PEDIATRICS Flashcards
-Measurable: Inch, Kg, lbs, cm,
-Observable
Quantitative: GROWTH
-Observable
-Maturation: Predictable
-behavioral Changes
Qualitative: Development
Best indicator of development
Behavioral Changes
start of Growth and Development
Start: Conception/Fertilization
1st human cell
Zygote
8-16 Cells that Stays 3 days in fallopian tube
Morula
8 weeks or 2 months
Embryo:
1st human cells to embryonic cell
O-Z-M-B-E
Ovum-Zygote- Morula- Blastocyst-Embryo
a complete cessation of cardiopulmonary & circulatory system and the entire brain, including the brainstem.
Death
Non-modifiable factors
-Genetics
-The study of how your behaviors and environment can cause changes that affect the way your genes work.
Epignetic Factor
Modifiable Factors
-food, air,water,
-Shelter, home
Mileau/ Environment:
Learning by doing
Enactive learning
Learning by observing
Vicarious learning:
Time: toilet training
18 months
early to achieve T.T. would lead to…?
Delayed Child
Readiness for toilet training:
Physiological: walk, sit, stand, squat (W-S-S-S)
Psychological: verbalize the need to T.T.
Psychosocial: Not shy & afraid
most important changes in readiness for toilet training:
Physiological:
Age: Bowel training: Anal phase
18 months- 30 months
*Bowel precedes Bladder
age: Bladder training: Day time bladder training
30 mons- 36 mons
age: bladder training: Night time B.T.
36 mons-48 mons
age: bladder training: Night time B.T.
36 mons-48 mons
Bed wetting
Enuresis:
*Should be resolved before school age
Bed pooping
Encopresis
*Should be resolved before school age
Discipline during Toilet Training
FIRM & CONSISTENT
Problem:
-Strict/rigid parents: OCPD
-Lenient/ laxity: Disorganized
Cheek: head will turn to side of stimulation—> sucking
Rooting Reflex:
Lips: vacuum lips
Sucking reflex
Anterior tongue (protective hindrance to complementary feeding)
Spitting/ Extrusion reflex:
Posterior tongue
Swallowing reflex
introduction of solid foods
-increase iron demand
(physiologic anemia
COMPLEMENTARY FEEDING
Best time COMPLEMENTARY FEEDING
6 mons
Earliest time: COMPLEMENTARY FEEDING
4 mons
FOODS: COMPLEMENTARY FEEDING
1.Cereals, Am (rice water): With iron
2.Vegetables: soft, mashed
Avoid: Chunk,Hard vegetables
3.Fruits: One at a time
4.Soft meat: well cooked (fish)
Avoid: chunky
5.Egg yolk
FOODS TO AVOID: COMPLEMENTARY FEEDING
1.Grapes, corn, popcorn, etc.,
:Aspiration
2.Egg white: Allergy
3. Honey: Botulism/ Poisoning
*Skin of fruits has latex content= high allergy
1st: Vegetable
2nd: Fruits
-Process of gradual decrease of breastmilk and increasr of semi-solid food.
Weaning
Best time: Weaning
6 months
Earliest: Weaning
4 months
feeling sensation
-supine w/ head slighlty elevated—>
-Elevated & down—.>
-Embracing
Startle:
Moro:
Nagulat/ shookt
-loud noise, jarring of crib
-quick extension of extremities
Startle
Disappearance: Moro/startle
4-6 months
Permanent & Absent startle/moro
Permanent: CNS lesions/scars
Brain cancer
Absent: Brain damage
Cerebral palsy
PKU (phenylketonuria)
Spinal Cord Injury
***PKU low IQ/Blue eyes
Disappearance: Tonic-Neck/Boxing/ Fencing
4 months
Baby can turn to side:
Tonic-Neck/Boxing/ Fencing
4 months
Absent: Dancing/Stepping reflex
sciatic nerve injury
EINC:Right leg: Hepa b inject.
Left leg: Vit. k
Dissapearance:
Dancing/Stepping reflex
4 months
Darwin/ palmar grasp: Start to assess
2 mons (Open hand)
1 mon (Fisted hand)
Disappearance: Darwin/ palmar grasp
4-5 months
Touch the sole= curling of toes
Plantar Grasp:
Disappreance: plantar Grasp:
8-10 months
stroke the sole inverted “j” = fanning of toes.
