PEDIATRIC NURSING

Lecturer: Alvin Palmos, RN, USRN

Transcribed by: Krystl Lianne A. Ersando
July 22, 2022  Arnold Chiari Malformation  Foramen
Magnum & Cerebellum
I. HYDROCEPHALUS  Dandy Walker Syndrome  Cerebellum
 Inside choroid plexus within ventricles
(absorbed in subarachnoid space)  CNS
(brain / Spinal Cord)
 CSF in head 22-year-old can have Hydrocephalus = there is an
 Enlarged ventricles / head increased ICP
 Ventricles filled with extra fluid
 Common: Infants Types:
 Communicating
 Non-communicating (common)

Manifestations:
 Head Circumference
 Bulging Fontanels
 Dilated Scalp brain
 ICP
 *Sunset Eyes  sclera is visible above Iris
Enlarged: Brain is not yet fused  Enlarged ventricle  tilts brain = result to
Ventricles  (brain is pushed upward)
Diagnostic Test:
2 fontanels: 1. Transillumination Test = approximately
 Anterior: 3 – 18 months check degree of separation of brain
 Posterior: 2 – 3 months 2. MRI
3. CT-Scan
Problem / Cause: 4. X-ray
1. Production
2. Absorption of CSF Mgt:
3. Obstruction 1. Support head well = using palms
2. Provide adequate nutrition
ICP = there is ICP if CSF is involved 3. Remove obstructing mass
It becomes abnormal if it increases 4. Shunting = to provide primary drainage
(artificial = exit)
Manifestation:
ICP  Early:  Possible cause of Mortality: CVA
 Altered LOC
 Restlessness Shunt Types:
 Irritability  Ventriculoperitoneal = Peritonitis
 Confusion Mental Status  Ventriculoatrial = Endocarditis
 Lethargy Changes
 Irresponsive VP = CSF  Glucose & Bacteria = Infection
GIT
 Late: Peritonitis
 Projectile vomiting
 Widened pulse pressure Post-op Care:
 High pitched shrill cry  Flat in bed = 24hrs (to prevent shunt from
discharging)
Causes:  Observe signs for increased ICP
 MIO
 Tumor
 Administer drugs
 2° infection  Meningitis
» Acetaminophen
 Congenital  Spina Bifida (Obstruction) » Antibiotics
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
 Observe for abdominal distention Infection
 Provide skin care
˗ Inspect surgical site Vascular Dissemination
 Teach on signs of Malfunction: Blood-brain barrier
˗ Increased ICP
˗ Worsening of neurologic status Inflammation
Pus formation
Complications:
 Shunt infection: Peritonitis & Meningitis Edema
Sample Questions: Obstruction
An infant who was born with meningomyelocele
develops Hydrocephalus. On return from the Increased ICP
operating room, the infant has a
Ventriculoperitoneal (VP) shunt in place. Nursing Manifestation:
care for the infant during the first 24hrs would  Infection
involve.  Increased ICP
a. Sedating the infant frequently for pain  Nuchal Rigidity (stiff neck) 4
b. Placing the infant in a high-fowler’s position  Opisthotonos (excessive arching of back)
cardinal
c. Position the infant on the side that has the  Brudzinski (batok)
shunt  Kernig’s sign (knee) signs
d. Monitoring the infant for increasing
intracranial pressure Diagnostic Test:
1. Lumbar Puncture = confirm, distinguish,
Nurse is performing an assessment on an infant determine, what medication to give
with a diagnosis of hydrocephalus. The nurse 2. Serum Blood Test
assesses for the major sign associated with
hydrocephalus when the nurse: Post-Procedure:
a. Tests the urine for protein  Flat on bed 2-3hrs WITHOUT pillow, to prevent
b. Takes the apical pulse Spinal Headache and CSF leakage
c. Palpates the anterior fontanel
d. Takes the blood pressure Question:
What to do after lumbar puncture?
A nurse has provided discharge instructions to the a. Position patient FOB without pillow 2-3hrs
patients of an infant who had a ventriculoperitoneal to prevent spinal headache & CSF leakage
shunt procedure performed for the treatment of b. Monitor V/S
hydrocephalus which statements indicates an c. Document the procedure
