REVIEWER IN PEDIA
PEDIATRIC NURSING OR CHILD HEALTH
NUSRSING
- Is the nursing specialty of caring
for infants, children and
adolescent
- A nurse who specializes in this
area is usually referred to as
pediatric nurse
ROLES OF THE PEDIATRIC NURSES:
1. Primary caregiver – provide
promotive, preventive, curative and
rehabilitative nursing care in all
levels of health services.
2. Coordinator and collaborator –
maintains good interpersonal
communication with the child,
family, and health team members.
3. Nurse advocate – safeguards the
child’s right to assist and provide the
best care from the health care team.
4. Health educator – provide
information to children, parents and
significant others about the
prevention of illness, health
promotion, or maintenance.
5. Nurse consultant – guides parents
for maintenance and promotion of
health.
6. Nurse counselor – provides guidance
to parents in hazards of children and
health team for own decision
making in different situations.
PRINCIPLES OF GROWTH AND
DEVELOPMENT
Growth vs. Development
- Often used interchangeably but
they are different
Growth
- Increase in physical size or a
quantifiable change
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- Increase in the number and size
of cells
Parameters of growth:
Weight – most sensitive indicator or growth
Doubles – 6 months
Triples – 1 year
Quadruples – 2 and 3 years
*most infants lose 5-10% of birth weight
days after delivery
Height:
1 inch/month – 1st 6 months
1 ½ inch/month – remainder of the first
year
3 inches/year – 1-7 years
2 inches/month – 8-15 years
Height comparision:
9 y/o – male = female
12 y/o – male < female
13 y/o – male > female
Head circumference – reflects brain growth
At birth – 13-14 inches (33-35.5 cm)
Teeth – firat to erupt: lower (mandibular)
central incisor – 6-8 months
Age of child in months – 6 = number of
teeth (x-6=number of teeth)
DEVELOPMENT
- Increase in skill or the ability to
function (qualitative change)
- Synonymous with maturation
- Measured by observing the
child’s ability to perform tasks
Psychosexual development
- Developing instincts or sensual
pleasure (Freudian theory)
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Psychosocial development
- Refers to personality
development (Erikson’s theory)
Moral development
- Ability to know right from wrong
and apply these to real life
situations (Kohlberg’s theory)
Cognitive development
- Ability to learn and understand
from experience, acquire and
retain knowledge, and solve
problems (Piaget’s theory)
FACTORS INFLUENCING G&D
- Genetics
- Health
- Gender
- Intelligence
Role of play in development
- Sensorimotor development
- Self awareness
- Cognitive
- Moral
- Creative
- Therapeutic
- Socialization
Things to remember when choosing toys:
Toys should have no:
- Sharp edges that can cut and
puncture
- Propelled objects that can injure
the eyes
- Small parts that can be
swallowed
- Excessive noise that can damage
hearing
- Weak points (brittle/broken
easily)
- Elements that can burn
- Electric toys (for 8y/o above)
2
- Toxic materials (lead->poisoning)
Infancy – period of 1 month to 1 year of age
FREUD’S PSYCHOANALYTIC THEORY
Oral phase
- Infants are interested in oral
stimulation or pleasure during
this time
- Infants suck for enjoyment or
relief of tension
ERIKSON’S PSYCHOSOCIAL THEORY
Trust vs. mistrust
- Learning confidence or learning
to love
- Infants whose needs are met
view the world as safe place
- Infants who receives inadequate
and inconsistent care becomes
fearful and suspicious
INFANCY
FEAR: STRANGER ANXIETY
- Begins at 6 months and peaks at
8 months and diminishes at 9
months
PLAY: SOLITARY PLAY
Health promotion of an infant and family
Develop trust
- Arises when one can peredict
what is coming next
- Caring should have a rhythm or
consistency
Promote safety
- Aspiration prevention
o toilet paper roll test
o inspect toys for loose
parts
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o avoid clothes with
buttons
- Fall prevention
o lower the crib mattress
o raise side rails (narrow
enough to avoid the child
to insert their head)
- Car safety
o place the infant in rear-
facing seats in the back
seats (inflating front seat
airbag could suffocate
the infant)
- Suffocation
o allow no plastic bags
within infant’s reach
o remove constricting
clothes/clothing at
bedtime (bib from neck)
PROMOTING NUTRITIONAL HEALTH OF AN
INFANT
Feeding during the first year
Birth to 6 months – BREASTFEEDING
- Most desirable complete diet for
first half of life
6-12 months – SOLID FOODS
- Due to depleting iron stores
Things to remember when introducing
solid foods:
- Soluid foods may be started by
5-6 months
- First foods are strained, pureed,
or finely mashed
- Figer foods (raw
fruit/vegetables) can be
introduced by 6-7 months
- Avoid foods that have potential
for choking (hotdogs, nuts,
grapes, carrots, popcorn, and
hard candies)
3
Methods of introduction
- Introduce 1 food at a time
- Intevals of 5-7 days to identify
food allergies
- Never introduce foods by mixing
them with the formula in the
bottle
SUGGESTED SCHEDULE FOR INTRODUCTION
OF SOLID FOODS
Cereals (Iron-fortified) (5-6 months)
- Usually introduced FIRST
- Easily digested
- Aids in preventing iron deficiency
Vegetables (7 months)
- Good source of vitamin A
Fruits (8 months)
- Best source of vitamin C and a
good source of vitamin A
Meat (9 months)
- Good source of protein, iron,
and B vitamins
Egg yolk (10 months)
- Good source of iron
BABY BOTTLE SYNDROME
- Occurs when the carbohydrate in
the solution such as formula or
glucose water ferments to
organic acids that demineralize
tooth enamel until it decays
- Propped bottles continuously
soaks upper teeth and lower
back teeth that causes tooth
decays
TODDLERHOOD
FEAR: SEPARATION ANXIETY
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- Begins at 9 months and peaks at
18 months
PLAY: PARALLEL PLAY
- Provide duplicate toys (avoid
arguments)
- Offer toys that they can play by
themselves and that requires
action
- Toys that children can
manipulate gives a sense of
power, an expression of
AUTONOMY (independence)
- Examples: trucks they can go,
waddling duck they can pull, toy
telephone they can talk into
Separation Anxiety
Prevented by:
- Not prolonging goodbye
- Saying goodbye firmly to develop
trust
- Saying when you will be back
CHARACTERISTIC TRAIT OF A TODDLER
- NEGATIVISM
o loves to say “no”
o a way of achieving
independence
Managed by:
o Limiting questions and
offering options
o If the child’s answer is
still “no”, parents should
make a choice for the
child
- RITUALISM
o a way of achieving
MASTERY
TEMPER TANTRUMS
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- A way of achieving
independence by
violating/objecting to discipline
- May lie down on the floor, kick
their feet, and scream as loud as
possible, others hold their
breath
- Indications that of child’s
inability to control emotions
Managed by:
- Ignoring the behavior (if not
injurious to the child)
- If can result to injury: substitute
a toy or a favorite activity for the
request
- Continue to be present to
provide feeling of control and
security
- Corporal punishment may
further aggravate the situation
- Offer options instead of “all or
nothing” and praise positive
behavior
LOVES TOILET TRAINING
Five markers of toilet training readiness:
1. Bladder readiness
2. Bowel readiness
3. Cognitive readiness
4. Motor readiness
5. Psychologic readiness
*physiologic and psychologic readiness is
not complete until ages 22-30 months but
preparation should start earlier than 20
months
- Night time bladder control
normally takes several months to
years after daytime training
(sleep cycle needs to mature)
- Bowel training is usually
accomplished before bladder
training (bowel training has
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greater regularity and FEAR: ASSOCIATIVE/COOPERATIVE