Babinski
Disappearance: babinski
0-12 months
-Test for Spinal Cord Injury
Galant Reflex
Disappearance:Galant Reflex
9-10 months
Foot; motor coordination
Cross-extension reflex
Disappearance:Cross-extension reflex
12 months
-Prone
-Falling sensation–> opening/extension of extrimities
Parachute reflex
Disappearance: OF PARACHUTE REFLEX
18 months
Aka “superman reflex
Landau reflex
Disappearance: OF LANDAU REFLEX
2 years old
what is the most important neuro relfex?
MORO/STARTLE REFLEX
PERMANENT/ PROTECTIVE REFLEXES
aspiration
-touch uvula (posterior position)
Gag reflex
PERMANENT/ PROTECTIVE REFLEXES
-protection: Pneumonia
Coughing & sneezing
PERMANENT/ PROTECTIVE REFLEXES: Protection: Hypoxia
Yawning
Controlled CNS (trigimenalPERMANENT/ PROTECTIVE REFLEXES)
Blinking
Inflammation of corneal:
keratitis
new EINC
ENC
WHO GOAL FOR ENC
↓ NMR ( 28 days) & ↓ MMR
Before ENC/EINC:
increase number of neonatal death in the first 7 hours.
2009: EINC IN PH
Adopted by the DOH: EINC/Unang Yakap
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
30 seconds
1.Dry the baby
Immediate: 30 seconds
Thorough: Face, Head, Body, Extremity
Purpose: Dry the baby
-Stimulation: crying
-Prevents hypothermia: Evaporation
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
next 30 secs; within 1 minute
SKIN-TO-SKIN CONTACT
-Prone with head turned to side to the mother’s chest/abdomen.
Crawling of the baby to breast.
Nudging:
produces oil: pheromones in mother’s breast
Montgomery’s:
delays crede’s prophylaxis until baby finds breast >1hr.
Vision (10 in)
Purpose: of skin to skin
-promotes bonding, B.F., Baby’s sucking reflex.
-Prevents hypothermia, hypoglycemia, infection
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
Time: 1-3 minutes
DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
Best time: DELAYED/PROPERLY TIMED CORD CLAMPING & CUTTING
when the pulsation stops
-Prevents ANEMIA
Observe aseptic technique.
-Breech: Tetanus Neonatorum
No milking of the cord
-Can cause intracerebral hemorrhage
Observe: A-V-A
-Lacking: complication
-Heart defects
-Renal agenesis: Dysfunctional kidneys
-Down syndrome: Trisomy 21 (translocation)
Distance of Clamp in cutting of cord
Umbilicus –2cm—C1–3cm–C2
-5cm from umbilicus to c2
-cut near clamp 1
After cord clamping & cutting
-give 10 u of oxytocin (IM)
-To stimulate uterine contraction
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
90 mins (1 1/2 hrs)
Nonseparation:
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
start within 60 minutes
Breastfeeding:
duration of breastfeeding
Duration: 20 minutes;
10 mins & 10 mins
1st :10 minutes: nourishment
2nd: 10 minutes: sucking pleasure
***5 mins per breast
Interval: B.F. per demand/ 2-4 hrs
Feeding cues:
-Opening mouth -Licking
-Rooting -tonguing
-Crying: late sign of hunger.
late sign of hunger of newborn
crying
EYE OINTMENT: DELAYED IN 1 HOUR
CREDE’S PROPHYLAXIS
DRUG: Antibiotic (erythromycin)
Manner of applying crede’s prophylaxis
1-2 cm; inner to outer canthus
crede’s prophylaxis prevents:
Opthalmia Neonatorum
Chlamydial conjuctivitis
Gonorrheal conjuctivitis
Newborn Blindness.
Causes of opthalmia Neonatorum:
-Gonorrhea: Neisseira Gonorrhea
-Chlamydia:Treponema Pallidum
TIME BOUND INTERVENTIONS:
Birth-90 Mins: (1.5 hours)
90 MINUTES- 6 HOURS
vaccine administration
2 Vaccines: BCG & HEP B
and Vit. k
BCG:
ID; Right deltoid; 0.05 ml; TB
HEP B:
IM; Right Vasus Lateralis muscle (outer middle aspect of thigh); 0.5ml
VIT K.