accurate understanding of the presence of a shunt d. Offer a glass of H2O
malfunction?
a. “If my infant has a high-pitched cry, I shall Mgt:
call the doctor.” 1. Antibiotic Therapy
 Given IV or intrathecal administer as soon
II. MENINGITIS as it is ordered
Infection (inflammation) of Meninges  CNS  Continue 10-14 days
(Brain, Spinal Cord)
 Anti-convulsant – Dilantin
Causative Agent:  Universal Precautions
 Bacterial (Neisseria Meningitidis) ˗ Enforce strict handwashing
 Viral (self-limiting)  Protective Isolation
 Fungal (rare type) ˗ Maintain Respiratory isolation
for minimum of 24hrs.
 Seizure Precaution
˗ Minimize stimuli
 Position: Fowler’s
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Question:  Flaccid Paralysis  teach to use, Assistive
A 9month old infant is admitted to the pediatric unit  Contracture & Deformities
with a tentative diagnosis of meningitis. A lumbar
puncture is performed. The nurse recognizes that Mgt:
the primary reason for this procedure is to:  Promote Sac Care:
a. Reduce ICP  Moist
b. Identify the presence of bleeding  Change dressing 2-4hrs
c. Measure the spinal fluid glucose level  Moist non-adherent sterile gauze
d. Determine the causative agent  Bottle of NSS
 Tape measure
III. SPINA BIFIDA  Provide Meticulous Care:
Failure of Neural Tube to close  CNS  Position: PRONE (SIDS) Sudden Infant
(Brain, SC) Death Syndrome
˗ Check for early signs of infection
Causes: ˗ NO diapers until repaired, fully healed
 Neural tube defects ˗ Inspect for leaks, halo signs (notify)
 Lack of B9 (folic acid)
 Genetics Short Term  Meningocele
Long Term  Myelomeningocele
Two Major Types of Spina Bifida
 Occulta = hidden (NO visible spina defect) Post-op Care:
 Cystica 1. Prone
2. Monitor S/S of increased ICP
Spina Bifida Cystica 2 Types 3. MIO
 Meningocele 4. V/S
Common in Lumbar Sacral 5. Side Effects
 Myelomeningocele
More dangerous Sample Question:
A nurse is performing an admission assessment
Spina Bifida Occulta Types on newborn with a diagnosis of spina bifida
 ФSac, Ф Surgery, Ф Problem (myelomeningocele). The nurse assesses for a
 Tufts of hair major symptom associated with this type of spina
 Dimpling, Redness bifida when the nurse:
 NO paralysis, NO bowel & bladder a. Checks the capillary refill of the nailbeds of
the upper extremities
 (+) Meningocele  CSF b. Tests the urine in blood
Meninges c. Palpates the abdomen for masses
d. Checks for responses for painful stimuli
from torso downward
 (–) Myelomeningocele  CSF
Meninges
SC IV. DOWN’S SYNDROME
Obstruction  Prone to Leukemia / Cancer
Nerves
46 chromosomes
Diagnostic Test: 23 pairs
1. Amniocentesis = to determine AFP done 16-18 Trisomy 21
AOG  Caused: by an extra chromosome on the 21 st
2. Ultrasound pair.
3. Transillumination  Common: to infants born to mother less than
20y.o and over 45y.o
Spina Bifida Cystica  Teratogenic, age, genetics
Manifestation:  Under expression or Over expression
 (+) sac
 Altered bowel (“soiling”) & bladder function
(neurogenic)
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Manifestation:
1. Flat broad nasal bridge Duodenal Atresia
2. Protruding tongue
3. Inner epicanthal eye fold GIT TEF
Hirschsprung’s disease
4. Broad short neck
5. Protruding abdomen Aganglionic Megacolon
6. Short, sturdy finger
7. Simian crease * Mgt:
8. Low set ears * Hallmarks  Parental Support
9. Gap between toes (big toe) *  Monitor for signs of cardiac difficulties
10. Hypotonia  Help child reach optimal level of function
11. Brachycephaly Therapeutic Communication = Silence

V. CLEFT LIP & CLEFT PALATE

Cleft Lip  Failure of fusion of the maxillary & the
Median nasal processes.

Cleft Palate  an opening of the palate, usually in

the midline & may involve just the
anterior palate, posterior soft
palate or both.