predictability) - Role playing
- There is no universal right age to
begin toilet training or absolute Characteristic traits of a preschooler
deadline to complete training - Curious
- Imaginative
PRESCHOOL AGE – period of 4-6 y/o - Creative
- Imitative
FREUD’S PSYCHOANALYTIC THEORY - Views DEATH AS SLEEPING
PHALLIC STAGE
- Children’s pleasure zone appears BEHAVIORAL PROBLEMS OF A
to shift from the anal to genital PRESCHOOLER
area - Telling tall tales
- Masturbation is common o Overimagination
- Children may also show - Imaginary friends
exhibitionism suggesting they o Way of relieving tension
hope this will lead to increased and anxiety
knowledge of the sexes o Educate parents that this
- Also known as oedipal stage is normal
o Oedipus complex (son o Parents can acknowledge
wants to marry his the presence of the
mother) imaginary companion but
o Electra complex should not be used by
(daughter wants to marry the child to avoid
her father) punishment or
o Penis envy (female) responsibility
o Castration complex - Sibling rivalry
(male) o Due to jealousy
- Resolved by identification with - Regression
same sex parent o Going back to an early
developmental stage
ERIKSON’S PSYCHOSOCIAL THEORY o Bedwetting, baby talk,
INITIATIVE VS. GUILT thumb sucking, fetal
- Freedom and opportunity to position
initiate motor play reinforces - Masturbation
their sense of initiative o If not excessive, it is
- Initiative is also encouraged normal and healthy
when parents answer a child’s o Part of sexual curiosity
questions (intellectual initiative) and exploration
*if they will feel their self-initiated activities o May be an expression of
are silly or nuisance, they may develop boredom and anxiety
GUILT and may persist in later life Managed by:

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o Accept and emphasize
that it is a private act
o Divert attention (offer
toys)
SEXUAL EDUCATION
Questions about procreation
- If answered by a “tall tale” or
“you are too young to know
that”, children will keep the
question with themselves
- They formulate their own
theories to explain birth
Two rules in answering
1. Find out what children know and
think
a. To help children understand
why their explanation is
accurate
b. To avoid giving an “unasked
for” answer
2. Be honest
a. Honesty doesn’t mean
imparting every fact of life or
allowing excessive
permissiveness
b. One question, one answer
SCHOOL AGE – period of 7-12 years old
FREUD’S PSYCHOANALYTIC THEORY
LATENT PHASE
- Time in which children’s libido
appears to be diverted into
concrete thinking
ERIKSON’S PSYCHOSOCIAL THEORY
INDUSTRY VS. INFERIORITY
- Children learn how to do “things
well”
- Sense of INDUSTRY grows when
they are praised and rewarded
for their finish results
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- Parents who do not appreciate
their child’s effort may cause the
child to develop INFERIORITY
rather than pride and
accomplishment
FEAR: SCHOOL PHOBIA
- Displacement from school
- Loss of privacy
- Fear of death (death =
permanent loss)
PLAY: COMPETITIVE PLAY
Significant person:
- Teacher
- Peer of same sex
SIGNIFICANT DEVELOPMENT
- Boys are prone to fracture
(greenstick)
- At age 12 (girls are taller than
boys)
- Vision matures (20/20)
Characteristic traits of a school age
- Industrious
- Modest
- Can’t bear to lose (competitive)
- Loves to collect things
SIGNS OF SEXUAL MATURITY IN FEMALES
- Thelarche (1st sign) – increase in
the size of breast and genitalia
- Widening of hips
- Adrenarche – appearance of
pubic and axillary hair
- Menarche (last sign)
ADOLESCENT – period of 12-18-21 y/o
FREUD’S PSYCHOANALYTIC THEORY
GENITAL PHASE
- Main events of this period is the
establishment of new sexual
REVIEWER IN PEDIA
aims and the finding of new love
objects
ERIKSON’S PSYCHOSOCIAL THEORY
IDENTITY VS. ROLE CONFUSION
- Bringing everything they have
learned about themselves and
integrate these different image
into a whole that makes sense
- Failure to do so leaves them in
ROLE CONFUSION
FEAR: OBESITY, ACNE, HOMOSEXUALITY,
DEATH, REPLACEMENT FROM FRIENDS
CLASSIFICATION ACCORDING TO
GESTATIONAL AGE
1. Premature (preterm) infant – an
infant born before the completion of
37 weeks of gestation, regardless of
birth weight
2. Full term infant – an infant born
between the beginning of 38 weeks
and the completion of 42 weeks of
gestation, regardless of birth weight
3. Postmature (post term) infant – an
infant born after 42 weeks of
gestational age, regardless of birth
weight
PRETERM VS. FULL TERM
POSTURE
Preterm – lies in RELAXED attitude, limbs
are more extended; body size is small, head
is somewhat larger in proportion than the
body
Post term – more subcutaneous fat and
rests in a more flexed attitude
EAR
Preterm – ear cartilages are poorly
developed; may fold easily; hair is fine and
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feathery, lanugo may cover the back and
face
Post term – ear is well formed; hair is more
firm and grows in separate strands
SOLES
Preterm – appears more turgid and may
only have fine wrinkles
Post term – well and deeply creased
FEMALE GENITALIA
Preterm – clitoris is prominent, labia majora
is poorly developed
Post term – labia majora is fully developed,
clitoris not prominent
MALE GENITALIA
Preterm – scrotum is underdeveloped snd
not pendulous, MINIMAL RUGAE are
present, testes may be in the inguinal canal
or in the abdomen
Post term – scrotum is well-developed,
pendulous, and rugated and are down in
the scrotal sac
SCARF SIGN
Preterm – infant’s elbow may be easily
brought across the chest with the little or
no resistance
Post term – infant’s elbow may be brought
to the midline of the chest, resisting
attempts to bring the elbow past the
midline
GRASP REFLEX
Preterm – grasp is weak
Post term – grasp is strong
HEEL-TO-EAR MANEUVER
Preterm – heel is easily brought to ear with
no resistance
Post term – the maneuver is not possible,
there is considerate resistance
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ILLNESS OF THE HIGH-RISK - TDx fetal lung maturity assay