(Phytomenadione/ Aquamephyton): Left Vastus Lateralis; MI; 0.1ml
ANTHROPOMETRICS:
Height
Normal:
18-22 inches; Ave: 20 in
45-55cm/ ave: 50cm
Height gain:
1 mon-6 mon: 1inch/month
6mon-12mon: 1.5 inch/month
ANTHROPOMETRICS:
Weight
Normal:
2,500-4,000 grams
2.5-4 kg; 5.5-8.8 lbs
weight loss newborn
*1st 10 days/ within 10 days
Weight loss (10% max wt loss)
Physiologic weight loss: extrauterine life
After 10 days- Progressive weight gain
weight gain of baby
Doubles (2x) 6 months
Triples (3x) 12 months
Quadruople (4x) 24 months
Head Circumference
13-14 inches; 33-35 cm
Chest circumference
12-13 inches; 31-33 cm
Abdominal Circumference
12-13 inches/ 31-33 cm
circumference: if HC is < CC
Abnormal microcephaly (Low IQ, M.R.)
Cause:
-Hereditry
-Viral infection: Zika, Rubella (Forchheimer’s spot)
ENC: 6 HOURS AFTER
Bathe the baby
-Bathe 1 part at a time
-test & feel temperature of water (use elbow)
-never remove vernix caseosa
-For insulation & Infection
Prevention
-Craddle cap/Seborrhea
-Remove by bathing
WOF: hypothermia
PREVENT HEAT LOSS
-Contact with Cold object/Surface.
-Touching wall, Weigh scale w/o cloth
Conduction
PREVENT HEAT LOSS:
-proximity/near cold object;
-Near wall
Radiation:
PREVENT HEAT LOSS: Wet body parts
Evaporation:
PREVENT HEAT LOSS:
-Room air drafts (Window doors)
-Thermostat
Ideal room tempt: 25-28 C
Convection:
WITHIN 24-72 HOURS (1-3 DAYS
NEWBORN SCREENING
-Heel prick blood
-Med tech: Collect specimen
Trained RN
-diagnose metabolic congenital diseases
Basic Newborn screening
-6 diseases
Expanded/ Advance N.S.
-28 diseases
-results are available in 1 week
NO in ENC
-Bathing within 6 hours
-no foot printing
-slapping, spanking, turning upside down,
-application of anything in cord stump
Frequence of APGAR scoring
-Conduct twice
1st: within 1 minute
-Determine the need for resuscitation
2nd: 5 minutes
-check for the adaptation to extrauterine life
-Basis for FDAR
APGAR SCORE: SEVERLY DEPRESSED
SEVERELY DEPRESSED: 0-3
Management:
-Cpr
-Intubation
-Mechanical Ventilator
-Manual ventilation (ambubag)
-Treat the cause
APGAR SCORE: FAIR/GUARDED
4-6
Management:
-Suction: withdrawal; 10 secs max
-Hyperoxygenation before & after intermittent
-Gentle and rotating motion
O2: high flow
WOF: Retrolental Fibroplasia
-Blindness caused by ↑ o2
-Drop light
EXTENDED SKIN-TO-SKIN CONTACT:
KMC (Kangaroo-mother-care)
-can be done by father, grandmother, relatives.
APGAR SCORE: GOOD
7-10: GOOD
-Routine Newborn care
HR:
120-160 bpm
RR:
30-60 cpm
BP:
Sytole: 60-80 mmhg
Diastole: 40-50 mmhg
Temperature:
36-5- 37.2 C
-1st rectal: imperforated anus
-2nd axillary
SaO2:
> 95%
HEAD/FONTANELS
B-A-D
Bregma-Anterior-Diamond
Size: 3x4
Closure: 12-18 months
HEAD/FONTANELS
L-P-T
Lambda-Posterior-Traingle
Size: 1x1
Closure: 2-3 months
Swelling made of fluids
CAPPUT SUCCEEDANEUM
Well outlined swelling
:doesn’t cross the suture line
CEPHALHEMATOMA
Swelling made of blood
CEPHALHEMATOMA
Vaguely outlined
:crosses suture line
CAPPUT SUCCEEDANEUM
Disappearance CAPPUT SUCCEEDANEUM
1 week
Disappears: CEPHALHEMATOMA
weeks- months
Causes Jaundice
CEPHALHEMATOMA
Both are normal
CAPPUT SUCCEEDANEUM
CEPHALHEMATOMA
Sunken/Depressed
-Dehydration (↑BP,↓ HR& ↓RR)
Bulging/Swelling
-↑ ICP
-Narrow pulse pressure <30 mmhg
-Cushing Triad (Hyper, Brady, Brady)
