PEDIATRIC NURSING

Sir Michael C. Borras, RN RM CNN CTN MSN USRN

Immediate Care for Newborn (OLD)
Neuroblastoma: Adrenal medulla “PoSuDrAW BaMIHI”
Cheiloschisis: Cleft Lip 1. Position
Peer play/Team Play/Intellectual Play: Play for adolescents  Without complication: Supine
RA 9288: Newborn Screening  With complication: Lateral
Rice Cereal: First food  No prone
G6PD: Most common screenable disease in the NBS  No Trendelenburg
2. Suction
Head  1st: Mouth
1. C – Caput succedaneum  2nd: Nose
 Bleeding or edema crosses over the sagittal  Newborn:
line. o Obligate Nasal Breathers
2. C – Cephalhematoma  Infant:
 Bleeding or edema does not cross over the o Obligate Mouth Breathers
sagittal line.  Abdominal or Diaphragmatic Breathers
3. M – Molding (Both)
 Overlapping of sutures o No prone
 Sagittal, Frontal, Coronal, Lambdoid o May lead to SIDS
4. F – Fontanels  Suction time:
a. Anterior o 3-5 secs.
 Diamond o If >5 secs., it will stimulate vagus
 12 – 18 mos. nerve – leading to reflex
 1 – 3 cm bradycardia (<120)
b. Posterior  If nose first:
 Triangle o It will stimulate GASP Reflex
 2 – 3 mos. leading to aspiration.
 0.5 – 1 cm 3. Dress
Relevance:  For warmth
 If <N: Craniosynostosis  4 Risk Factors:
o Premature closure of the fontanel 1) Aircon DR
o Expect among post-term babies 2) Immature hypothalamus
3) Cannot shiver
 If >N: Craniotabes (Shivering at birth is a sign of
o Abnormal softening distress)
o Hydrocephalus 4) Little/no brown fats
Eyes  Hypothermia
1. Tears  Cold stress
 Start at 3 – 4 mos.  Respiratory Distress
2. Vision o Grunt
 1 – 6 mos. – MYOPIC (8 – 12 in.)  Management:
o Enfacement Preterm
o Best colors: Black and white o Swaddle
 7 – 12 mos.:  Mummify
o Red and blue  Kangaroo care
 Develop sensorimotor o Phototherapy
(Intellectual capacity)  Photoisomerization
3. Cross Eye  Heat lamp therapy
 Normal for the 1st 4 months.
 > 4 mos: Pathological: Strabismus Drop Light InfraPhil
o Hypertropia (Billie Light) Bulb
Yellow Blue
o Hypotropia
6-12 in. 12 – 18 in.
o Esotropia
20-30 mins. 5-10 mins.
o Exotropia
 Cover:
o Double Esotropia
Eyes:
 Management: Keratoconjunctivitis
o Cover the unaffected to prevent eye Genitals:
straining Sterility
o Botox the affected  Check skin every 5 mins.
 If burn 2 HLT:
4. Eye Conditions Bronze baby syndrome
Term
Osteogenesis Imperfecta o Breastfeeding
BLUE
First Sign o 5 correct technique
RED Stimson’s Line 1. Eye contact
PINK Conjunctivitis 2. Chin touch breast
Erythroblastosis fetalis 3. Areola: Fully covered
YELLOW
Rh-ABO Incompatibility 4. Slow and deep sucking
ORANGE Rifampicin Use (Maternal) 5. Lips turned out
GREEN Candidiasis o Heat Lamp
Coloboma
CAT’S EYE Genetic Disorder: Blindness 4. APGAR
#8 or oval shaped  Developed by Dr. Virginia APGAR
CROSS EYE Strabismus  First 1 minute
PUS EYE Ophthalmia neonatorum  Repeat 5 minutes after birth
CAT’S EYE REFLEX Retinoblastoma 8-10 Good Breast feed
ONE EYE Cyclops 4-7 Mild – Moderate HLT, Oxygen, Monitor
0-3 Severe Intubate
 Resuscitate  Chloromycetin
Incubate
9. Hemorrhage
5. Weight  Vitamin K
 6 – 9 lbs. (2,500 – 4,000 g.) o Prevent Hemorrhagic Disease of
 BW: the Newborn
o x2 @ 6 mos. o Preterm: 0.5 mg
o x3 @ 12 mos. o Term: 1 mg
o x4 @ 18-30 mos. o Upper Outer Middle Third of Vastus
 BW: Lateralis
o 1-6 mos.:  1.5 lbs./mo.
o 7-12 mos.:  1 lb./mo. 10. Initial cord care
 Use Sterile Water or NSS
Example: (To determine BW is normal)  No alcohol, betadine.
 BW: 8 lbs.
 @10 mos.: 21 lbs. (Actual) Essential Intrapartum and Newborn Care
1-6 mos.: “Unang Yakap”
1.5 x 6 = 9 lbs. 1. Dry (0-30 mins)
+ 8 (Actual)  No prone.
17 lbs.  No Trendelenburg.
7-10 mos.:  No suction, unless…
4 lbs.  No ventilation, unless…
21 lbs. (Normal)  No shaking
 No slapping
6.5 lbs.
 No rubbing
@11 mos. = 20.8
 No removing of vernix
1-6 mos.:
1.5 x 6 = 9 lbs.  No squeezing
+ 6.5 (Actual)  No footprint
15.5 lbs.  Yes supine.
7-11 mos.:  Yes, to lateral.
5 lbs.  Yes, to mummify.
20.5 lbs. (Normal)  Yes, to wiping the face.