NEWBORN (determines PG level in amniotic
- aka Hyaline membrane disease fluid or neonatal tracheal
o A condition of surfactant aspirate)
deficiency and
physiologic immaturity of *carbon monoxide poisoning is another
the thorax reason for saturation
o Seen almost exclusively
Therapeutic management
in PRETERM infant
- Administration of exogenous
(multifetal pregnancy,
surfactant
infants of diabetic
- Nitric oxide (pulmonary dilation)
mother, C/S delivery, etc)
- Oxygen therapy (maintains
correct PO2 and PH)
*Betamethasone – speeds up lung maturity
- IV therapy (hydration and
*Lung surfactant
nutrition)
- PG (phosphatidyl glycerol
- PC (phosphatidyl choline)
Nursing management
*Wet lung syndrome – for CS babies
- Close monitoring
- Keep oxygen consumption as low
Clinical manifestations
as possible (handle infants as
- Chest indrawing and retractions
little as possible)
(stiff lungs)
- Suction only when necessary
- Tachypnea (fast breathing)
(gently but quickly)
- Labored breathing
- Encourage parents to verbalize
- Substernal retraction
feelings
- Flaring of nares
- Fine respiratory crackles
MECONIUM ASPIRATION SYNDROME
- Central cyanosis (late sickness
- Relaxation of the anal spinchter
sign) (bluish lips)
and passage or meconium into
amniotic fluid due to
*increase in CO2 causes respiratory acidosis
intrauterine stress
which increases carbonic fluid
- Occurs primarily in full term and
post term infants
Diagnostic evaluation
- Pulse oximetry (determines
Clinical manifestation
hypoxia) normal 95-100%
- Stained from meconium stool
o Clip type (spring tension
- Tachypneic
type)
- Expiratory grunting, nasal flaring,
o Adhesive type (nose,
retractions
forehead, or wrapped
- Initially cyanotic
around the feet)
- Classic barrel chest
- Radiography
- Respiratory distress with gasping
- L/S ratio

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Therapeutic management
- Tracheal suctioning (poor
respiratory effort, low heart rate,
poor tone)
- Ventilatory support
- Exogenous surfactant
administration
- IV fluid
- Systemic antibiotics
Nursing management
- Same with other high risk
neonate
APNEA OF PREMATURITY (AOP)
- Common phenomenon in
preterm infant
- Characterized by apneic spells
Types:
o Central apnea – CNS does
not transmit signals t the
respiratory muscles
o Obstructive apnea –
airflow ceases due to
upper airway obstruction
o Mixed apnea –
combination of central
and obstructive apnea
(most common)
Therapeutic management
- Methylxanthines (aminophylline,
theophylline, caffeine)
o CNS stimulants to
breathing
o Observe for Sx of toxicity
(tachycardia at rest,
vomiting, irritability
diuresis)
o CafCit (caffeine citrate)
o Urine output should be
closely monitored (mild
diuretic effect)
9
Nursing management
- Observation combined with
monitoring is the most effective
means of identifying neonatal
apnea (if apnea began)
- Gentle tactile stimulation
rubbing the back or chest gently)
- Flow-by oxygen and suctioning
- Chin is raised gently to open
airway
- Infant is NEVER SHAKEN
- Record episodes of apnea
SUDDENN INFANT DEATH SYNDROME
(SIDS)
- Sudden death of an infant under
I year
- “crib death”
- Etiology: UNKNOWN
Contributing factors
- Prone sleep position
- Soft bedding
- Use of pillow
- Brainstem abnormality
- Co-sleeping with parents
- Maternal smoking
Manifestations and diagnosis
Manifestations:
May be seen:
- Frothy-blood tinged fluid in the
mouth
- Lying face down in the secretions
- Hands clutching the sheets
Diagnosis:
- Autopsy
- Investigation of the scene
Nursing management
- Allow the parents to say
goodbye
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- Encourage to hold their infant
- Provide a quite room with dim
lighting
- Explain that the death is due to
SIDS and it is not preventable or
predictable
Recommendations in preventing SIDS
- Place infants on their back when
sleeping (plagiocephaly: change
head position periodically)
- Use firm mattress
- Avoid exposure to smoke
- Offer a pacifier to sleep
RETINOPATHY OF PREMATURITY (ROP)
- A disorder involving immature
retinal vasculature
- Formerly known as “Retrolental
Fibroplasia”
- Etiology: hyperoxemia, hypoxia,
hypercarbia, hypocarbia,
prenatal complications, exposure
to light
Therapeutic management
- Strict oxygen management
- Cryotherapy ablation (cold as
medium)
- Laser therapy
Nursing management
- Decreasing constant bright
environmental light
- Inform the parents that infant’s
eyelid will be closed and
edematous post operatively
NEWBORN SCREENING PROGRAM
(NBS)
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- Essential public strategy that
enables the early detection and
management of several
congenital metabolic disorders,
which if left untreated, may lead
to mental retardation and even
death
- For early detection and
management of congenital
metabolic disorders
NBS
- Mandated through RA 9288 (The
newborn screening act of 2004)
- Done between 24- 72 hours after
birth
Collection of NBS samples
- Through heel prick method: 4
drops of blood is drawn from
heel puncture blotted into a
filter paper
- Airdry 4-6 hours
- Sent to laboratory within 24
hours
- BEST – 48th to 72nd hours of life
- ACCEPTABLE – anytime after 24
hours from birth until 2 weeks of
age
Sample collection done before the ideal
time may result in:
- Falsely elevated thyroid
stimulating hormone (TSH) =
false (+) screen for CH
- Falsely elevated 17
hydroxyprogesterone (17-OH-P)
=false (+) screen for CH
- Falsely low galactose and
phenylalanine = false (-) screen
for GAL and PKU
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DISORDERS TESTED FOR NEWBORN - Hyporeflexia

