THE HIGH-RISK NEONATE Appearance

✓ Low average wt, length, HC

CLASSIFICATION ACCORDING TO ✓ Wasted appearance
GESTATIONAL AGE ✓ Small liver
• Full Term: 38-42 weeks, regardless of ✓ Poor skin turgor
weight ✓ Large head
• Premature (preterm): less than 38 weeks ✓ Dull and Lusterless hair
• Postmature (postterm): more than 42 ✓ Sunken abdomen
weeks ✓ Dry/yellow stained umbilical cord
✓ Better developed neurological response
CLASSIFICATION ACCORDING TO WEIGHT ✓ Firmer skull
1. Appropriate-for-gestational-age (AGA): ✓ Alert and active
10th - 90th percentile
2. Small-for-gestational-age (SGA): below Labs:
10th percentile ✓ Increase Hct
a. Baby is small but not necessarey ✓ Polycythemia
that the baby is a preterm, most of ✓ Persistent acrocyanosis
the time they are term or posterm ✓ Risk for thrombus formation
3. Large-for-gestational-age (LGA): above ✓ Hypoglycemia
90th percentile o Mommy is hypergly
o Big babies most of the time it is o Baby is secreting insulin to balance
preterm glucose intrauterine
o Extrauterine: baby is adjusting
Normal: 2500 – 4000
• Low birthweight (LBW): below 2500 Interventions
grams 1. Monitor VS
a. Temp: the baby is using glucose to
• Moderately-low-birthweight (MLBW):
increase temperature which leads
1501-2499 grams
to hypoglycemia
• Very-low-birth weight (VLBW): below
2. Thermoregulation
1500 grams
3. Promote early parental bonding
• Extremely-very-low-birthweight
4. Adequate stimulation
(EVLBW): below 1000 grams
LGA INFANTS
SGA INFANTS
• Macrosomia
• below 10th percentile
• above 90th percentile
Causes:
Causes:
1. Mother's nutrition during pregnancy is
1. Overproduction of growth hormone
inadequate
2. Multiparous women
2. Pregnant adolescents
3. TOGV
3. Placental anomaly
4. Congenital anomalies
4. DM/ PIH
5. Smokers/ use of narcotics
Appearance
6. Rubella/ toxoplasmosis
✓ Immature reflexes
7. Chromosomal abnormalities
✓ Extensive bruising
✓ Birth injury- broken clavicle
✓ Signs of increase ICP, respiratory distress
 ✓ Prominent caput, cephalhematoma and ✓ Use to determine the appropriate age of
molding maturity.
✓ Cyanosis
✓ Polycythemia
✓ Hyperbilirubinemia
✓ Hypoglycemia

Note: this babies should be delivered cesarean

section.