 Etiology:
 Familial tendency
 Teratogenic agents

 Incidence:
 CL – Males
 CP – Females
Associated Problems: A Sia
Surgical Correction:
 Cardiac Defects  ASD, PDA, VSD, TOF CL – Cheiloplasty: 10 weeks old then revisions
CHF may be made between 4-6years.
ASD, VSD, PDA, TOF CP – Palatoplasty: 12-18 weeks old, prone, at risk
Hypoxia  Q
for aspiration.
 Feeding defects Pre-op Mgt:
 Delayed developmental skills  Feed in up-right / sitting position (Breck’s
 Mental retardation Feeder)

CA Lymphoma (Hodgkin’s)
Pre-op Care:
Leukemia
Cleft Lip
 Metal appliance / adhesive strips (LOGAN
ALL AML
BAR)
(kids) (adults)
More dangerous  Elbow restraints  infant, close hitch, fingers
2-3y.o
WBC – Infection ˗ Provide meticulous care to suture site:
WBC – risk for infection Side Lying
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Cleft Palate Nagstastay ang GABHS sa Mitral valve, kasi mas
 Position: PRONE = to prevent aspiration maliit so mas may chance mag stay.
 Feeding  nipple-soft, large bole-hole
 Lamb’s nipple = elongated Tricuspid Valve – mas Malaki, easier to pass
 Oral packing secured to palate  check the
package Left heart failure because it is heart & mitral valve
 Restraints is located in left.
 AVOID:
 Use of suctions, tongue blades, Diagnostics:
thermometers, spoons, straws 1. ESR – elevated (sed rate) (non-specific)
 Toasts hard cookies 2. ASO-titer increased (specific)
 Administer Narcotics  Gagalaw lang nang gagalaw ang ASO if
GABHS ang reason
Sample Question:
To prevent tissue infection & breakdown after cleft Jones Criteria:
palate or lip repair, the nurse would use which of 1. 2 major & 1 minor
the following intervention? 2. 1 major & 2 minor
a. Keep the suture line moist all times
b. Allow the infant to suck on his pacifier Mgt:
c. Rinse the infant's mouth with water after  Prevent Cardiac Damage  CARDITIS
each feeding  Strict bed rest
d. Follow orders from the physician to not  Monitor Apical pulse  before & after
feed the infant by month giving meds
 Low Na diet = Lonalac (low Na milk)
Most cleft palates are repaired at what age?  Relieve Discomfort  Arthralgia
a. Immediately after birth  Use bed cradle  Blanket
b. 1-2 months
c. 3-4 months  Medications: administer as prescribed…
d. 1 to 2years » Benzathine Penicillin (Pen-G)  IM thigh
or buttocks (monthly)
˗ If allergic, give Oral Erythromycin,
VI. RHEUMATIC FEVER Clarithromycin)
Systemic inflammatory disease affecting » Aspirin / Salicylates
heart, joints, CNS and subcutaneous tissue. » Prednisone  prevent & manage
Polyarthritis
Causative Agent: » Digoxin  Lasix, K+ = Digibind  IV
Pharyngitis  RA 30mins
GABHS Laryngitis  AGN » Oxygen
Tonsilitis  SLE
GABHS – is in Blood = if left untreated: may cause Sample Question:
a lot of complication A child is being seen in a clime for a sore throat
Manifestation: caused by group A beta-hemolytic strep. The
 Major characteristics: (memorize major) nurse provides care with the understanding that
 Carditis (Peri, Myo, Endo) the nick of developing rheumatic fever is greatest:
 Migratory Polyarthritis (no infection / a. Two weeks later
inflam) b. Poor to administering an antibiotic
 Sydenham chorea  St. Vitus Dance c. Once the child has begun antibiotic therapy
 Erythema Marginatum d. With the onset of the strep infection
Non-itchy, painless
 Subcutaneous Nodules
A nurse receives a phone call from the admitting
 Minor characteristics office and is told that a child with rheumatic fever
 Arthralgia will be arriving in the nursing unit for admission. On
 Fever ≥38°C (2 weeks) admission, the nurse prepares to ask the mother
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
which question to elicit assessment info specific to Sub-Acute
the development of R.F? (massive DHN & Thrombocytosis)
a. “Did the child have a sore throat or  Cracking of lips
unexplained fever within the last 2 months"  Desquamation of palms & toes (peeling)
b. “Has the child have any nausea or  Joint pain
vomiting”  Thrombocytosis