normal ICP pressure
(N: 0-15 mmhg)
-protusion of sac in occipital area that contains CSF & Meninge
-1-10 weeks of life: occurrence
ENECEPHALOCELE (back)
-Absence of cranial bone
-Brain is visible = death
-breech presentation : ↓ head
weight= cannot move
ANENCEPHALY
-Abnormal early closure of suture line= can’t moulding
CRANIOSYNOSTOSIS
-closure of nasal passage
Both nostrils: Immediate cyanosis after birth
Choanal Atresia
how to assess Choanal Atresia
Alternately Pinching/occluding each nostrils that leads to cyanosis
Mngmnt: of choanal atresia
Surgery
Flat nasal bridge
Down syndrome (Trisomy 21)
EAR: ABNORMAL
Hearing loss:
No startle Reflex
EAR: ABNORMAL
Low set ears:
Down syndrome
NECK: ABNORMAL
Short neck:
down syndrome
NECK: ABNORMAL
-Overstreched fascia
-missing x chromosomes (23rd)
Webbed neck/Turner Syndrome:
NECK: ABNORMAL
-weakness of SCM
-Breasfeeding baby should lean on affected side; to exercise
Torticollis (Wry neck)
↑Estrogen & ↑Prolactin :Normal
Witch milk:
Abnormal
-Protusion & displacement of sternum
-Seen in pt with Marfan syndrome
Pigeon’s chest:
-See-saw respiration (in-in)
-Sign of respiratory distress
Chest indrawing/ Chest retraction
-necrotizing enterocolitis: inflammed large & small intestines
↑abdominal diameter
closure of membrane
7-10 weeks:
Management: for (-) sac : raw intestine
Complications: Gastroschisis
NPO, No BF, IV, Moist Pnss
(+) sac:
Small <4cm
Large >4cm
Small <4cm
Umbilical hernia
Management:
-allow breastfeeding
-Moist: PNSS
Large >4cm
-Stomach, liver, intestines
-Omphalocele
MANAGEMENT:
-NPO
-No breastfeeding
-Moist: PNSS
divided spine
Spina Bifida
“dumpling”; lumbar sacral
-common in 1 out of 20
Occulta
-protusion: sac of
Meninges + CSF
Meningocele
-Protusion: sac of
Meninges +CSF+ Spinal cord
-Incontinence & paralysis
-Position: Side lying
Myelomeningocele
absence of extremity
Amelia:
Incomplete extremity
Phocomelia:
Small extremity
Micromelia:
what medication during pregnancy can cause incomplete/absence of extremity
halidomide (thalomid)
fusion of digits
Syndactyly:
Excess digits
Polydactyly:
Talipes Disorders: abnormal flexion of foot (plantar flexion)
Clubfoot
Turned inward: Talipes Disorders: Foot
Varus deviation:
Turned outward: Talipes Disorders: Foot
Valgus deviation:
Talipes Disorders: Forefoot (toes) lower than the heel
Equinus/horse foot:
Talipes Disorders: Heel first
Calcaneus:
Management: Talipes Disorders: Foot
Casting
Corrective Boots
Danger:
-Always check toes
-Neurovascular compromised
-Exposure to maternal hormones
-↑ Estrogen & Progesterone
Pseudomenstruation: Normal
Pseudohermaphroditism: Abnormal
-Undescended testis
-Expected in premature baby
Cryptorchidism
DOC:Cryptorchidism
HCG Hormone
unretracted foreskin/prepuce
Phimosis
Mngmnt: phimosis
Circumcision at birth
Urethral opening : Upper/Dorsal aspect
EpPerDor
Epispadias
***doesnt necessarily need surgery: angle when urination
Urethral opening: Lower/Ventral aspect
HyVenLow
Hypospadias
MNGMNT: hypospadias
Hooding (Surgery)
NEWBORN SCREENING
G-O-C-C-P-M
-Glucose 6 phosphate dehydrogenase
-RBC health/life
Problem:Hemolytic Anemia: Oddly shaped RBC
G6PD Deficiency
Triggers:G6PD Deficiency
Hemolytic Anemia
Drugs: Aspirin, Chloramphenicol, quinine, quinidine, chloroquine, sulfa drugs, cotrimoxazole.
