FAR EASTERN UNIVERSITY

INSTITUTE OF HEALTH SCIENCES AND NURSING

FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

MODULE # 2 – ALTERATIONS IN OXYGENATIONS

Introduction

Respiratory disorders are among the most common causes of illness and hospitalization
in children. (Witt,Weiss, & Elixhauser, 2014). Respiratory disorders range from minor illnesses
such as a viral upper respiratory tract infection ( a common cold), to life-threatening respiratory
tract disease. Because the level of acuity can change quickly, respiratory deterioration or
compromise must be recognized and be responded to immediately.

Cardiovascular issues in children are complex, spanning the spectrum from congenital
defects that may present at birth to acquired heart disease or late- onset inherited disorders.
Severity, complexity and presentation vary depending on the disorder and the child’s age.
Managing a child with a cardiovascular disorder is very challenging ang requires the nurse to
have an in-depth understanding of a multitude of disease process, congenital heart defects, and
treatment regimens as well as the ability to work with children of any age and families in
varying states of emotional health.
This module discusses some of the common disorders in oxygenation in children both
respiratory and cardiovascular disorders such as asthma, pneumonia, sudden infant death
syndrome (SIDS) and patent ductus arteriosus (PDA).

Learning Outcomes

At the end of this module, the student will be able to:

1. Describe common oxygenation disorders in children.

2. Assess a child with common oxygenation disorders

3. Formulate nursing diagnoses related to oxygenation disorders in children.

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

4. Identify expected outcomes that address the priority needs of a child with oxygenation
disorders to help him or her manage seamless transitions across differing healthcare
settings.

5. Implement nursing care for a child with oxygenation disorders.

6. Evaluate expected outcomes for achievement and effectiveness of care.

Topic Outline

• Sudden Infant Death Syndrome (SIDS)

• Asthma

• Pneumonia

• Patent Ductus Arteriosus (PDA)

Content

A. SUDDEN INFANT DEATH SYNDROME (SIDS)

Sudden Death Syndrome (SDS; cot death ; Crib Death) "sudden unexpected infant
deaths" (SUID)

a sudden, unexpected death of an infant younger than 1 year old (between 2 months
and 4 months) which may occur during sleep, whilst awake, or just after exercise.

Occur between the hours of 10 at night and 10 in the morning

Risk of SIDS:

1. Affects boys more often than girls

2. Rates are highest for African Americans, Alaska natives and American Indians and
lowest for Asians and Hispanics

3. Increased incidence during cold weather

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

4. Being around cigarette smoke while in the womb or after being born

5. Sleeping in the same bed as their parents (co-sleeping)

6. Multiple birth babies (being a twin, triplet, etc.)

7. Prematurity or low birth weight

8. Having a brother or sister who had SIDS

9. Mothers who smoke or use illegal drugs

10. Being born to a teen mother

11. Short time period between pregnancies

12. Late or no prenatal care

13. Soft bedding in the crib

14. Living in poverty situations

15. Lack of breastfeeding

16. Overheating from excessive sleepwear and bedding

17. Infant has an underlying cardiac abnormality

18. Infants with an abnormality in the arcuate nucleus, a part of the brain that may help
part of the brain that may help control breathing & awakening during sleep.
control breathing & awakening during sleep. If a baby is breathing stale air and not
getting enough oxygen, the brain usually triggers the baby to wake up and cry. That
movement changes the breathing and heart rate, making up for the lack of oxygen.

But a problem with the arcuate nucleus could deprive the baby of this involuntary
reaction and put him or her at greater risk for SIDS.

19. Stomach sleeping

a. Puts pressure on a child's jaw, therefore narrowing the airway and hampering
breathing.

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

b. Can increase an infant's risk of "rebreathing" his or her own exhaled air,
particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a
pillow near the face. The soft surface could create a small enclosure around the baby's
mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the
body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could
contribute to SIDS.

Causes

1. Problems with the baby's ability to wake up (sleep arousal)

2. Inability for the baby's body to detect a build-up of carbon dioxide in the blood.

Diagnostic and Laboratory Procedures

1. ECG (electrocardiogram) test.

2. History of any young sudden deaths in the family, or if a young person is suffering
from symptoms of:

a. Chest Pain (Exercise related) d. Dizziness

b. Breathlessness e. Fainting

c. Palpitations

Therapeutic Management

1. Educate the family about the risk of prone sleeping position in infants from birth –
6months of age

2. Communicate to parents or care giver about the risk factors for SIDS

3. Avoid any remarks that may suggest responsibility

4. Allow the parents to say good–bye to their child

5. Encourage the parents to express their emotions

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

6. Family counseling may be recommended to help siblings and all family members cope
with the loss of an infant

Prevention

1. Screening family members where there has been a heart condition or a previous
sudden death
2. Infants younger than 1 year old should be placed on their backs to sleep — never
face-down on their stomachs or on their sides