Interventions
• Monitor VS Appearance
• Offer breast milk/ supplemental formula ✓ Small and underdeveloped
feedings ✓ Disproportionately large head
• Adequate stimulation ✓ Ruddy skin
✓ Noticeable veins
• Warm nurturing
✓ Acrocyanosis
✓ Extensive lanugo
PRETERM INFANTS
✓ Small anterior and posterior fontanels
✓ Few or no creases on the soles of the feet
FACTORS:
✓ Immature cartilage
1. Decrease socioeconomic level
✓ Less active with a weak high-pitched cry
2. Poor nutritional status
3. Lack of prenatal care
4. Multiple pregnancy Potential Complications
5. Prior previous early birth 1. Anemia of prematurity
6. Race (africans) 2. Kernicterus – too much bilirubin
7. Cigarette smoking 3. Persistent patent ductus arteriosus
8. Mother's age (too young, too old) 4. Cerebral palsy
9. Birth order 5. Visual motor deficits
10. Closely spaced pregnancy a. Blurring vision
11. Abnormalities of the reproductive system b. Increase blood vessels that will
12. Infections “TORCH”S” engulf the retima
o Toxoplasmosis c. Retinopathy of prematurity
o Others d. Retrolental fribroplasia – post term
o Rubella 6. Altered intellectual functioning
o Cystomegalovirus
o Herpes POST TERM/MATURE INFANTS
• Beyond 42 weeks
o Syphilis
• Unknown cause
13. Obstetric complications
• Progressive placental dysfunction
14. Early induction of labor
15. Elective "CS"
Appearance
✓ Absence of lanugo
Ballard score
✓ Little/no vernix caseosa
✓ The higher the score, themore term the
✓ Abundant scalp hair
client is
✓ Long fingernails
✓ Add everthing
✓ Cracked, parchmentlike, desquamating
skin
✓ Wasted physical appearance
Medical/ Nursing Care (as a whole) HYDROCEPHALUS
1. Respiratory support • Complication of spinabifida
a. Hook on mechvent (CPAP) o Meningocelle vs. myomeningocell
b. Provide O2 = movement of extremeties
i. Nasal canula • Excess of CSF in the ventricles and
ii. Facemask subarachnoid spaces of the brain
iii. Oxygen per hood • Causes enlargement of the head
iv. Oxygen per tent
v. Oxygen per incubator TYPES
2. Thermoregulation 1. COMMUNICATING HYDROCEPHALUS
a. Incubator and mechanical (extraventricular hydrocephalus) –
ventilation passage of fluid between the ventricles
3. Protection from infection and the spinal cord.
a. Change to scrub suit 2. NON-COMMUNICATING/ OBSTRUCTIVE
b. Handwashing HYDROCEPHALUS (intraventricular
4. Hydration hydrocephalus) – block in the passage of
5. Nutrition CSF
a. TPN (total parenteral nutrition)
b. Pedia: nakabottle, pharmacist will CLASSIFICATIONS ACCORDING TO ETIOLOGY
be the one to prepare and compute • Congenital – exposed to radiation,
for it teratogenic drugs
c. Weigh the baby (tpn is based on the • Acquired
weight)
d. Check blood sugar level (D50 – CAUSES:
hyperglycemia) 1. Overproduction of fluid by the choroid
e. Good only for 24 hours plexus
6. Feeding resistance 2. Obstruction of the passage of fluid
7. Energy conservation somewhere between the point of origin
8. Skin care and the point of absorption
a. No full bath 3. Interference with the absorption of the
b. May take weeks before bathing the fluid from the subarachnoid space
baby
9. Administration of medications ASSESSMENT
10. lnfant stress ✓ Generally, not evident at birth
11. Developmental interventions and care ✓ 2 cm increase in the measurement of
12. Neonatal pain baby’s head in a week
a. MLA: topic meds (anesthetic agent) ✓ Wide and tense fontanels
i. Entectic ✓ Skull suture lines separate
ii. Mixture ✓ Enlarge head diameter
iii. Local ✓ Shiny scalp
13. Family support and involvement ✓ Prominent scalp veins
14. Facilitating parent-infant relationship ✓ Bulging brows
15. Discharge planning and home care ✓ Sunset eyes – increase occular pressure
16. Neonatal loss ✓ Increased ICP
✓ Neurologic impairment
✓ Muscle atrophy
✓ Ultrasound/ MRI/ CT scan/ skull x-ray/
transillumination
MANAGEMENT
o Depends on cause and extent
o Destruction of a portion of the choroid
plexus
o Acetazolamide – decreases ICP
o Tumor removal/ laser surgery
o Corrective management
o Shunting
o Paliative management
o Focuses on manifestation
o Decrease CSF accumulatin in the
brain
o Infants lie flat/slightly raised, not on the
side with VP shunt
o Position after procedure:
o Side lying in non operative
site

NURSING INTERVENTIONS
1. Assess neurological status
2. Measure HC/ assess fontanels
3. Position the infant
4. VS
a. Check temp: risk for infection post
op
5. O2
6. I and O
7. Osmotic diuretic/corticosteroids
8. Encourage mother to breastfeed
9. IV/ TPN
10. Daily weights
11. Assess parent's understanding
12. Provide support
CHILD WITH RESPIRATORY CONDITIONS Under treatment/no tretment

CHOANAL ATRESIA Antigen

➢ A unilateral or bilateral congenital
obstruction of the posterior nares by an Antibody reaction production of
obstructing membrane or bony growth, Immunecomplex
preventing a newborn from drawing air
through the nose and down into the Complement
nasopharynx
➢ Congenital – surgical Plug in glumerolus

Management AGN
• Surgical removal of the obstruction (Acute Glomerulonephritis)
• Piercing of the membrane
Antibody reaction production of
ACUTE NASOPHARYNGITIS immunecomplex
➢ Layman’s term - sipon
➢ Most frequent infectious disease in Aschoff body
children
➢ 2-3 days incubation period Plaque in the mitral valve
➢ Caused by rhinovirus, coxsackie virus,
respiratory syncytial virus (RSV), ARF/RHD
adenovirus, parainfluenza and influenza (Acute rheumatoid fever/rheumatoid high fever)
virus.
ACUTE GLUMEROLONEPHRITIS
Management ✓ Tea colored urine
• Palliative management ✓ Preorbital edema
• Antibacterials are not effective ✓ Hypertension
✓ Proteinuria
PHARYNGITIS
➢ Sorethroat or strepthroat Management
➢ Caused by group A B-hemolytic • Palliative management
streptococci o Soft food
➢ Affected children are at risk for serious o Small frequent food
sequela such as: • Compliance to pharmacological therapy
o Acute Rheumatic Fever (ARF)- an o Penicillin 7 – 10 days
inflammatory disease of the heart,
joints and CNS; onset in about 10 CAN CAUSE AGN IF LEFT UNTREATED:
days 1. Pharygitis
o Acute Glomerulonephritis (AGN)- 2. Tonsilitis
acute kidney infection; onset is an 3. Epiglotits
average of 18 days 4. Otitis media
5. Enpitigo
Pharyngitis 6. Scarlet fever
(Sore/strepthroat)