An eight-year-old child who is hospitalized with a Convalescent

diagnosis of rule out rheumatic fever makes all of  Child appears normal but signs of infection
the following comments to the nurse. which may be present  Residual  fatigue, loss of
comment will assist in confirming the diagnosis? appetite
a. “Sometimes I have pain in my knees, then
It goes away & then my elbow hurt”
b. "I don't feel hungry in the mornings
anymore"
c. I have a big black and blue spot on my skin"
d. "I've been yawning a lot lately"

VII. KAWASAKI DISEASE

Mucocutaneous Lymph Node Syndrome
(Vasculitis)
Diagnostic Test:
 Non-specific disease affecting the mucous 1. CBC – WBC, Platelet
membrane, linings of blood vessel and heart 2. ESR – elevated  Non-specific
Arteries  Arterioles  Vasculitis ECG  C.A.A (Coronary Artery Aneurysm)
MRI
Causes: unknown, alteration of the immune system CT-Scan
Pathophysiology:
Kawasaki Disease  Self-limiting
Altered immune response

Anti-body antigen reaction Mgt: Viral Infection: Aspirin Prohibited

 Administer meds
Inflammation  Aspirin / Ibuprofen – anti-inflammatory agents
 IV immunoglobulin – reduce immune response
Aneurysm  10 days  High grade fever
 Abciximab – Platelet receptor inhibitor
Platelet accumulation
Provide Comfort Measures:
Thrombi Formation  TSB
 Offer pregnant cool fluids (increase)
Obstruction in Heart & Blood vessels  Apply petroleum jelly to ups
 Give bland foods.
Manifestation:  Prevent infection & dehydration
Acute Stage  Keep skin well-lubricated
(inflammation & rupture of BV – 2wks)  *Prevent scratching & itching → Cotton mittens
 High grade fever  lasting for 5-7 days  Monitor skin turgor
(intractable) (unrelieved by any Pyretic)
 Force fluids
 Strawberry tongue  “Beefy Red Tongue”
 Polymorphus rash Sample Question:
 Conjunctivitis  Ф Pus A nurse is preparing for the admission of a child
 Enlargement of Cervical L.N with a diagnosis of acute KAWASAKI disease. On
assessment of the child, the nurse expects to note
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
which clinical manifestation on the acute stage of Hypoxia (cause) → Obstruction (prob) = Hypoxia
disease?
a. Conjunctivitis  Risk: African American Kids
b. Cracked lips
c. Desquamation of skin Sample Question:
d. A normal appearance What is the most significant, (pinakamalala)
among sickle cell factors?
The nurse is assessing child admitted possible a. Cold weather
Kawasaki's disease. A characteristic sign or b. Extreme Exercise
symptom that the nurse should observe and c. Swimming in public pools
document would be: d. Flying on a plane for 6 hours
a. Cardiac dysrhythmia
b. Decreased urine output Sickle Cell Crisis:
c. Peeling skin on fingers Vaso-occlusive crisis = caused by obstruction
d. Decreased level of consciousness  Pain & Priapism

The nursing care plan for a toddler diagnosed with Splenic sequestration = pooling & increased
Kawasaki disease (mucocutaneous lymph node destruction of sickle cell in liver & spleen
syndrome) should be based on the high risk for
development of which problem?  Hepatosplenomegaly
a. Chronic vessel plaque formation  Jaundice
b. Pulmonary embolism  Cholelithiasis
c. Occlusions at the vessel bifurcations
d. Coronary artery aneurysms Aplastic Crisis = severe anemia due to decreased
RBC Weakness
VIII. SICKLE CELL ANEMIA Dyspnea
Presence of abnormally shaped RBC’s & Hgb Severe Anemia
Pallor
SOB
O2 carrier
Hyper hemolytic Crisis = increase destruction of
Hct Hgb RBC