3. Place your baby on a firm mattress to sleep, never on a pillow, waterbed, sheepskin,
couch, chair, or other soft surface

4. To prevent rebreathing, do not put blankets, comforters, stuffed toys, or pillows near
the baby

5. Make sure your baby receives all recommended immunizations

6. Make sure your baby does not get too warm while sleeping. A baby who gets too
warm could go into a deeper sleep, making it more difficult to awaken

7. Do not smoke, drink, or use drugs while pregnant and do not expose your baby to
second hand smoke

8. Receive early and regular prenatal care

9. Make sure your baby has regular well-baby check ups

10. Breastfeed, if possible

11. Put your baby to sleep with a pacifier during the first year of life

12. Keep the cribs and bassinets in the room where parents' sleep

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

B. ASTHMA

Asthma – Greek word for “panting”

Is a chronic lung disease in which there is airway obstruction, airway inflammation &
airway hyper responsiveness or spasm of the bronchial smooth muscle.

Risk Factors:

1. Among children, more boys have asthma than girls. But after 15 years of age, more
women have asthma than men

2. Smoking during pregnancy and after delivery

3. Low air quality from factors such as traffic pollution or high ozone levels

4. Use of antibiotics in early life

5. Exposure to bacterial endotoxin in early childhood from environmental sources

including tobacco smoke, dogs, and farms

7. Delivery via caesarean section

8. Having allergies, eczema (an allergic skin condition), or parents who have asthma.

Causes:

1. Genetic factors

Atopy is an inherited tendency to develop allergies

Parents who have asthma

2. Environmental factors

Allergens, air pollution, dust mites, cockroaches, animal dander, and mold

Exposure to some viral infections in infancy or in early childhood when the

immune system is developing
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Results from complex interactions & automatic neural regulation of the airways, where
the following occurs:

a. Bronchial smooth muscle contraction.

b. Bronchospasm

c. Mucosal edema from inflammatory cells in the airways with injury to the
epithelium.

d. Increased mucus production

e. Mucus plugging

f. Air trapped behind occluded or narrowed airways

g. Insufficient oxygenation & ventilation.

h. Air hunger responses, resulting in anxious behaviour

Pathophysiology

The airways are tubes that carry air into and out of the lungs. People who have
asthma have inflamed airways. The inflammation makes the airways swollen and very
sensitive. The airways tend to react strongly to certain inhaled substances. When the
airways react, it results in increased contractability of the surrounding smooth muscles

which thus tightening them. This narrows the airways, causing less air to flow into the
lungs (symptoms of wheezing). Bronchial constriction is a normal reaction to foreign
stimuli, but in the child with asthma it is abnormally severe, producing impaired
respiratory function. The smooth muscle arranged in spiral bundles around the airway
causes narrowing and shortening of the airway, which significantly increases airway
resistance to airflow. Because the bronchi normally dilate and elongate during
inspiration and contract and shorten on expiration, the respiratory difficulty is more

pronounced during the expiratory phase of respiration. Typical changes in the airways
include an increase in eosinophils and thickening of the lamina reticularis. Chronically
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

the airways' smooth muscle may increase in size along with an increase in the numbers
of mucous glands. Other cell types involved include: T lymphocytes, macrophages,

and neutrophils. There may also be involvement of other components of the immune
system including cytokines, chemokines, histamine, and leukotrienes among others.
Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid
that can further narrow the airways. Increased resistance in the airway causes forced
expiration through the narrowed lumen. The volume of air trapped in the lungs
increases as airways are functionally closed at a point between the alveoli and the lobar
bronchi. This trapping of gas forces the individual to breath at higher and higher lung
volumes. Consequently, the person with asthma fights to inspire sufficient air. This
expenditure of effort for breathing causes fatigue, decreased respiratory effectiveness,
and increase oxygen consumption. The inspiration occurring at higher lung volumes
hyper inflates the alveoli and reduces the effectiveness of the cough. This chain reaction
can result in asthma symptoms. Symptoms can happen each time the airways are
inflamed. As the severity of obstruction increases, there is a reduced alveolar ventilation
with carbon dioxide retention, hypoxemia, respiratory

acidosis, and eventually respiratory failure.