Cause by GABHS

Treated with Pennicillin x 7 – 10 days

TONSILLITIS o No carbonated drinks
➢ Inflammation of palatine tonsils often as a o No ice cream (a dairy product, milk
result of a viral or bacterial pharyngitis and sugar increases production of
➢ 10% to 15% caused by Group beta secretions)
hemolytic streptococci ▪ But you may give light
o Majority – heamophillus influenza colored popsicles
▪ DOC: cephalosporin • Less milk and sugar
o If cause by GABHS content
▪ DOC: penicillin 7 – 10 days
o IF VIRAL – none (no need) EPIGLOTTITIS
➢ Adenitis- infection and inflammation of ➢ Inflammation of the epiglottis (the flap of
the adenoid (pharyngeal) tonsils tissue that covers the opening of the larynx
➢ Kissing tonsils to keep out food and fluid during
➢ Haritosis – bad breath swallowing)
➢ An emergency situation because the
Management swollen epiglottis is unable to rise and
• Palliative management allow the airway open
o Hygiene ➢ 3-6 years of age
o Small frequent feeding ➢ H. influenza type B, pneumococci,
o Side lying to drain secretions streptococci
• Compliance to pharmacological ➢ Echovirus and RSV
• Surgical removal of tonsil: tonsilectomy
Cardinal Signs
Tonsillectomy 1. Restlessness
• Tonsil 2. Drooling of the saliva
o Filtering organ a. Side lying
o Very vascular (madugo) 3. Muffled voice or absence of cough
• Tonsillar tissue is removed by ligating the 4. Cherry red epiglottis (inflammed)
tonsils or by laser surgery; indicated for 5. Xray result reveals swollen epiglottis
chronic tonsillitis; never done if the organs 6. Child assumes tripod position
are infected
• Never done it if infected: antibiotic test Management
first 1. DO NOT INSERT ANYTHING INSIDE THE
• Loose teeth might cause obstruction MOUTH.
o Do not attempt to remove the a. NPO
teeth, refer to doctor and later to b. No suction
dentist 2. PREPARE AT BEDSIDE A TRACHEOSTOMY
• Post op: SET OR AN INTUBATION SET
o Side lying position 3. Compliance to pharmacological therapy
o Check for frequent swallowing –
may indicated bleeding FOREIGN OBJECT ASPIRATION
o Check for throat clearing – may • Inhalation of a foreign object into the
indicate bleeding airway
o Give icechips • Dislodge the object by purposeful
o Give ice candy coughing
o Jelly ace
o No coughing
o No creamy and warm foods Management
o No citrus fruits/juices (irritating)
 1. For children: Heimlich maneuver (sub ✓ Viral
diaphragmatic abdominal thrust) ✓ Atypical
2. For infants: back blows and chest thrust o Usually cause by Microplasma
Pnuemoniae
3. Xray – most common
✓ Bacterial
4. Bronchoscopy – a fiber outlet tube will be ✓ Aspiration of foreign substances
inserted inside the cavity
5. Diagnostic and interventional Management
6. Lidocaine Spray to prevent gag reflex 1. Oxygenation
7. Check RR and respiratory quality 2. Pharmacologic therapy
(bronchospasm) 3. Palliative management
a. Tsb
8. Peanut and popcorn cannot be given
b. Calm environment
because it can block the airway when mix 4. CPT (chest physiotheraphy) with postural
with fluids (it will expand) drainage
a. Diagnostic only because it will Phlegm
become soft and spongy • Right lower lobe
b. If it crumble it will go to other o Position to drain: left trendelenburg
respiratory passageway
9. Surgical removal of the obstruction SIDS (Sudden Infant Death Syndrome)
a. Opening the baby ➢ Sudden death of an infant under 1 year of
age that remains unexplained after a
PNEUMONIA complete post-mortem examination
✓ Inflammation of the pulmonary ➢ SIDS is a dianosis but unknown cause
parenchyma ➢ Brainstem abnormality in the neurologic
✓ Infancy and early childhood regulation of cardiorespiratory control
✓ Color of phlegm: it depend on the cause ➢ Males
o Viral - white ➢ 95% occur by 6 months
o Bacterial – yellowish to greenish ➢ Lower socio-economic class
▪ Coughing: pink, rudish ➢ Premature infants/LBW (<2500 grm)
✓ Respiratory acidosis ➢ Multiple births
Normal lab values: ➢ Neonates with low APGAR score
o Ph: 7.35 – 7.45 o 0-3: poor
o HCO3: 22 – 26 o 3-7: fair
o CO2: 35 – 45 o 7-10: good
o O2: 80 – 100 ➢ Infants with CNS disturbance and
o O2 sat: 95 – 100% respiratory disorder
➢ Increasing birth orders
TWO (2) CLASSIFICATIONS ➢ Infants with recent history of illness
➢ NO PRONE POSITION
According to Morphology (structure) ➢ Use of soft beddings
✓ Lobar pneumonia ➢ Overheating
✓ Bronchopneumonia/ lobular pneumonia ➢ Co-sleeping with adults
✓ Interstitial pneumonia ➢ Lower incidence in breastfed infants
➢ May have greater incidence in infants of
young mothers, cigarette smoker esp.
According to Etiologic Agents (cause) during pregnancy, poor prenatal care,
substance abuse
 ➢ Most often occurs in preterm infants;
Management o LGA babies: prema
1. "A compassionate and sensitive approach ➢ Infants of diabetic mothers, infants born
of Caesarean births
to the family in the first hours of grieving
➢ Caused by low level or absence of
could spare them of their overwhelming surfactants
guilt." o Surfactant – phospholipid that line
2. Do not ask questions that may imply up the structure of alveoli
negligence (collapsed during expiration)
o Dinapa nyo po ba yung anak nyo? Manifestation
o Theracom: ano po ang position ni ✓ Tachypnea
baby nung nakita nyong wala ng ✓ Shortness of breath
buhay ✓ GRUNTING
Note: ideal birth spacing 3 YEARS ✓ Seesaw respiration
✓ X- RAY: Ground glass appearance of alveoli
ASTHMA ✓ Respiratory acidosis
➢ Immediate hypersensitivity response
➢ Most common chronic illness
Management
o There should be no fever
➢ Before 5 years of age 1. Mechanical ventilation (CPAP mode)
➢ Affect the small airways and involves 3 2. Replacement of exogenous surfactant
separate processes 3. Palliative management
o Bronchospasm
o WEEZING – heard in
EXPIRATION
o Inflammation of bronchial mucosa
o Increased bronchial secretions
➢ Status asthmaticus – acute, severe
prolonged asthma attack and is
unresponsive to usual treatment.