Hemochromatosis → Hemosiderosis
carrier shaper
Cause: Both Iron toxicity
 Autosomal Recessive Trait
N RBC → 120 days, round concave (shape), Diagnostic Test:
flexible / pliable, smooth 1. Sickledex (sickle turbidity test) = blood sample
mixed with solution sickledex
AbN RBC → 12-20 days, crescent moon sickle Cloudy = Suspect
shape, rigid (hypoxia → ischemia → pain) Hemoglobin Electrophoresis = electrocute
blood; identify hemoglobin
Predisposing Factors:
NO sickling will take place if there is no exposure Mgt:
to predisposing factors:  Prevent sickling
 Low levels of O2 * (hypoxia) ˗ Avoid conditions of Low Oxygen
 DHN ˗ Provide extra fund to prevent Dehydration
 Cool Weather ˗ Oral & IV therapy
 High Attitude  Maintain infection Free State
 Vigorous Exercise All will lead to Hypoxia ˗ Handwashing
 Severe emotional stress  Provide supportive therapy during crisis
 Anemia ˗ Apply heat to affected painful areas.
 Infection
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
˗ Administer Oxygen to believe hypoxia Classification of Hemophilia A.
prevent Sickling  Mild = will bleed if there is injury
˗ NO aspirin  Moderate = with episodes of spontaneous
˗ Blood Replacement bleeding during injury
 Don’t give lron  Severe = spontaneous bleeding without injury
Hemosiderosis – Increased storage of Iron in
the over resulting to Hemochromatosis
Manifestation:
Sample Question: 1. Epistaxis → "nosebleed" (flexed to close
A 4-year-old child is having a sickle cell crisis. The airway)
initial nursing intervention should be to: 2. Hemarthrosis - bleeding within points * HS
a. Place ice packs on the client's painful joints 3. Easy bruising
b. Administer antibiotics 4. Hematoma
c. Provide oral & IV fluids 5. Hematuria
d. Administer folic acid supplements. 6. Petechiae
7. Purpura
When teaching parents about sickle cell disease 8. Ecchymosis
the nurse should tell them that their child's anemia 9. Hematochezia
is caused by: 10. Melena
a. Reduced O2 capacity of cells due to lack of
Fe Bleeding Precautions:
b. An imbalance between red cell destruction. 1. RICE F
and Production 2. Avoid contact sports (swimming)
c. Depression of red & white cells & platelets 3. Minimize invasive IM, N
d. Inability of sickle shaped cells to 4. Use soft bristled toothbrush
regenerate 5. Electric Razor
6. Helmets Elbow & knee pads
IX. HEMOPHILIA 7. ФASA
A group of (prolonged) bleeding disorders 8. Wear medic Alert bracelet *
characterized by a deficiency in a clotting
factor. Administer replacement of missing clotting
factor: for replacement
Cause:
Boys
 X-linked recessive Factor will concentrate → Hemophilia A
Females = carrier
DDVAP (desmopressin) → clotting factor
Common forms: Cryoprecipitate
1. A → Factor 8 Fresh frozen plasma → clotting factor
2. B → Factor 9 (royalties)
aka. Christmas disease – Rare X. LEUKEMIA
3. C → Factor 11
Leukemia → Ca in blood → Immature WBC
Question:
A toddler is admitted to the hospital with classic
Blast Cell Stem Cell
hemophilia. Which admission procedure by the
nurse would not be the one to perform & probably
1. If…
the most frightening for this child?
RBC (anemia) → fatigue, pallor, irritability, dyspnea Ф DNA
a. BP
WBC (infection) abN
b. Weight
Platelets (bleeding) → epistaxis
c. Urine Specimen
d. Renal Temperature
2. Bone Pain
RBC
WBC Pancytopenia
Platelets
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Multiple Myeloma → Ca within Plasma (makes) Ig  NO Fresh Fruits / vegetables / flowers /raw
food
Bone – BM – WBC  May cause problem/harbor microorganism
 Avoid crowded places
S/S:  Universal precautions
 Bone pain  Reverse Isolation
 Hypercalcemia
 Calculus Sample Question:
 Pathological Fracture A 74y.o. who has had leukemia for 2 years was in
 Osteoporosis primary remission for 18 months but recently
experienced infections, epistaxis, & abdominal
Neoplasm – Tumor petechiae. The doctor suspects she is no longer m
Cancer / Tumor marker remission and admits her to the hospital. In
Bence Jones Protein (seen in urine) reviewing her admitting blood work, the nurse
notes all the following which finding should the
Leukemia nurse interpret as the probable cause of
 Anemia infections?
 Infection → will most-likely kill patient a. Anemia
b. Clotting
 Bleeding
c. Neutropenia
 Bone pain
d. Thrombocytopenia