SCREENING - Bradycardia
- Congenital hypothyroidism (CH) - Hypotension
- Congenital adrenal hyperplasia
(CAH) Treatment
- Galactosemia (GAL) - Lifelong thyroid hormone
- Phenylketonuria (PKU) replacement therapy
- Glucose-6-Phosphate- - Drug of choice
Deydrogenase Deficiency (G6PD) o Synthroid
- Maple syrup urine disease o Levothroid
 Regular
Congenital Hypothyroidism (CH) measurement of
- Cretinism T3 and T4 and
- Lack or absence of thyroid TSH
hormone
- T3 and T4 Nursing management
- Early identification of the
disorder
- Explanation of lifelong therapy
H-U-Mi-D - Drug compliance
Hereditary condition - Drug tasteless
Underdevelopment of fetal thyroid glands - If a dose is missed, twice the
Maternal Intake of anti-thyroid drugs during dose should be given the next
pregnancy day
Deficiency, Maternal iodine - Breastfeeding is acceptable
- Signs of overdose
- NB does not exhibit obvious
signs of hypothyroidism Excessive medication can cause:
- Poor feeding DITS
- Lethargy Diarrhea
- Prolong hoarse cry Inability to sleep
- Large fontanels Tachycardia
- Neonatal jaundice Shakiness in the child
- Bradycardia
- Post term: 8.8 lbs or over 4 kgs Treatment
- Regular monitoring of the child’s
Clinical manifestations weight, overall health and
- Depressed nasal bridge thyroid hormone levels
- Short forehead
- Puffy eyes CONGENITAL ADRENAL HYPERPLASIA
- Large tongue (CAH)
- Skin cold to touch - Excessive or deficient production
- Dry or sex steroids
- Abdominal distention

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- Sever salt loss, dehydration and Muscle growth at an early stage

abnormally high levels of male Enlargement of penis during childhood
sex hormones in both guys and Early deepening of the voice
girls Early beard
- If not detected and treated early, Pubic hair and underarm hair during
infants may die within 7-14 days childhood
- CAH is caused by a deficiency of Smaller than normal testicles
adrenal gland hormones Severe acne
- 21 hydroxylase is missing or not
working S-M-E-L-E-D
Severe acne
Male pattern baldness
- 21-OH is responsible for the Early puberty changes such as hair in
production of hormones: armpits and pubic hair area
o Cortisol is involved in Lack of menstrual periods or scanty or
glucose metabolism and irregular periods
in normal inflammation Excess hair on the face and body
and immune response Deep, husky voice
o Aldosterone is
responsible for blood Therapeutic management
pressure and sodium - Oral hydrocortisone
retention - ACTH decreases -> production of
androgen returns to normal
Cortisol limits -> no masculinization
- Glucocorticoid
- Necessary for glucose and Nursing considerations
protein metabolism - Corticosteroid therapy should be
- Inflammatory response monitored
Aldosterone - Periodic analysis or cortisol
- Mineralocorticoid levels
- Renin angiotensin system, serum
potassium and sodium levels Overmedication can result to Cushing’s
syndrome (stretch marks, rounded faces,
Manifestations weight gain, hypertension, and bone loss)
- Poor feeding
- Listlessness and drowsiness Undermedication can occur during periods
- Vomiting of stress and illness when higher doses of
- Diarrhea the drug are required by the body
- Weight loss (addison’s disease)
- Hypotension
- Hyponatremia Corrective surgery for enlarged clitoris (can
- Metabolic acidosis be done as early as one to three years of
age. To separate labia and create a normal
M-E-E-E-P-S-S vagina