Management
1. Palliative management
o Increased fluid
o Dilute milk
2. Phamacologic therapy
o Suctioning and oxygen
o Bentolin
o Corticosteroids
o Metered dose inhaler
▪ Remove cannister
▪ Soak/merge in water
• If lumubog – full pa
• If lumutang – wala
na
RESPIRATORY DISTRESS SYNDROME CHILD WITH HEMATOLOGIC DISORDERS
(HYALINE MEMBRANE DISEASE)
ANEMIAS o Better absorption
➢ Not a disease Itself but a manifestation of 8. injection site is not massaged
an underlying pathologic condition; 9. skin test recommended
➢ Low RBC, Hgb 10. blood transfusions
11. Given with meals or 1- 3 hours after meals
Classifications 12. Taken with citrus juice (vit,c)
A. Etiology/Pathophysiology • Never wwith:
• excessive blood loss o Tea
• destruction of erythrocytes o Milk
• decreased or impaired production o Coffee
of erythrocytes or its components o Softdrinks
B. Mophology • Normal Side effects:
• Cell size o Passage of black tarry stool
• Cell shape o Contipation
• Staining characteristic or color
HEMOLYTIC DISEASE OF THE NEWBORN
(HDN)
IRON DEFICIENCY ANEMIA
➢ erythroblastosis fetalis
➢ anemia caused by:
➢ abnormally rapid rate of RBC destruction
o an inadequate supply of iron
o impaired iron absorption
Rh incompatible
▪ thalassemia: iron is outside
✓ Mommy – Rh (-) absent Rhg antigen
the cell
✓ Baby – Rh (+) present Rhg antigen
o increased body's need for iron, and
✓ First pregnancy (safe)
anything that may affect the
✓ Rhogam
synthesis of Hgb
o Suppress the production of
➢ More prone to more than 6 months
antibody in fetal RBC but it will not
onwards
reverse the action
➢ Female – more prone than male bacause
o Given to mother immediately after
of menstruation
o Within 72 hours / 3 – 4 weeks
✓ Second pregnancy (unsafe)
Minifestation
o Give rhogam 26 – 28 AOG
✓ Pallor
o (-) coombs test – no antibodies
✓ Easy fatiguebility
▪ Direct – use of baby’s blood
✓ Malaise
▪ Indirect – use of mother
✓ Pica eating
blood
Management
1. iron fortified infant formula/ cereals
2. oral iron supplements for 3 months
3. should be taken with a citrus fruit or juice
4. turns the stool into a tarry green color
5. liquid prep may stain the teeth
a. Drink with straw
b. If di kaya, dropper
6. parenteral iron
7. use the 2- tract method
o no staining ABO Incompatibility
o No leakeage
 ✓ major blood group antigens of the fetus ✓ A group of bleeding disorder in which there
are different from those of the mother is a deficiency of one of the factors
✓ most common incompatibility: mother necessary for the coagulation of the blood.
with blood group "O" and an infant with "A"
✓ Common in Male
or "B" blood group
✓ O negative universal donor ✓ Carrier is female
✓ AB – universal recipient o Carrier has the traits, can passed it
to other but no signs and
symptoms
o If you passed it to others and there
is a manifestation of signs and
symptoms = carrier
o If you passed it to others and no
manifestation of symptoms – not a
carrier
Blood type Antigen Antibody ✓ X linked or sex linked
A A B ✓ No cure
B B A ✓ More of supporting management
Ab A and B (-)
✓ Skips generation
O (-) A and B

