Pediatric Diseases

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The term “Growth” and “Development” are occasionally used interchangeably but are different. GROWTH is generally used to denote an increase in physical size or quantitative change. DEVELOPMENT is used to denote an increase in skills or ability to function. COGNITIVE DEV’T is the ability to learn or understand from experience, to retain knowledge and to solve problems (Intelligence). Factors affecting Growth and Development 1. Gene Genetic tic Influe Influences nces 6. Env Environ ironment ment 2. Gender 7. Nutrition 3. Race and National nality 8. Soci cio o-Eco cono nom mic Level 4. Intelligence 9. Parent-Child Relationship 5. Health 10. Ordinal Position (Family)

Developmental Screening for Newborn – done by Pediatrician 1.Denver II Developmental Screening Test - divide streams of Development into gross motor, Fine motor, language and  personal-social  personal -social..

2. Clinical Adaptive Test - rates problem solving and visual motor ability.

Criteria for Suitability of Toys 1. Is it safe? 2. Is it Useful? 3. Is it compatible?

Infancy

Solitary

Toddler

Parallel

Pre-school

Schooler

Associative

Cooperative

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st stac ack k ttoy oys, s, bl bloc ocks ks,, p pot otss drums to bang push and pull toys rocking horse, swing fin ing ger pai paint ntss, puz puzzzle

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Trucks, do dollho hou use Doct octor and and nur ursse kit kitss Sand andbox, ox, out outdo door or gym

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Games and Spo porrts Boa oard rd ga game mess, boo books ks an and d TV TV

PLAY medium form expression, communication and growth in children

Functionss of Play Function

 

1. 2. 3. 4. 5.

Educ ducatio ationa nall Recr Recrea eattiona ionall Phys Physic ical al Dev ev’t ’t Social Social and Emotio Emotional nal Adjust Adjustmen mentt Ther herapeut peutic ic

Growth and Development Throughout Lifespan Infancy (0-1)  Nutrition  Nutrit ion - Vit. C, D and Iron is not found in milk  - Solid food introduce at 4 to 6 months Psychosocial Dev’t - mother should not expect too much from infant Health Maintainace

Toddler (1-3) - Auton utonom omy y / Ind ndeepe pend nden ence ce - Reco Recogni gnize ze that that they they are are sep separ arate ate indiv individu idual al > negativistic > Difficult to manage Socialization - imitates what she/ he sees - differentiate boy from girl Toilet Training - stays dry for 2 hours with regular bowel mov’t - Can sit, walk and squat - Can verbalize the desire to void or defecate  Negativism  Negati vism - undergo extreme negativism, hates to do anything

- reply to every request is definite NO! Temper tantrums Pre-schooll (4-5) Pre-schoo

Oedipus and Electral Complexes - awar awaree of se sexua xuali lity ty,, sexua sexuall role roless and and orga organs ns Phallic Stage - Aware of body’s anatomy and sexual identity (Male and Female) - Sexual identity is important to preschool in play (Boys-toy guns / Girls-dolls) - Penis envy or castration fear  - Deal with masturbation in non-judgmental manner  Oedipus and Electral Complexes

 

- awar awaree of se sexua xuali lity ty,, sexua sexuall role roless and and orga organs ns Phallic Stage - Aware of body’s anatomy and sexual identity (Male and Female) - Sexual identity is important to preschool in play (Boys-toy guns / Girls-dolls) - Penis envy or castration fear  - Deal with masturbation in non-judgmental manner  School Age (6-12)

Strives for Achievements of: 1. Gross motor competency (Sports) 2. Fine motor dexterity (crafts/arts) 3. Cognitive proficiency (reading, math) 4. Social mastery (friends, peer groups) Psychosocial Development - master master skills skills that will will help help them them fxn in the the adult adult world world - St Steal ealing ing is a com commo mon n scho school ol-ag -agee pro probl blem em Ways to assist a school-age child develop psychosocially 1. Recognizing Recognizing success success and and providing providing praise for achievements. achievements. 2. Guiding children children to perform perform task in in w/c they they are likely to succeed. succeed. 3. Guiding Guiding the child child to to compl complete ete task  task  4. Teaching Teaching the child child to get get along along with with peers peers 5. Teaching Teaching the child child to get get along along with with adut

Play - collecting age begins (Cards, posters, marbles etc.) Cognitive Dev’t - develop logical reasoning, cause and effect Moral and Spiritual Dev’t -- God is good always present to help Hygiene and and Nutrition Adolescent (12-18)

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Period Period during during w/c w/c the perso person n becomes becomes physic physicall ally y and psychol psychologic ogicall ally y mature mature and acquires personal identity.