Classification:

1. Atopic (extrinsic)

Occupational asthma - when a person develop asthma because of contact with

certain chemical irritants or industrial dusts in the workplace

2. Non-atopic (intrinsic)

Clinical Manifestations:

1. Dyspnea with prolonged expiration

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

2. Expiratory wheeze (a whistling sound when you breathe), progressing to inspiratory &
expiratory wheezing, progressing to breath sounds becoming audible

3. Grunting respirations in infancy

4. Chest tightness (may feel like something is squeezing or sitting on your chest)

5. Shortness of breath (can't catch their breath or feel out of breath; may feel like can't
get air out of lungs)

6. Nasal flaring

7. Cough occuring at night or early in the morning

8. Accessory muscle use

9. Anxiety, irritability, to decreasing level of consciousness

10. Cyanosis

11. reversible airflow obstruction and bronchospasm

The airways are so swollen that air can’t get through client stops wheezing and
breath sounds aren’t audible

Exacerbation of Asthma:

1. Dust 6. Runny nose 11. Psychological stress

2. Mold 7. Sinus infections 12. Cockroach allergens

3. Pollen 8. Reflux disease 13. Exercise or emotional factors

4. Foods 9. Sleep apnea 14. Animal dander (especially cat and dog hair)

5. Perfumes 10. Weather 15. Both viral and bacterial infections of the upper
changes respiratory tract

Diagnostic and Laboratory Procedures:

1. Pattern of symptoms
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

wheezing, a runny nose or swollen nasal passages, and allergic skin conditions
(such as eczema)

2. Allergy testing

to find out which allergens affect you, if any.

a. Bronchoprovocation test - to measure how sensitive the airways are

b. Spirometry - forced expiratory volume in one second (FEV1), and peak

expiratory flow rate)

to check how the lungs are working. This test measures how much air a
person can breathe in and out. It also measures how fast you can blow air out

3. Chest x ray or an EKG (electrocardiogram)

to help find out whether a foreign object in the airways or another disease might
be causing the symptoms

4. Response to therapy over time

5. Arterial blood gas

initially mild respiratory alkalosis from hyperventilation then subsequently

respiratory acidosis

6. Eosinophil count – increased in blood, sputum

Therapeutic Management

The goal of asthma treatment is to control the disease

1. Prevent and control asthma symptoms, reduce frequency and severity of asthma
exacerbations, and reverse airflow obstruction.

2. Drug Therapy

General Categories of Asthma Medications:

a. Long term control medications (Preventor medicines)

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

To achieve and maintain control of inflammation

a.1 Long acting B2 agonist (to open the airways)

a.2 Leukotriene modifiers (help block the chain reaction that increases
inflammation in the airways)

a.3 Methylxanthines (Therapeutic range 5-15 mcg/ml)

Side effects:

Nausea & Vomiting Headache

Irritability Insomnia

Early sign of toxicity greater than 20 mcg/ml:

Distractibility Poor school performance

Nausea Tachycardia and Irritability

Theophylline levels greater than 30 mcg/ml (helps open the airways):

Seizure Arrhythmia

b. Quick relief medications (Rescue Medications)

To treat symptoms and exacerbations

b.1 Inhaled corticosteroids

b.2 Cromolyn sodium and nedorcomil (helps prevent airway inflammation)

b.3 Omalizumab (anti-IgE) (helps prevent body from reacting to asthma

triggers)

c. Asthma medications are given by inhalation by:

Metered dose Inhaler

Nebulizer

d. Hyposensitization

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

To identify allergens

Used for treatment of seasonal allergy and when single substance were
identified as offending allergen

e. Oral corticosteroid are recommended with five days of prednisone being the same
2 days of dexamethasone.

f. Magnesium sulfate intravenous treatment shown to provide a bronchodilating

effect when used in addition to other treatment in severe acute asthma attacks.

g. Heliox, a mixture of helium and oxygen, may also be considered in severe

unresponsive cases.

3. Exercise is advantageous for children with asthma (B-adrenergic or cromolyn sodium

before exercise)

4. Oxygen to alleviate hypoxia if saturations fall below 92%.

5. Bronchial thermoplasty

involves the delivery of controlled thermal energy to the airway wall during a
series of bronchoscopies

Nursing Management

Management is targeted at preventing asthma exacerbations by avoiding asthma

triggers by decreasing airway obstruction, inflammation & reactivity with medications.

1. Promote pulmonary functions

2. Assess & monitor child’s hydration status

3. Avoid milk and milk products

4. Alleviate or minimize child’s & parents’ anxiety, using development level

5. Assess child’s & parents’ feelings about having asthma & taking medications.

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

6. Assess willingness to participate in education programs & refer family to support

groups as needed.