Types:
Management
• Factor VIII deficiency (hemophilia A, or
• Phototherapy
classic hemophilia)
• Rhogam given in the 1st 72 hours after the
• Factor IX deficiency (hemophilia B, or
first delivery, or as long as 3-4 weeks; and
Christmas disease)
re-administered on the 26th-28th week of
• Factor XI deficiency (hemophilia C)
gestation of the succeeding pregnancies
(if there is still no antibody present) • Von Willebrand disease (Vwd)
o Psuedohemophila
• If phototherapy is not effective – exchange
o Lack of protein
transfusion
o Site umbiliccal vein
Signs and Symptoms (bleeding)
o 10 cc then change again to 10 cc
o Why hindi 50 ml agad? Because or ✓ Epistaxis
✓ Gum bleeding
risk for abrupt hypovolemic
✓ Hematuria
✓ Bleeding over the joints

Bleeding = give clotting factor 8

Management
✓ Protect the part
✓ Rest (immobilize)
✓ Ice
Note: blood colume of pedia 300-350 ml only ✓ Compress
✓ Elevate
✓ Support
HEMOPHILIA
 • Transfusion of the deficient ✓ Avoid strenuous activity
clotting factor ✓ Oxygen as ordered
• No contact sport (solitary play ✓ Blood transfuision
pwede) • Neutropenia
• No aspirin ✓ Risk for infection
o Anti coagulant (lalo ▪ Limit visitors
duduguin ▪ Offer neutrophenic diet (all
• Punnet’s square - determine the foods are cook)
percentage of hemophilic and ▪ Reverse isolation
carrier ▪ No fresh flower or food
• Gene mutation – if walang carrier ▪ Handwashing
pero naging hemophilic sya
Types
Hemophilia trait XX XY 1. Acute Lymphocytic Leukemia
Female Male a. Increase lymphoblast
X.X X.Y b. the malignant cell involved is the
(Carrier) Hemophilia lymphoblast, which is an immature
lymphocyte
Father = hemophilic c. unknown cause
Mother = normal 2. Acute Myelogenous Leukemia
X. Y a. Increase granulocytes
X X.X XY b. non-ALL or ANLL
c. in its chronic form, it is the most
X X.X XY
common type of leukemia in
adulthood a overproliferation of
LEUKEMIA
granulocytes
➢ distorted and uncontrolled proliferation
of WBC
Management
➢ cancer of the blood-forming tissues
1. Bone marrow aspiration- (+) leukemia if >
➢ males between 2-6 years of age
or = 25% of blast cells present in the
marrow
Diagnostic
2. Chemotherapy
• Bone marrow aspiration
o Side effects
o Presence of blast cells
▪ Alopecia
o More than 25 %
▪ Nausea and vomiting
o Site: iliac crest
3. Bone marrow transplant (BMT)
TEN
Types os BMT: ASA
• Thromobocythopenia
1. Allogenic – donor is a sibling
✓ Bleeding tendency
2. Synergenic /Syngenic – donor ia as
▪ No aspirin
identical twin
▪ Use of soft bristled
3. Autologus -donor is patient himself
toothbrush
▪ Small frequent bleeding
▪ No IM injection
• Erythrocytopenia
✓ Anemia
✓ Fatiguebility
✓ Malaise
✓ Provide rest
SPECIFIC CARDIAC DISORDERS PATENT DUCTUS ARTERIOSUS (PDA)
✓ failure of the ductus arteriosus to close,
Cardiac Conditions wherein blood will be shunted from the
Acyanotic Cyanotic aorta because of aortic pressure to the
• Left – right • Right – left pulmonary artery, causing a left-to-right
shunting shunting shunt (May butas)
• COA • TOGA / V
✓ causes right ventricular hypertrophy and
• PDA • TOF
increased pressure in the pulmonary
• VSD • TA
• ASD circulation
• PS ✓ High pressure – left side of the heart
• AS (pumping of blood into circulation)
✓ Machinery like murmur