2 common forms: (4, but only 2 were discussed) XI. CROUP

ALL → Lymphocytic (“1” phil) = good prognosis  Laryngotracheobronchitis
AML → Myogenous (“All” phils)  A syndrome of acute UPPER RESPI TRACT
 Acute Myelogenous Leukemia INFECTION, causing inflammation & swelling.
 Common in Men  3 months – 3 y.o

Causative Agent:
Diagnostic Test:  Parainfluenza virus → self-limiting
1. Bone Marrow Aspiration – done to identify
the type of WBC involved in type of leukemia Pathophysiology:
2. Lumbar Puncture – Metastasis → Glioma
(brain cancer) Parainfluenza Virus

Mgt: Mucosal inflame & Edema

 Chemotherapy
 Complications, Anorexia, Alopecia, Narrow Airway
infection
sudden onset of harsh metallic cough, inspiratory,
 Bone marrow transplant
Stridor or hoarseness
 Prevent infection
 Reverse Isolation
Respiratory distress
 Isolate from chicken pox or known
communicable disease
Manifestation:
 Avoid IM / IV
 Croupy cough *
 Do not give aspirin  Barking, brass, croupy, metallic
 Use soft bristled toothbrush
 Inspiratory stridor *
 Avoid rectal suppository  Dyspnea
 Sternal retraction *
 Diet: high Cal, Protein, Fe
 Fever
 Extra fluids  Restlessness & irritability
 Pallor or Cyanosis
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Mgt: a. Call the physician and obtain an order for a
 Assess for airway obstruction mild sedative.
 Keep emergency equipment b. Tell the mother that the child must stay in
 Administer 02 & the atmosphere humidity- the tent.
hood/tent c. Place a toy in the tent to make the child feel
Croquette, croupy tone → mist more comfortable.
 Administer prx med: d. Let the mother hold the child and direct the
 Racemic Epinephrine cool mist over the child's face.
 Corticosteroid
 Hot water XII. EPIGLOTTIS
 Acute, severe inflammation of the Epiglottis
 3 to 6 y.o
Sample Question:
A 4 y.o female client is brought to the emergency Causative Agent:
room after waking up with bark-like cough and  H. influenzae, type & (bacterial)
stridor on arrival to the ER, she has respiratory Hib
distress and is afebrile. The diagnosis is croup.
What instruction should you give the parents? Pathophysiology:
a. Perform percussion & postural drainage
before putting the child to bed & before Hemophilus influenzae
meal
b. Run a cool mist vaporis in patients’ room Edematous & Cherry red epiglottis
during the day.
c. Encourage the child to do coughing & deep Severe Edema
breathing exercises.
d. Bring the child to the bathroom & have with Complete obstruction
warm water during acute episodes of
cough. Hypoxia

The mother of a preschool girl who occasionally Acidosis

has symptoms of croup at night says to the nurse
in the physician office, "I get so scared when her Death
breathing gets croupy at might". Which of these
instructions would be appropriate for the nurse to Manifestation:
give to the mother.  Drooling
a. "Whenever your child begins to have  Dysphagia
 Dysphoria Important!!!
symptoms of croup, take her to the
bathroom and turn on the hot water"  Depressed respiration
b. "If your child begins to have symptoms of  Tripod position – the child is leaning forward
croup, give her sips of a mixture of lemon & the chin thrust out
and honey (a.k.a sniffing dog)
c. "Your child will be less apt to get croup if neck-hyper-extended
you withhold milk and products before her
bedtime" Mgt:
d. "Your child will be less apt to get croup if  Closely monitor respiratory status to
her bed linen is washed with hypoallergenic ensure airway patency
soap”  Never use tongue blades! * (gag reflex)
 Administer antibiotics
Child with croup is placed in a cool mist tent. The  Corticosteroids
mother becomes concerned because the child is
frightened, consistently crying, and trying to climb
out of the tent. The most appropriate nursing action
for the nurse to teach the mother would be:
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Sample Question: from the lungs & been pumped into the left
A 3-year-old child was brought to the pediatric ventricle flow to the right ventricle through the
clinic after the sudden onset of findings that include hole instead of being pumped into the aorta.
irritability, thick muffled voice, croaking on Because the heart has to pump extra blood and
Inspiration, hot to touch sit leaning forward, tongue is overworked, it may enlarged.
protruding drooling and suprasternal retractions.
What should the nurse do first? Systemic Circulation:
a. Prepare the child for X-ray of upper airways
b. Examine the child's throat
c. Collect a sputum specimen
d. Notify the healthcare provider of the child's
status