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- Calcium and vitamin D

GALACTOSEMIA supplement
- If a galactosemic infant is given
milk, unmetabolized milk sugars Treatment
build up and damages the liver, - Giving the child a special lactose
eyes, kidneys, and brain) free formula and exclusion of
lactose and galactose foods such
as milk (including breastmilk)
GAL and other dairy products from
- Inborn error of carbohydrate the diet throughout life
metabolism
- Galactose-1-phosphate uridyl Foods that should be avoided:
transferase (GALT) - Milk and all dairy products
- Damage to brain, liver, and eyes - Processed and prepackaged
- Jaundice foods
- Splenomegaly - Tomato sauces
- Cataracts - Certain medications
- Cerebral damage: lethargy and - Any foods or drugs which
hypotonia contain the ingredients
- Vomiting, diarrhea and weight lactulose, casein, caseinate,
loss lactalbumin, curds, whey or
whey solids
Initial symptoms
- Failure to gain weight Calcium and vitamin D deficiency is likely to
- Lethargy develop in a child on a lactose free.
- Irritability Therefore, the child is given supplements to
- Poor feeding and poor suck avoid/ prevent deficiencies.

Diagnostic evaluation PHENYLKETONURIA (PKU)

- Infant’s history
- Galactosuria
- Increased levels of galactose in
the blood
- Decreased levels of uridine
diphosphate
Therapeutic management
- Eliminate all milk and lactose
containing foods including
breatmilk
- Baby cereals: 4-6 months
- Fruit juices and vegetables: 5-8
months
- A metabolic disorder
characterized by lack of enzyme
phenylalanine hydroxylase (PAH)
needed to process the amino
acid phenylalanine
- The resultant buildup of the said
protein in the body leads to
mental retardation
- Hyperphenylalaninemia
Diagnostic evaluation
- Guthrie bacterial inhibition
test/Guthrie test
- Bacillus subtilis

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REVIEWER IN PEDIA
Therapeutic management
- Restriction of dietary protein
- Diet allowed 20-30mg of
phenylalanine/kg/day
- Brain damage if greater than 11
to 15 mg/dl
- Enzymatic casein hydrolysate:
28. 5 mg/8 oz.
Formula milk for PKU
- Phenyl free 1
- Phenyl free 2
- Phenex
- Phenyl free 2 HP
- Similac isomil, isomil advance,
isomile 2 advance
- Enfamil prosobee lipil
- Enfamil next step prosobee lipil
GLUCOSE-6-PHOSPHATE-DEHYDROGENASE
DEFICIENCY (G6PD)
- G6PD is one of many enzymes
that help the body process
carbohydrates and turn them
into energy
- G6PD is a condition where the
body lacks the enzyme called
G6PD a metabolic enzyme
especially important in RBC
metabolism
- Hemolytic anemia resulting from
exposure to certain drug, food,
and chemical
- Electrophoretic analysis of RBCs
Non spherocytic hemolytic anemia
- Hemolysis
- Jaundice
- Splenomegaly
- Aplastic crisis
MAPLE SYRUP URINE DISEASE
- Aka branched-chain ketoaciduria
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- Deficiency of branched-chain
alpha -keto acid
dehydrogenase(BCKDC)
- Leading to buildup of branched-
chain amino acid (ketoacids)
- Sweet smelling urine
- Causes BRAIN DAMAGE
- Rare disorder
- Autosomal trait
- Leucine, isoleucine, and valine
- Cerebral degeneration similar to
that observed in children with
PKU
- Urine smells like maple syrup
- Ketoacid
- Child may die as early as 2-4
weeks
Isoleucine – this amino acid contributes to
the biochemical process that gives you
energy. Such as formulas help build lean
muscle mass and reduce fat
Leucine – essential for growth as a
stimulation for protein synthesis in muscle.
Is helpful in healing wounds and injuries.
Helps balance your blood sugar because it
produces energy
Valine – Produces energy, which spares
energy stored in your blood glucose
- Loss of the moro reflex
- Feeding difficulty
- Irregular respirations
- Opisthotonus
- Generalized muscular rigidity
- Seizures
- Hemodialysis
- DIET
o Thiamine and food low in
leucine, isoleucine, and
valine
REVIEWER IN PEDIA