Management
1. Closes spontaneously
2. Indomethacin
o Suppress the production of
Prostaglandin
o Closes ductus arteriosus
3. PDA ligation

ACYANOTIC
COARCTATION OF THE AORTA (COA)
✓ localized narrowing near the insertion of
the ductus arteriosus, resulting in
increased pressure proximal to the defect
(head and upper extremities) and
decreased pressure distal to the
obstruction (body and lower extremities)

Management
• Balloon angioplasty
• Cardiac stenting
• Resection and anastomosis
VENTRICULO-SEPTAL DEFECT (VSD) Manifestation
✓ most common congenital cardiac defect • Congestion
✓ an opening is present in the septum • Boot shaped heart
between two ventricles • Murmurs
✓ result in right ventricular hypertrophy and Management
increased pressure in the pulmonary
• Closes spontaneously
artery
• Cardioseal using a Silastic or
✓ Boot shaped heart – hypertrophy of the
Dacron Patch
ventricles

PULMONIC STENOSIS (PS)

✓ narrowing at the entrance to the
pulmonary artery
✓ causes RV to hypertrophy
✓ may lead to pulmonary atresia

Management
• Closes spontaneously
• Cardioseal using a Silastic or Dacron
Patch

ATRIAL SEPTAL DEFECT (ASD)

✓ Also known as Patent Foramen Ovale
✓ Abnormal opening between the atria, Management
allowing blood from the higher pressure • Balloon angioplasty
left atrium to flow into the lower right • Cardiac stenting
atrium
• Resection and anastomosis
• Valvotomy or valvuloplasty
AORTIC STENOSIS (AS)
✓ narrowing or stricture of the aortic
valve, causing resistance to blood
flow in the left ventricle, decreased
cardiac output, left ventricular
hypertrophy, and pulmonary
vascular congestion

Management
• Balloon angioplasty
• Cardiac stenting
• Resection and anastomosis
• Valvotomy or valvuloplasty
CYANOTIC Manifestation
• Cyanosis during crying or feeding
TRANSPOSITION OF THE GREAT VESSELS
• Clubbing of the fingers
/ ARTERIES
✓ the pulmonary artery leaves the left
ventricle, and the aorta exits from the right
ventricle, with no communication
between the systemic and pulmonary
circulation
✓ PDA/ patent foramen ovale/ VSD must be
present

Nursing Management
• Knee chest position/squatting position –
decrease venous return and decreases
cardiac demand
• Morphine sulfate – prevent pulmonary
spasm

Management Management
• Prostaglandin o Modified Blalock - Taussig Shunt
• Arterial Switch Procedure o Brock Procedure (corrective surgery)

TETRALOGY OF FALLOT (TOF) TRUNCUS ARTERIOSUS

✓ S - eptal defect (VSD)
✓ H - ypertrophy of the right ventricle ✓ failure of normal septation and division of
✓ O - verriding aorta the embryotic bulbar trunk into the
✓ P - ulmonic stenosis pulmonary artery and aorta, resulting in a
single vessel that overrides both ventricles

