIGN AND SYMPTOMS  Vibration
 PATHOGNOMONIC SIGN: Barking seal like  Postural drainage
cough  Nursing resp:
 Inspiratory stridor  before meal→ empty stomach or 2 hrs
 passage of air in a narrowed airway after meals
 Dyspnea
 Cyanosis MEDICATIONS
 NO fever/ low grade fever  Pancreatic enzymes
 WOF:  with meals - to prevent auto-digestion of
 Drooling enzymes
 Nasal flaring  NEVER double the dosage
 Use of accessory muscles
 For breathing → SIGN OF RESPIRATORY ASTHMA
DISTRESS SYNDROME or EPIGLOTTIS =  Reversible
EMERGENCY  Cause are allergens: substance that can cause
*wheezing = expiratory hypersensitivity/ allergic reactions
 Hyper responsiveness → bronchospasm
MANAGEMENT  Allergens
 Increase humidity in the room (COOL MIST)  Pollen, molds, dust, weeds (sea) , et danders
 Inhale cool night air/ warm bathroom air **iodine - common allergen
(BRONCHODILATION) ** egg white - rich in protein
 Tracheostomy set at the bedside → emergency  Exacerbation:
airway  Cold heat weather changes
 Air pollutions
MEDICATIONS  Strong odors
 DOC: Antiviral “vir”  Exercise
 Antibiotics: prophylaxis  Exertion
 Bronchodilator - dilate the bronchus  Sinustis
 side effect: Tachycardia  Gerd
 X with caffeine products → dysrhythmia  Strong emotion
CYSTIC FIBROSIS
SIGN AND SYMPTOMS
 Blockage of the exocrine glands → mucus
 Wheezes - expiratory
bumara
 during asthma attack → absence of
 Organ affected
 pancreas wheezing → complete obstruction (Status
 Lungs Asthmaticus)
 Sweat glands  BAD SIGN = ABSENCE OF WHEEZE →
 Intestines COMPLETE CLOSURE OF AIRWAY

SIGN AND SYMPTOMS MANAGEMENT

 PANCREATITIS: Auto digestion  BRONCHODILATORS
 Dyspnea: inffective airway clearance  CORTICOSTEROIDS
 Meconium Ileus  O2 Therapy
 PATHOGNOMONIC SIGN: Increase salty sweat  Avoid allergens

10
 PEDIA NORMAL  requirements:
 Growth and Development Theories  Audible timer - alarm clock (to
be consistent)
INFANCY: 0-1 yr old  1 min per year of age
 ERIKSON  PLAY
 Trust vs Mistrust  Parallel play → side by side play (maglalaro
 Trust: providing basic needs → Consistency ng sabay in the same place , not related ang
 FREUD: laro)
 Don’t share toys
 Oral stage → center of gratification
 FEAR: Separation Anxiety
 Mouth → lahat ng nadadampot nilalagay sa
bibig
PRE-SCHOOLER: 3-6 years olds
 Risk for Aspiration → Satisfy through:
 Highest imagination
feeding, pacifier and tether's
 ERIKSON
 PIAGET:
 Initiative vs Guilt
 Sensorimotor→ learning through senses
 Allow them to participate
 Mainly reflex
 Therapeutic use of PLAY → idadaan sa
 Repetition of acts
laro ang activities
 Rattles
 puppet
 Mobiles - naka sabit sa crib
 FREUD:
 KOHLBERG:
 Phallic stage → complexes = they hate the
 NO THEORY → di tinatanong sa boon
 PLAY: Solitary (alone) same sex parent → nakikita nila as
 FEAR: Stranger Anxiety ka-kompetensya
 will cry because no sense of familiarity  Oedipal = baby boy → mother =
mama’s boy
 Elektra = baby girl → father = daddy’s
girl
TODDLER: 1-3 years of age  PIAGET
 ERIKSON  Pre-operational → still Egocentric → but
 Autonomy vs Shame and Doubt → Self they can understand symbols
 Dahon as play money
determination (siya nasusunod)
 KOHLBERG
 Saying NO → Offering a choice (autonomy)
 Pre-conventional → self only
→ Give options
 PLAY: Associative/ Cooperative
 FREUD:
 related laro, sabay na naglalaro
 Anal stage → Anus → Toilet training  lutu-lutuan
 CRITERIA FOR READINESS:  bahay-bahayan
 Can sit and Squat  FEAR:
 Remain dry for 2 hrs  Body mutilation & Castration (takot masugatan)
 Ability to verbalize the need to defecate
and urinate
SCHOOLER: 6-12 years old
 Willing to please parents
 Soiled diapers = They want to be change  ERIKSON:
immediately  Industry vs Inferiority = mahilig magsipag →
 PIAGET: Industrious → they know the authority
 Pre-operational → Egocentric - inability to  FREUD
see the POV of others  Latent stage → same sex orientation (ang
 Egocentrism babae ay sasama sa babae, ang lalaki ay
 Use of symbols and magical thinking sasama sa lalaki)
 No cause and effect reasoning  PIAGET
 kahit anong paliwanag gawin mo  Concrete Operational → Logical - they know
wala silang maiintindihan what is right and wrong but they can’t explain it
 KOHLBERG → No form of rationalization
 Pre-conventional → Punishment and  Uses memory to learn
Obedience  Aware of reversibility
 Best punishment = Time out  Inductive reasoning
 Authoritative parenting style  KOHLBERG
 Face the wall

11
  Conventional → good to the eyes of others
 PLAY: Competitive play → more on indoors
 board games
 Common in sport injuries
 FEAR: DEATH → they know that death is final

ADOLESCENT: 12-19 years old

 ERIKSON
 Identity vs Role confusion
 FOCUS: Body Image
 FREUD:
 Genital stage → sexual curiosity/ question/
experimentations
 PIAGET
 Formal Operational → Hypothetical →
abstract thinkers = they can rationalize
 Reality, abstract thought
 Can deal with past, present and
future
 Deductive reasoning
 KOHLBERG
 Post-conventional → know morals, laws, be
responsible enough
 PLAY: Competitive → outdoor → sports
 basketball
 Volleyball
 Swimming
 FEAR: Peer Rejection
 friend > parents

12