Puberty – first stage of adolescent in w/c sexual organ begins to grow and mature. girls – 10 to 14  boys – 12 to to 16 Menarche – occurs in girls Ejaculation - occurs in boys Physical Dev’t

 

- adolescent growth Spurt - Glandular changes – sweat, acne Cognitive Dev’t - ability to use scientific thought – plan their future Psychosocial Dev’t Psychosocial - task task is is to est establ ablis ish h identi identity ty and and sel selff-co conce ncept pt - Adoles Adolescent cent are are sexuall sexually y active active and may may engage engage in mast masturba urbatio tion n or hetero heterosexu sexual al activity. - Dating helps prepare them for marriage by teaching them how to act with members of  opposite sex. Promoting Healthy Family Functioning - It is not easy easy to to be with with teen teenager agers, s, it is is equall equally y difficul difficultt to be teenage teenagers rs - Teenage Teenagers rs need need good adult adult role role mode models ls so that that they they can see see that that adult adult roles roles are are not frightening but desirable. Sex Education Common Health Problems - Obesity - Acne - Adolescent Pregnancy - STD - Drug / Alcoholism - Suicide - Motor Vehicular Accident

Physiologic Status of Newborn CIRCULATORY STATUS

• • • • • •

UMBIL UMBILICA ICAL L VEIN VEIN and DUCTU DUCTUS S VENO VENOSUS SUS constri constrict ct aft after er cord is clampe clamped. d. DUCTU DUCTUS S ARTERI ARTERIOSU OSUS S constri constricts cts w/ est establi ablishm shment ent of respira respirator tory y functio function. n. FORAM FORAMEN EN OVALE OVALE closes closes functio functionall nally y as respir respirati ations ons are establi established shed,, but but anatomic or permanent closure may take several months. months. HEAR HEART T RATE RATE av aver erag ages es 14 140 0 bmn bmn BP 73/55 mmHg PERI PERIPH PHER ERAL AL CIRC CIRCUL ULAT ATIO ION N acr acroc ocyan yanos osis is w/n w/n 24H 24H

Renal System

 

• Urine Urine prese present nt in the blad bladder der at at birth birth,, but NB may may not not void void for for 1st 1st 12-24 12-24 hours hours.. • Later Later patter pattern n is 6-10 6-10 voidi voidings/ ngs/day day - indicat indicative ive of of suffi sufficie cient nt fluid fluid intake. intake. • Ur Urin inee is is pal palee and and st stra raw w col color ored ed.. - initial voidings may leave brick-red spots on diaper r/t passage of uric acid crystals in urine • Infa Infant nt unab unable le to to conce concentr ntrat atee urine urine for for the the 1st 1st 3 mos mos   DIGESTIVE SYSTEM •

• • • •

intact, small raised white areas areas on the palate are normal.  Hard palate should be intact, EPSTEIN’S PEARLS  Newborn can’t move  Newborn move food from from lips lips to pharynx. pharynx. capable of digesting simple CHO and simple CHON but fats Stomach capacity caries= 50-60 ml Feeding patterns

FIRST STOOL is MECONIUM. - black, tarry residue from lower intestine.



- usually passed within 12- 24 hours after birth. After 3 days MILK STOOLS are usually passed. a. MILK STOOLS for BF-INFANT - Loose and golden yellow b. MILK STOOLS for FORMULA-FED - Formed and pale yellow TEMPERATURE • • • • •

 HEAT PRODUCTION - Metabolism of “BROWN FAT” Axillary temperature: 96. 8 to 99ºF  NB’s body temp temp drops quickly after after birth. birth. - cold cold stress stress occurs occurs easily. easily.

Body stabilizes temp in 8-10 hours if unstressed. Cold stress increases O2 consumption. - may lead to metabolic acidosis and respi distress.

WEIGHT • norma normal= l= 250 2500 0 - 4300 4300 g (5.5 (5.5 to to 9.5 9.5 lbs) lbs) at ter term. m. • Init Initial ial los losss of of 5-1 5-10% 0% of body body wei weight ght - normal for the first few days - this should be regained in 1-2 weeks LENGTH • Aver Averag agee 45. 45.77-55 55.9 .9 cm (18(18-22 22 in) in) CHEST CIRCUMFERENCE

 

• •

30 30-3 -33 3 cm cm (12(12-13 13 inch inchees) shou should ld be be equal equal to or or 2-3 2-3 cm < head head cir circu cumfe mfere rence nce

HEAD

25% of the body length; circumference 33-37cm • Bone Boness of of the the sk skul ulll aare re no nott fus fused ed • Palpable sutures • Fontanels • Mold Molding ing ,Ca ,Caput put Succ Succed edane aneum um,Ce ,Cepha phalo lohem hemat atom omaa • SKIN • • • • • •

Pigmentation increases after birth Skin may be dry. ACROCYANOSIS Small amounts of lanugo and vernix caseosa still seen May develop “NEONATAL RASH HARLEQUIN SIGN

INITIAL CARE OF THE NEWBORN • • • • • •

Observe and assist with initiation of respirations Assess Apgar score Note characteristics of cry Monitor for nasal flaring, grunting, retractions and abnormal respirations Obtain vital signs Observe NB for signs of hypothermia or hyperthermia.