Manifestation
• Cyanosis
• Poor oxygenation

Management
• Modified Rastelli Procedure – corret the
defect
ACQUIRED CONDITIONS Signs and Symptoms
Kawasaki Criteria – 5 out of 6
RHEUMATIC FEVER/ RHEUMATIC HEART ✓ fever for 5 or more days a
DISEASE ✓ conjunctivitis
✓ inflammatory disease affecting the heart, ✓ "strawberry" tongue and red cracked lips
joints, CNS, and subcutaneous tissues ✓ rashes often confined to the diaper area
✓ A recent episode of Pharyngitis. ✓ enlarged cervical lymph nodes
✓ desquamation of palms and soles
Rheumatic Heart Disease
✓ damage and scarring of the mitral valve a Treatment
follows a previous infection with group A • Administration of salicylic acid
streptococci • IV immunoglobulin
o 2 grams/kg body weight per dose
Signs and Symptoms • Steroids are contraindicated
Jones Criteria - 2 majors + 1 minor + (+) throat o IV ig + sterois = cerebral aneurysm
culture to streptococcal ▪ Risk for aneurysm
formation
Major • Observe for signs of heart failure
✓ carditis • Supportive nursing interventions
✓ polyarthritis
✓ erythematous macules (erythema Meds:
marginatum) 1. Gamma Globulin
✓ chorea (St. Vitus Dance, Sydenham 2. Warfarin
Chorea) (twitching) 3. Aspirin
✓ nontender swelling of the joints
NURSING MANAGEMENT (congenital defect &
Minor
acquired conditions)
✓ arthralgia
1. Monitor for signs of respiratory distress
✓ fever
• Pulmonary Hygiene
✓ elevated ESR/ C-reactive protein
✓ positive throat culture to streptococci • 02
• Head elevate
Treatment: • ABG
• bed rest 2. Monitor for signs of altered cardiac
• penicillin therapy output
• oral salicylates • Pulmonary Edema
• corticosteroids • Arrythmias
• phenobarbital • Characteristic ECG/ cardiac
sounds
KAWASAKI DISEASES 3. Evaluate fluid status
✓ mucocutaneous lymph nodes syndrome • I&O
✓ occurs before age of puberty • Daily weight
✓ boys under 4 years of age • Edema / severe diaphoresis
✓ vasculitis is the principal life-threatening • Electrolytes / hct LEVELS
finding • Strict fluids restrictions
✓ unknown cause though genetic 4. Administer prescribe meds
predisposition possible • Antiarrhymics
• Diuretics
 • Antihypertensive
• Fa/Folic supplements
5. Prevent infection
6. Reduce demands
7. Promote adequate nutrition
8. Promote optimal growth and
developmentt
9. Follow up care and discharge

DIGOXIN
• Increase myocardial contractility
• Check HR before administration
• Witholds if:
o Adult: CR below 60 bpm
o 12 yrs and above: CR below 60
bpm
o 1 year – less than 12 y/o: CR
below 80 bpm
o Less than 1 year: CR below 100
• Digoxin toxicity: “BANDAM”
o Bradycardia
o Anorexia
o Nausea and vomiting
o Diarrheaa
o Altered visual perception
o Male gynecomastia
CHILD WITH GASTROINTESTINAL DISORDERS • TPN
• 4C’s
CLEFT LIP o Coughing
✓ The failure of the maxillary and median o Choking
nasal processes to fuse which should o Cyanosis
normally occur between 5-8 weeks of o Continuous drooling
intrauterine life
✓ May range from small notch in the upper
lip to a total separation of the lip and facial
structure up into the floor of the nose

CLEFT PALATE
✓ An opening in the palate which usually
closes at approximately 9-12 weeks of
intrauterine life, is usually in the midline
and may involve just the anterior hard Management
palate, or the posterior palate • Surgical correction of all defects between
the trachea and the esophagus
Management
• Cleft lip (chelloplasty) GASTROESOPHAGEAL REFLUX DISEASE
o Done shortly after birth because of • Neuromuscular disturbance in which the
feeding/nutrition gastroesophageal (cardiac) sphincter
• Cleft palate (palatoplasty/ uranoplasty) and the lower portion of the esophagus are
o Done at 18-24 months lax, therefore, allow easy regurgitation of
▪ They have to wait for gastric contents into the esophagus
spontaneous closure • Non projectile vomiting or effortless
▪ If none, operate. To prevent vomiting
speech problem • Metabolic alkalosis
• Feeding in upright position • Assess for signs of dehydration
o HABERMANN/BRECK FEEDER • Antacids
• Right sided position (baby) to drain acid
Post op management:
(stomach content) to pylorus
• Post cheiloplasty position: upright, o Normal Gastric time: 3 – 4 hours
supine
• Thicken the feeding
• Post platoplasty: prone o Each oz of milk formula add 1 tbsp
• Restraint of cereals
• Logan’s bow/bar

TRACHEO-ESOPHAGEAL FISTULA/
ESOPHAGEAL ATRESIA
✓ abnormalities found in infants if the
trachea and esophagus are affected by
some teratogens that do not allow the
esophagus and trachea to separate
normally and should take place between
4-8 weeks of intrauterine life Management
• NPO • Nissen Fundoplication - is a surgery to
• IV FLUIDS correct gastroesophageal reflux disease
 (GERD). The surgery tightens the junction INTUSSUSCEPTION
between the esophagus and the stomach ✓ Invagination of one portion of the intestine
to prevent acid reflux. into another
✓ Point of invagination: juncture of the
distal ileum and proximal colon
PYLORIC STENOSIS ✓ Surgical emergency because necrosis of
✓ Hypertrophy or hyperplasia of the muscle the invaginated portion of the bowel may
surrounding the pyloric sphincter, occur
thereby making it difficult for the stomach ✓ Currant jelly stool
to empty ✓ Sausage like mass
✓ Projectile vomiting (around 3 – 4 feet) – ✓ Enema
increase gastric pressure
o Metabolic alkalosis
o Dehydration
o F&E imbalance
✓ Olive size/like mass – circular mass
✓ Visible persitaltic waves
✓ (+) string sign – the pylorus is narrowed,
and the radio-opaque material will take on
the appearance of a thin string as it passes
through this narrowed channel. A single
stripe of barium within the narrowed
elongated pyloric channel