RESPIRATORY DISORDERS Air – ausculatate on 2nd/3rd ICS

Anatomy and physiology
Respiratory system
- Provides avenue where
exchanges of gases happen from
the higher pressure atmosphere
to the lower pressure lungs
- Responsible for the oxygenation
of the blood and the excretion of
CO2 from the body
Thoracic cavity
- Right lung – 3 lobes
- Left lung – 2 lobes
- Mediastinum
- Smooth parietal pleural
- Visceral pleural sac
Thoracostomy tube – used to drain pleural
fluid
Pleural effusion – dumadami tubig na
bumabalot sa lungs causing
absent/diminished breath sounds
Fluid – on 8th/9th ICS
Upper airway
- Pharynx – passes through the
Waldayer’s ring (ring of tonsils)
- Larynx
Lower airway
- Trachea – provides opening from
the bronchi (if namaga, stridor
will be heard)
- Bronchus – smaller airways (right
more vertical than the left) (if
namaga, wheezing will be heard)
UPPER RESPIRATORY DISORDERS
ACUTE VIRAL NASOPHARYNGITIS
- “common cold”
- Causative agent: rhinovirus,
respiratory syncytial virus (RSV),
adenovirus, influenza virus,
parainfluenza virus
- Left-limiting, resolves within 4-
10 days

Pneumothorax – air in lungs Clinical manifestations

- Fever
Lobectomy – 1 lobe is removed - Sneezing
Pneumonectomy – 1 side of lung is - Muscular aches
removed - Chilly sensations
- Irritability
LUPA
L – lob Therapeutic management
U – unaffected side - No specific treatment
P – pneumo - Rest
A – affected side - Decongestant (infants over 6
months)
Water – hydrothorax - Cough suppressants (with
Air - pneumothorax (entire black on xray) dextromethopan: should not be
Blood – hemothorax administered to young children
Pus – pyuthorax continuously due to alcohol
content
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REVIEWER IN PEDIA
Nursing management
- Elevate the head of the crib
- Suctioning and vaporization
- Maintaining adequate fluid
intake (offer favorite fluid)
- Educate patient and family to
prevent infection
ACUTE STREPTOCOCCAL PHARYNGITIS
- “strep throat”
- Causative agent: Group A Beta-
hemolytic Streptococcus
(GABHS)
- Complications: rheumatic fever
and glomerulonephritis
Clinical manifestations
- Pharyngitis
- Headache
- Fever
- Anterior cervical
lymphadenopathy
Diagnostic evaluation
- Throat culture
- Antistreptolysin o titer
(retrospective Dx)
<200 todd units
Therapeutic management
- Obtain throat swab for culture
- Administer medications
- Cold or warm compress the neck
- Offer cool liquids or ice chips
- Teach on the prevention of
transmission
TONSILITIS
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- Tonsils (masses of lymphoid
tissue) that protect the
respiratory and alimentary tract
- Causative agent: viral or
bacterial
Grade 1 – behind the pillar
Grade 2 – between the tonsillar pillar & the
uvula
Grade 3 – almost touching the uvula
Grade 4 – “kissing tonsils”
Clinical manifestations
- Dysphagia/odynophagia
- Mouth breathing (dry and
irritated mucous membrane)
- Cough is also common
Therapeutic management
- Self-limiting
- Treatment is symptomatic
- Surgical tx:
o Tonsillectomy
adenoidectomy
o Should not be done for
children under 3 y/o
Nursing management
- Give cool-mist vaporizer
- Give warm saltwater gargle
- Administer acetaminophen
Pot op:
- Until fully awake: place on the
abdomen or side (drain
secretions)
- Careful suctioning
- Give cool water, crushed ice, ice
pops
- Avoid red or brown colored food
- Discourage coughing frequently,
clearing the throat, blowing the
nose
- Monitor for hemorrhage
REVIEWER IN PEDIA
CROUP SYNDROME
- General term applied to complex
symptoms
Characterized by:
- Hoarseness
- Resonant (barky,brassy,croupy)
- Rough
- Inspiratory stridor
- Respiratory distress
ACUTE EPIGLOTITIS
- “acute supraglottitis”
- The condition requires
immediate attention
Clinical manifestations
- Fever and drolling
- Dysphagia and odynophagia
- Child insists a TRIPOD position
Therapeutic management
- Antibiotic (bacterial)
- Corticosteroid
- Intubation or tracheostomy
Nursing management
- Allow the child to assume tripod
position
- Continuous monitoring
- *never attempt to check the
throat with tongue depressor if
suspecting epiglottitis: refer
immediately
ACUTE LARYNGITIS
- Common in older children and
adolescents
- Causative agent: viruses
Clinical manifestations
- Hoarseness
- Nasal congestion
- Sore throat
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- Fever
- Coryza
Therapeutic/nursing management
- Symptomatic
o Fluid and humidified air
ACUTE LARYNGOTRACHEOBRONCHITIS
- Most common type of croup
- Causative agent: viruses
Clinical manifestations
- Low-grade fever
- Child awoke with barky, brassy
cough
- Inspiratory stridor
- Cough
- Hoarseness
Therapeutic management
- Maintenance of airway
- Humidity/cool air vaporizer
- Cool temp therapy
- Nebulized epinephrine (racemic
epinephrine)
- Corticosteroid (IM
Dexamethasone)
Nursing management
- Assessment and monitoring
- Available
intubation/tracheostomy set
should be available at bedside
ACUTE SPASMODIC LARYNGITIS
- “midnight croup”
- Paroxysmal attacks of laryngeal
obstruction that occur most
often at night
Clinical manifestations
- No fever
- Metallic cough
- Hoarseness
REVIEWER IN PEDIA
- Noisy inspiration
- Restlessness
Therapeutic/nursing management
- Warm mist
- Self-limiting: supportive therapy
BACTERIAL TRACHEITIS
- Infection of the mucosa of the
upper trachea
- Obstruction -> respiratory alert
Clinical manifestations
- Crooping cough
- Stridor unaffected by position
- Similar to LTB (no responsive to
LTB treatment)
Therapeutic/nursing management
- Antibiotics
- Humidified oxygen
- Antipyretics
- Tracheal suctioning
- Endotracheal intubation
LOWER RESPIRATORY TRACT
DISORDERS
ACUTE BRONCHITIS
- Aka “tracheobronchitis”
- Inflammation of the large
airways
- Causative agent: viruses
Clinical manifestations
- Dry, hacking, non-productive
cough that is worse at night, that
becomes productive in 2-3 days
- Self-limiting: symptomatic tx
BRONCHIOLITIS
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- Causative agent: RSV and
paramyxovirus
Clinical manifestations
- Rhinorrhea and intermittent
fever
- Pharyngitis
- Coughing and sneezing
- Dyspnea
- Tachypnea (flaring of nares and
retractions)
- Wheezing
Diagnostic evaluation
- RSV antigen
- Immunofluorescent antibody
- ELISA (Enzyme-linked
immunosorbent assay)
Therapeutic management
- Humidified oxygen
- Adequate fluid intake
- Maintenance of airway
- Bronchodilators
- Ribavirin (aerosol)
o Use goggles/mask – can
cause dryness of eyes
and oral mucosa
Nursing management
- Assess respirations
- Oxygen therapy
- Hydration
LONG TERM RESPIRATORY
DISORDERS
ASTHMA
- A chronic inflammatory disorder
of the airways in which many
cells play a role such as:
o Mast cells
REVIEWER IN PEDIA