XIII. HEART DEFECTS

Fetal Circulation

1. Ductus Arteriosus (between the pulmonary

artery & aorta)
 to shunt blood from the lungs
2. Foramen Ovale (base between R & L atrium)
 atrial septal defect SVC – IVC
3. Ductus Venosus -(ovale) ↓
RA – RV
↓
Once baby comes out to the mother, it inhales immediately PA – Lungs
with lungs, lungs will now inflate & function. 3 ducts will ↓
close, baby will assume N adulty function, if not closed = PV
defect. ↓
LA – LV
↓
Acyanotic Defects (L to R shunt) Aorta
 Major Problem: CO2 (kulang)
A. Increased Pulmonary Blood flow VSD: Ventricular Septal Defect is an abnormal opening in the
 Ventricular Septal Defect wall between the two ventricles.
 Atrial Septal Defect ASD: Atrial septal Defect is a hose between 2 atria
 Patent Ductus Arteriosus
Major – kulang
B. Obstruction to Blood flow from Ventricles Patent Ductus Arteriosus:
Aorta → Coarctation of Aorta (aorta Specific) Minor – ↑ PBF
AV → Aortic Stenosis (value only)
PV → Pulmonic Stenosis

Atrial Septal Defect:

 An opening exists between the heart’s two
upper chambers. This lets some blood from
the left atrium (blood that's already been to the
lugs) return via the hole to the night atrium
instead of flowing through the left ventricle, out
the aorta and to the body.

Ventricular Septal Defect:

 An opening exists between the heart's two This defect allows blood to mix between the
lower chambers. Some blood that's returned pulmonary artery & the aorta. Before birth an open
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
passage way (the ductus arteriosus) exists
between these two BV. Normally this closes w/in
a few hours of birth. When this doesn't happen,
some blood that should follow flow through the
aorta & on to nourish the body returns to the lungs.

Coarctation of the Aorta (stenosis):

Major – kulang
Aortic Stenosis: Obstruction to BF to V

The aorta is pinched or constricted. This

obstructs blood flow to the lower body & increases
blood pressure above the constriction. usually
there are no symptoms at birth, but they can
develop as early as a baby's first week.
The aortic valve, between the left ventricle & the
aorta, is narrowed. The heart has difficulty
pumping blood to the body. Aortic Stenosis
occurs when the aortic valve didn't form
properly.

Major – kulang
Pulmonary Stenosis: Obstruction to blood
flow from ventricles

The Pulmonary or pulmonic value is between the

right ventricle & the pulmonary artery. It opens to
allow blood to flow from the right ventricle to the
Ings. A defective pulmonic valve that doesn't open
properly is called stenotic. The forces the right
ventricle to Pump than normal to overcome the
obstruction.
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Manifestation: 3. Administer drugs
 Tachycardia » Digitalis
 Hypotension → Coarc, lower extremity » Diuretic
 Bounding Pulses → Coarc, upper extremity » Indomethacin → PDA
 Machinery-like murmur (PDA) » Morphine Premature w/in 10 days
 Chest pain
 Dizziness

Cyanotic Defects → (mixing)

A. Decreased Pulmonary Blood flow
 Tetralogy of Fallot

B. Mixed Blood flow

 Transposition of Great arteries
 Truncus Arteriosus

Teratology of Fallot
 Four abnormalities that results in insufficient
blood supply in the body. (mixed blood → un
O₂ + O₂)