6. Bathe 2. Skin (30-1 hr.)

 Eyes  Place baby on mom’s chest or abdomen
 Face  Place baby prone/lateral.
 Neck  ID Band
 Chest o No wrist
 Abdomen o Yes ankle.
 Arms o Pink – Girl, Hermaphrodite
 Back o Blue – Boy,
Change water o White or red – IUFD
 Feet 3. Clamp (1-3 hrs.)
 Legs  1 – 3 mins after delivery
 Genitals  1st clamp
 Butt o 2 cm from umbilicus
Change water o Cord clamp
 Head o Cut nearest the 1st clamp
 nd
2 clamp
7. Measure o 5 cm
 Head (35-55) cm o Kelly
 Chest (31-33) cm  No milking (towards baby)
 Body (30-33) cm  Yes stripping (towards placenta)
 Length: 48-55 cm  No clamp if (+) pulsation.
 Thigh: 18-20 o If cut: can lead to anemia.
o <15 cm: Duchenne 4. Breastfeed (1st 90 mins)
 Muscular Dystrophy  Every 2-3 hours or 8-12 times per day.
 No bathing for 6 hours.
8. Infection o Can lead to cold stress that can
 Crede’s prophylaxis lead to respiratory distress (grunt).
o Prevent opthalmia neonatorum
 Silver nitrate Nutrition
o Drops Breastmilk
o 1-2 gtts/eye 
o Lower conjunctiva Rice cereal
o Flush after 30 secs. with NSS to 
prevent chemical conjunctivitis Vegetables
 Erythromycin 
o Ointment Fruits
o Inner to outer 
o Lower lid Lean meat (Chicken)
o No flushing 
 Tetracycline Red meats and fish (delayed:  iodine content)
o Ointment
o Inner to outer NO before 1 y/o
o Lower lid 1. No nuts
o No flushing 2. No honey (Food poisoning)
 Penicillin Ointment 3. No hotdogs/marshmallows. (Asphyxiation)
4. No eggs. (Egg yolk before egg white)
 Age Play Toys Anxiety Cause of Death Concept of Death Issues
Rattles, mobiles, shape sorter, Nutrition
8 mos. – Stranger
Infancy 0–1 Solitary pacifier, teether, vocalization, SIDS No concept. Trust
10 mos. – Separation
nursery rhymes Thermoregulation
Sleep. Tantrums (NC: Ignore behavior)
Blocks, balls, cards, action figures, Poisoning or
Toddler 1–3 Parallel Separation “Mommy, when will grandma Negativism (NO: Give options)
push and pull, coloring books Choking
wake up?” Egocentrism: Self-centeredness
Oedipal
Electra
Painful.
White Lies
Associative Set toys, cards, dolls, teddy bear, Castration Punishment.
Preschool 3–6 Drowning Imaginary friends
Cooperative collectibles, bicycle, tricycle, wagon (Body Mutilation) Reversible.
Masturbation
Avoidable.
(Curiosity – Divert attention. Do it in private
area.)
Failure Final.
Out of school youth.
School Street games, video games, sports, Unknown Inevitable.
6 – 12 Competitive Accidents Vices.
Age board games, school competitions Rejection Irreversible.
Comedones
Teachers Personify death.
Team Death is not for them. Identity crisis.
Adolescen Social media, electronics, extreme Body Image Disturbance
12 – 18 Peer Suicide Death is a search for the meaning Teenage pregnancy
t sports Surgery
Intellectual of life. Drugs