Foods: Ampalaya, Soya, Nuts, Beans, Mints
Substance: Mentol, Naphthalene (moth balls)
***Put in a medic ALERT DRUGS
MANAGEMENT: during hemolysis G6PD
RBC transfusion: Chronic
Risk for: Iron Toxicity
-First sign: Iron fist Sign or Pain on knuckles
-Liver Damage (LFT check)
7-56 u/l : SGPT (ALT)
10-50 u/l : SGOT (AST)
-Abdominal pain
S/sx: G6PD
V-A-N-D-A
Antidote: G6PD
Chelation Therapy: removal of excess minerals
Agent/Management: G6PD
-Deferoxamine (Desferral)
-Urination
-CI: kidney failure
-Agent:Deferasirox
-feces
-Last resort: Surgery (Spleenectomy)
-Lactose intolerance
-Dissacharide (glucose +galactose)
GALACTOSEMIA
Problem:GALACTOSEMIA
GI symptoms
-Diarrhea & vomiting
-Liver damage
***cataract: only seen on pt with galactasemia
MANAGEMENT: GALACTOSEMIA
No breastfeeding
Formula milk —> Lactose free
NEUTRAMIGEN
Milk for galactosemia
NEUTRAMIGEN
Problem:
Reflective Adrenal Cortex
↓Sugar(Cortisol)
↓Aldosterone (Hypovolemia)
N: Testosterone
CAH : CONGENITAL ADRENAL HYPERPLASIA
APG: ↑ ACTH
(Adrenocorticotropic Hormones)
↓
Stimulates Adrenal Cortex =Hyperplasia
↓
↑sex
CAH : CONGENITAL ADRENAL HYPERPLASIA
CAH Mortality
Increase mortality in first 7 hours because of ;
1st: shock,
2nd: Hypoglycemia,
3rd: Hypovolemia.
S/sx: CAH (MALE)
-early puberty
-enlarged penis, masculine voice, pubic hair
-4ft .
S/sx: CAH (FEMALE)
-no menarche
-virilisation (loss of feminity)
-deep voice
-hirsutism
-flat chested
-enlarged clitoris
MANAGEMENT: CAH
Hydrocortisone: synthetic cortisol
Medication is effective when:
-↑ Breastfeeding time
-↓ engorgement breast of mother
Fuducortisone: Synthetic aldosterone
-Effective: Weight Gain
Etiology:
Mother has Hyperthyroidism
-Common In girls
CONGENITAL HYPOTHYROIDISM
Birth
-Hypothermia/Hypoglycemia
-Bradycardia, Apnea
-WOF: SIDS
CONGENITAL HYPOTHYROIDISM
child with CONGENITAL HYPOTHYROIDISM
Cretinism (Child)
-physically & mentally challenged
MANAGEMENT: congenital hypothyroidism
Within 10 days give Levothyroxine (synthroid, levothroid)
Mix with milk
inability to metabolize protein
Phenylalamine
↓
Precursor: Melanin (skin
Thyroxine (heat; t4)
Epinephrine (Fight-Flight)
Toxic: Brain= brain damage
(Pround) M.R.
PKU (Phenylketonuria)
Phenylalanine Free milk for PKU
LOFENALAC
Management for PKU:
Phenylalanine Free milk:
LOFENALAC
Diet: low animal protein
↑fruits & Vegetables
-inability to metabolize protein
-Valine
-isoleucia
-leucin
MSUD (Maple Syrup Urine Disease)
Complications: MSUD
Brain damage & Kidney failure
Hallmark sign: Maple syrup urine odor
MANAGEMENT: MSUD
↓ animal protein
B-complex (IM)(IV)
First 12 weeks pus in BCG what will the nurse do?
do not report; MOTHER SHOULD WIPE
Antidote of warfarin
Vitamin K or Aquamephyton:
90 mins- 6 hour: Before Separation make sure you put ID band that contains?
-Hospital number
-Complete mother’s name
-Date & time of birth
Newborns are obligatory_____breathers
nose
Manner of suctioning
MoSe: 1st MOUTH & 2nd NOSE:
All fontanels will close at what time:
18 months
B9/folic acid dose:
400mcg/day
B9/folic acid source:
Green leafy vegetables
B12 source:
meat
s/e loss of extremities during pregnancy to newborn.
Thalidomide/Anti-emetic
LITHIUM TOXICITY: s/sx
V-A-N-D-A
Autosomal Recessive disease
G6PD, O, Galactosemia:
Not Autosomal recessive
Congenital hypothyroidism:
management for Sep-Anx:
-Temper tantrums
-Give security object
-give promise
-1 firm goodbye