NURSING INTERVENTION •

• • • •

• •

• • •

Suction mouth, then nares with bulb syringe. Dry baby and stimulate crying by rubbing. Maintain temperature stability. Keep newborn with mother to facilitate bonding. Place newborn at mother’s breast if breastfeeding is planned or place on mother’s abdomen. Place newborn in a warmer. Position newborn on the side or abdomen or in modified Trendelenburg position to facilitate drainage of mucus. Ensure proper NB ID Footprint NB & fingerprint mother on ID sheet/ agency’s policies & procedures Place matching ID bracelets on mother & NB

APGAR SCORING SYSTEM

 

• • • • •

Perform and record Apgar score at 1 min & at 5 mins. If the score score is less than than 7 at 5 mins., mins., the Apgar score score shld be perform at 10 mins. A score of 7-10 indicates a healthy newborn. A score of 3-6 is considered moderately depressed. A score of 0-2 is severely depressed.

Pediatric Neuro Disorders accumulation of CSF CSF more than normal normal volume volume Hydrocephalus  – accumulation Types: 1. Comu omunica nicatting ing 2. NonNon-co comu muni nica cati ting ng Dx Test: Myelogram Dyes: 1. Oil – FOB FOB 6- 8 hr hrs. 2. Wate Waterr – head head ele elevat vation ion 6 hrs. hrs. 3. Ai Airr – tren trende dele lenb nbur urg g Mgt: Shunting Spina Bifida – baby born without fusion of backbone Cause: folic acid deficiency Types: 1. Ocu cult ltaa – dimp dimple le 2. Cyst Cystica ica – sac sac prot protru rusi sion on Meningocoele – sac contains CSF Myeloeningocoele – sac contains CSF and Spinal cord

Mgt : Surgery within 24 hrs after birth Crede’s maneouver  Reye’s Syndrome – degeneration of aftes in the liver  Cause: aspirin toxicity Mani : Decorticate and Decerebrate posture Mgt: Oxygenation (No more than 4L/min – Retrolental Fibroplasia) Tumor – space occupying lesion Medulloblastoma – fatal type -death within hours to days Mgt: surgery

RESPIRATORY DISORDERS 

 

BRONCHIOLITIS Mani: Rhinorrhea & ⇓ fever  Lethargy Poor feeding Irritablity Tachypnea Dyspnea  Nasal flaring flaring Wheezing Diminished breath sounds

Mgt: Ribavirin (Virazole) PNEUMONIA Types: Viral : Whitish sputum Bacterial: non productive hacking cough

Primary Atypical: NURSING CARENon productive – productive- blood streak sputum  Administer O2, Mist tent  Suction PRN  Chest physiotherapy  Bed rest  Lie on the affected side  Isolation precaution  Anti-tussives, antimicrobial therapy, antipyretics  Thoracenthesis ASTHMA 

Wheezing  Dyspnea  Chest tightness  Exacerbations - air is trapped behind occluded or narrow airways and hypoxemia can occur  STATUS ASTHMATICUS   - child displays respiratory distress despite vigorous treatment - may result in respiratory failure & death if untreated

 

HOME CARE MEASURES - Allergens control - Avoid extremes of temperature - Avoid exposure to viral respiratory infection - Recognize early symptoms - Instruct the child child in the administration of medications as Rx - Adequate rest, sleep, and a well-balanced diet - Adequate fluid intake - Exercise as tolerated SUDDEN INFANT ‘s DEATH SYNDROME MATERNAL RISK FACTORS Maternal smoking Substance abuse Younger mothers APPEARANCE WHEN FOUND Apneic & blue Frothy blood-tinged fluid in the nose & mouth Typically found in a disheveled bed, with blankets over the head, Diaper is wet & full of stool GUT Cryptorchidism Whether or not to treat is still controversial. - If the testes remains in the abdomen, damage to the testes (sterility) is possible because of increased body temperature. If not descended by age 8-9 mos, chorionic gonadotropin can be given.  Orchipexy - surgical procedure to retrieve and secure testes placement - preformed between ages 1-3 years •



NURSING CARE Advise parents of absence of testes and provide nformation about treatment options. Support parents if surgery is to performed. Post-op Avoid disturbing the tension mechanism. - will be in place for about 1 week. Avoid contamination of incision. •







GIT DISORDERS Celiac’s dse aka Gluten Enteropathy

 

- Increase in amino acid glutamine Monitor gluten free diet Provide supplement fat-soluble vitamins Provide client teaching and discharge planning concerning: a. Gluten-free diet b. avoidance of infection. c. importance of adhering to diet d. importance of long term ff-up management. IMPERFORATED ANUS • Surger Surgery y to reconst reconstruct ruct the the anus anus and perfo perform rm a colon colon pullpull-thro through ugh or sigm sigmoid oid colostomy with anastomosis and pull-through 1 year later 

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