7. Emergency Setting: establish IV line for fluid therapy and route for emergency drugs

Prevention:

1. Avoid triggers

a. Allergens

dust mites, animal fur, cockroaches, mold, and pollens from trees, grasses,
and flowers

b. Irritants

cigarette smoke, air pollution, chemicals or dust in the workplace,

compounds in home décor

products, and sprays (such as hairspray)

2. Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and

nonselective beta-blockers and use of inhaled corticosteroids

3. Sulfites in foods and drinks

4. Viral upper respiratory infections, such as colds

5. Physical activity, including exercise

6. Limiting smoke exposure both in utero and after delivery

7. Breastfeeding

8. Dietary restrictions during pregnancy

9. Smoking bans

Prognosis

1. The prognosis for asthma is generally good.

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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

2. Early treatment with corticosteroids seems to prevent or ameliorates a decline in lung

function.

3. Asthma has no cure. Even when you feel fine, you still have the disease and it can
flare up at any time.

C. PNEUMONIA
➢ Inflammation of lung parenchyma
➢ Classified according to etiologic agent
➢ Classified according to location and extent of pulmonary involvement
Etiologic Agent
o Less than 3 mos - GBS, g (-) bacilli, chlamydia, [Link]
o 3 mos – 5y – S. pneumoniae, staphylococcus, H infuenzae, [Link]
o Adolescents – S and M pneumoniae, M. catarrhalis
o Hospital acquired – Pseudomonas, Klebsiella, [Link], Enterobacter sp
o Viral Pneumonia -RSV, Parainfluenza, Adenovirus, Influenza
o Mycoplasma pneumonia – common in more than 5y
Signs and Symptoms B
➢ High fever, chills
➢ Irritability, restlessness, lethargy
➢ Nausea, vomiting, Diarhhea, poor feeding
➢ Respiratory symptoms – cough, restlessness, tachypnea, retractions, crackles,
dullness on percussion, cyanosis
Signs and Symptoms V
➢ Mild fever, slight cough
➢ High fever, malaise, severe cough and prostration
➢ Non- productive cough – productive cough with whitish phlegm
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NUR 1210 – PEDIA CONCEPT
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 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

➢ Rhonchi and fine crackles

Signs and Symptoms M
➢ Sudden and insidious onset
➢ Fever, chills, malaise, headache, anorexia, and myalgia
➢ Hacking cough, rhinitis, anorexia
➢ Non productive to productive with semi mucoid sputum to mucopurulent or
blood streaked.
Location and Extent
Lobar Pneumonia – involve segment of one or more lobe
Bronchopneumonia – terminal bronchioles and involve nearby lobules
Interstitial pneumonia – confined to alveolar walls, peribronchial and interlobular
tissues.
Laboratory/ Diagnostic Tests:
neutrophils - bacteria
lymphocytes - virus
o CXR – diffuse patchy infiltrates, consolidation or disseminated infiltration
eiosinophils - allergy
basophils - allergy o CBC wbc increased and po2 inceras

o Blood and sputum C/S

o Positive ASO titer
Management:
➢ Assess for respiratory distress
➢ Administer prescribed meds – antibiotics ( penicillin, macrolides)
Patent Ductus Arteriosus
➢ Supportive care – viral - Oxygen-rich blood from the aorta mix with
oxygen-poor blood in the pulmonary artery.
➢ Promote adequate oxygenation - Too much blood flows into the lungs, which
puts a strain on the heart and increases blood
pressure in the pulmonary arteries.
- left to right shunt

- Ventricular hypertrophy
D. PERSISTENT PATENT DUCTUS ARTERIOSUS - Increased pressure in the pulmonary artery
- Wide pulse pressure
From the failure of the ductus arteriosus to close after birth - Machinery like murmur

Diagnosis is thru echocardiogram

Therapeutic Management:
Medical management:
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NUR 1210 – PEDIA CONCEPT - ligation of PDA (closed heart procedure)
Prepared by MCN FEU Faculty Lecturers
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

a. Administer IV therapy cautiously

b. indomethacin or Ibuprofen to close the PDA

c. Monitor Urine Output (Side effect of indomethacin is oliguria)

LEARNING RESOURCES:

1. Asthma - ..\..\Videos\Free YouTube Downloader\How does asthma work - Christopher

E. Gaw.mp4
2. Pneumonia - [Link]

3. SIDS - [Link]

4. PDA - [Link]

LEARNING ACTIVITIES:

REFERENCES

Hockenberry, M.; Wilson, D; Rodgers, C. Wong’s Nursing Care of Infants and Children (2019) 2nd

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NUR 1210 – PEDIA CONCEPT
Prepared by MCN FEU Faculty Lecturers
 FAR EASTERN UNIVERSITY
INSTITUTE OF HEALTH SCIENCES AND NURSING
FIRST SEMESTER – AY 2023 – 2024
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Philippine Edition: Elsevier Saunders

Silbert-Flagg, Joanne. Maternal and child health nursing. Care of the childbearing and

childrearing family. Ninth edition. Philadelphia; Lippincott Williams & Wilkins: 2023.

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NUR 1210 – PEDIA CONCEPT
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