o Eosinophils - Health teaching

o T-lymphocytes o Avoidance of allergens
- Most common chronic disease in o Maintenance of health
childhood and prevention of
complications
o Promotion of normal
activities
o Self-care (hallmark of
Clinical manifestations asthma mngt)
- Dyspnea and wheezing o Play techniques
- Cough (classic manifestation) in (breathing excercises)
the absence of infection occurs  Blowing cotton
at night balls/ping pong
- Shortness of breath balls (increases
- Younger children: tripod position expiratory time
- Older children: sitting with and pressure)
shoulders hunched over

CYSTIC FIBROSIS
Diagnostic evaluation - Inherited, autosomal recessive
- Based on signs and symptoms, trait
history, and physical - Etiology: mutated gene of
examination chromosome 7 (cystic fibrosis
- Spirometry transmembrane regulator)
- Chest radiograph - Common in Caucasians
- Skin testing (for hypersensitivity)
Diagnostic evaluation
Therapeutic management - Quantitative Sweat Chloride Test
- Allergen control (Pilocarpine iontophoresis)
- CPT (Chest Physiotherapy) - Chest radiography
- Pharmacotherapy - Stool fat or enzyme analysis
o Corticosteroids - Newborn screening for CF
o Cromolyn (NSAID)
o Beta-adrenergic agonists Therapeutic management
(albuterol, terbutaline) - Prevent or minimize pulmonary
o Anticholinergic complications
o Methylxanthines  CPT (cornerstone
of pulmonary
Nursing management therapy), exercise,
- Place the child in a semi fowlers deep breathing
position and coughing
- IV fluids (if cannot tolerate oral) o Bronchodilators and anti-
- Reassure the parents inflammatory

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REVIEWER IN PEDIA

o Flutter mucus device –

removal of mucus
o Huffing “forced
expiration”
o Antibiotics and oxygen
o Lung transplantation
- For other organ involvement:
o PANCREAS: obstruction
of duct
 Inadequate/no
release of enzyme
 Malabsorption of
fats, protein, and
fat-soluble
vitamins
 Steatorrhea
 High-protein high
caloric diet

o SKIN: high amount of Na

and Cl in sweat
 Skin care
 Add salt to all
meals (summer)

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