Management
• Barium enema
• Manual pulling
• Resection and anastomosis
o Anastomosis – if necrotic iccut na
tas pagdudugtunginn

HIRSCHSPRUNG'S DISEASE
✓ Also called Congenital Aganglionic
Megacolon
Management ✓ Mechanical obstruction caused by
• Fredet - Ramstedt Operation inadequate motility of a part of the
(pyloromyotomy) intestines
✓ Delay in passing the stool (no meconium
within 24 hrs)
✓ Feeling of fullness
✓ fecal mass
Management
• Colostomy
o Permanent
o Done to evacuate the feces
o Effluent – feces in colostomy
• Endorectal pull-through (ERPT)

Note:
• Assess patient for fever, explosive watery
diarrhea bacause it indicated
ENTEROCOLITIS (life threatening)

Biopsy – checking if the distal portion of the

anus is bumalik ang gangglion. Iccut yung
gagglion at pagkakabitin yung dalang end. Tas
tatanggalin na colostomy = ERPT

IMPERFORATE ANUS
✓ Stricture of the anus
✓ Minor: requiring surgical incision of the
persistent membrane
✓ Severe: involving sections of the bowels
that are inches apart with no anus
✓ Wink reflex – absent
✓ No passage of meconium

Management
• Anoplasty
• Colostomy
CHILD WITH RENAL OR URINARY DISORDERS HYPOSPADIAS CHORDEE
✓ cobra like appearance of the penis
BLADDER EXTROPHY
Management
✓ A midline closure defect that occurs
• Surgical correction of the urethral opening
during the embryonic period of gestation,
preferably done together with
usually on the first 8 weeks, wherein the
circumcision
bladder lies open and exposed on the
o Use of foreskin
abdomen
▪ May be use for the
✓ Get skin from the buttocks or leg
correction of the penis
o Best time to do this is 18 months
▪ Toilet training

HYDRONEPHROSIS
✓ Enlargement of the pelvis of the kidney
with urine as a result of back pressure in
the ureter
✓ Caused by obstruction, either of the
ureters or of the point where the ureters
join the bladder
✓ Acquired
Management o Stone (nephrlothiasis)
• Cover with sterile gauze ✓ Congenital
• Skingraft o Narrowing
• Ureterosigmoidoscopy o Ureteral stent
• Ileal conduit ✓ Repeated UTI’s
✓ Antibacterial agents
EPISPADIAS ✓ Extracorpurial shock wave (ESWL)
✓ urethral defect in which the opening is on
the dorsal (back) or upper surface of the
penis

Management
• Antibiotic therapy
• Ureteral stenting
• Surgical removal of the obstruction
HYPOSPADIAS
✓ urethral defect in which the opening is on
the ventral (front) or lower aspect of the
penis
WILM'S TUMOR ✓ Occurs as an immune complex disease
✓ also known as nephroblastoma after an infection with nephritogenic
✓ most common renal and intra-abdominal streptococcus
tumor of childhood
✓ peak at age 3 years old Cardinal sign “TECH”
✓ males ➢ Tea colored urine output
➢ Edematous eyes
Management ➢ CHON in urine
• Surgical removal of the tumor o Albumin (Steroids)
• DO NOT PALPATE THE ABDOMEN – risk for ➢ Hypertension (due to RAAS mechanism)
decapulation of the tumor (rupture) Diet: High protein, low sodium

NEPHROSIS (NEPHROTIC SYNDROME)

✓ Altered glomeruli permeability due to
fusion of the glomeruli membrane
surfaces, which causes abnormal loss of
protein in urine
✓ Massive protein loss
✓ HELP
o Hyperlipidemia
o Edema which is generalized
(anasarca)
o Low serum albumin
URINARY TRACT INFECTION o Proteinuria
✓ Involves the urethra, bladder, ureters, ✓ No oily food
renal pelvis, calyces, and renal ✓ Weigh babies
parenchym ✓ Give boiled egg
✓ Occurs most often in females because ✓ Diet: High protein water, low sodium
the urethra is shorter in girls and is located
close to the vagina and anus
✓ Escherichia coli – most common
causative agent
✓ Female (most common) (urethra: 2 -3
inches)
✓ Male – urethra (6 – 8 inches)
✓ No bubble baths

GLOMERULONEPHRITIS
✓ Inflammation of the glomeruli of the
kidney