 P – Pulmonary Stenosis
 R – Ventricular Hypertrophy
 O – Overriding of the AORTA GROWTH & DEVELOPMENT
 V – VSD < 18 years old
 E – eto lang 4
I. Principles
Transposition of the Great Arteries 1. Growth = ↑ size
 Defect characterized by the connection of the = Quantitative
R ventricle to the aorta & of the L to the 2. Development = ↑ skills
ventricle to the pulmonary artery. = Qualitative
Truncus Arteriosus
Patterns of Development
 A defect characterized by the presence of only
one major trunk. The R & L ventricles are 1. Cephalocaudal = head – toe
connected to this trunk, thus allowing: 2. Proximodistal = center – away
unoxygenated blood to flow in the Systemic 3. Mass-specific = simple – complex
Circulation.
II. New Born Care
S/S of Cyanotic Defects: 1. Temperature: ↓
3 C’s: Mgt:
 Cyanosis  Conduction (surfaces)
 Clubbing of fingers  Convection (air currents)
 Crouching  Radiation (droplight / incubator)
Hyper cyanotic Episode  Increase temp
 Tachycardia  Evaporation
 "Blue spells / Tet spells" (only on tetralogy of
Fallot) GOAL: Prevent Cold Stress
 Poor growth / Failure to thrive / slower dev't
2. Airway
Mgt: GOAL: Prevent Aspiration
1. Position Maintain Patent Airway
2. Administer O2
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
Mgt: c. Phallic → Preschool
 Suction (wiping) Area: Genital
 Mouth → Nose Activity: Masturbation (allow but in private)
 O2 Therapy
Complexes
3. APGAR  Oedipal – Son → Mother
 Dr. Virginia Apgar
 Electra – Daughter → Father
 Times
Mgt:
˗ 1st minute of life
˗ 1st 5 minutes of life  Bonding with same sex parents
Result:
APGAR  Exhibitionist (ignore the
0 1 2 behavior)
Appearance Blue/cyano Acrocyanosis Pink  Rapist (single males)
Pulse – <100 >100 ˗ Young @ <25y.o
Grimace – Grimace Strong cry
Activity Flaccid Some flexion Full flexion ˗ Low self-esteem
Respiration – Weak cry Strong cry  Victim
˗ Single females
Result: ˗ Age 11-25y.o
 Perfect: 10 ˗ Poor
 Normal: 7-9 = Document Types of Rape:
= Continue NB care i. Acquaintance
 Borderline: 4-6 = Suction as needed ii. Blitz
= 02 therapy
 Distress: 0-3 = CPR
d. Latency → School-age
Area: None
III. Theories
Activity: Lazy
1. Psychosexual = Sigmund Freud
Mgt: Reward / Praise
a. Oral → Infancy
 To ↑ self-esteem
Area: Mouth
Activity: Sucking
e. Adolescent → Genital Stage
Result: (-) fixation = Orally Fixated
Area: Genitalia
 Smoking
Activity: Sexual Intercourse
 Alcoholics
Mgt: Sex Education
 Eaters
Result: Maturity
 Talkative
Prone to Vaginismus = spasm of
b. Anal → Toddlers
Vagina (DOC: Diazepam)
Area: Anus
Activity: Toilet Training
2. Psychosocial = Erik Erickson
Below 2y.o (bowel → bladder)
a. Trust vs. Mistrust → Infant
 Sit, walk, stand
Source: Primary caregiver or mother
 Complains of soiled diapers
(+) Friendly = most developed
 Stay dry for at least 2hrs
(-) Paranoid = mistrust
 Readiness of the parents
Result:
Obsession = mind b. Autonomy vs. Shame & Doubt →
Strict Parents = OC
Compulsion = action Toddler
Source: Parents
Not Strict = Dirty = Conduct behavior
(+) Independent
Anti-social (criminal)
(-) Dependent
Mgt: Provide options
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 PEDIATRIC NURSING
Lecturer: Alvin Palmos, RN, USRN
Transcribed by: Krystl Lianne A. Ersando
c. Initiative vs. Guilt → Pre-school
Source: Family
(+) = Courageous
(-) = Inhibition

d. Industry vs. Inferiority → School-age

Source: Teacher
(+) ↑ self-esteem
(-) ↓ low-self-esteem

e. Identity vs. Role Confusion →

Adolescent
Source: Peers
(+) self-conduct
(-) Identity crisis

15