CARDIOVASCULAR DISEASES o Upper extremity hypertension

o Pulseless feet
o Cold, cyanotic feet
RIGHT TO LEFT SHUNT
 Management:
 Priority: OXYGENATION
o Balloon Stent (PICC)
 Cyanosis
o Aortic Endarterectomy
T / TR
+ LEFT TO RIGHT SHUNT
AEIOU I. Patent Ductus Arteriosus
 Murmurs:
I. Truncus Arteriosus (Y-disease) o Machinery-like
 Fusing of the pulmonary artery and aorta. o Gibson murmur
II. Transposition of Great Arteries (X-disease)  Opening between pulmonary artery and the aorta.
 Most dangerous. II. Patent Ductus Venosus
III. Tricuspid Atresia  Bruit
 No closure of Foramen Ovale due to the atresia of tricuspid valve.  Opening between the inferior vena cava and umbilical vein.
IV. Tetralogy of Fallot III. Atrial Septal Defect
V. Total Anomalous Venous Return  Silent murmur
 SVC is normal but the IVC is connected to the aorta.  Opening between the two atria.
IV. Ventricular Septal Defect
OBSTRUCTED  Loud murmur
I. Coarctation of Aorta  Opening between the two ventricles.
 Coarctation (Constriction or narrowing) of descending aorta only
 Signs and symptoms: To close the holes:
Use of Indomethacin and Ibuprofen. (IV Ig)
Both are NSAIDs with cardiac function to treat the problem. Artificial Passive (Anti, Ig)

Feto-Placental Circulation Frozen (MOV)

1. Placenta Measles
2. Umbilical Cord OPV
3. Umbilical vein Varicella
4. Bypass the immature liver through the Ductus Venosus
5. IVC Probable signs: BBCHUG+
6. RA Stages: (When u r happy…)
7. Foramen Ovale Latent, Active, Transition up to 40, 60, 90 (Duration of Contraction)
8. LA Variable – Cord compression
9. LV Early Deceleration – Head compression
10. Aorta Acceleration – O’right
11. Ascending and Descending Aorta Late – Placenta previa/abruptio placenta
12. Distribute to brain, heart and kidneys which are the only organs fully developed
13. Svc Therapeutic Com
14. RA T – Tell me more (Catharsis – verbalization of feelings.)
15. RV H – Holistic opening (Ex. What would you like to talk about?)
16. Pulmonary Artery E – Empathy
17. Bypass the immature lungs through the Ductus Arteriosus R – Restate
18. Aorta A – Active Listening
19. Hypogastric artery P – Presence
20. Umbilical artery E – Explore
21. Placenta U – Use of silence
Management of Left to Right Shunt: T – Touch
1. Small frequent feeding. I – Information
2. Rest and sleep. C – Clarify
3. Diet: Low residue, high calorie. S – Summarize
4. Avoid stress.
5. Developmental play. Non-therapeutic
6. Medicate PRN. B – Belittle
A – Advice
KAWASAKI DISEASE D – Disapprove
 Acute Mucocutaneous Lymph Node Syndrome N – Neglect
 Acute Systemic Vasculitis U – Underestimate
 Cause: R – Reassure
S – Stereotype
o Idiopathic
E – Ending inappropriately
 Common:
o Boys
 First case in Korea
HEMOPHILIA
 Sex-linked disorder
Acute Chronic  Boys: manifest (25% - oldest)
Red strawberry tongue  Girls: carriers (50-75%)
 ESR  Complication: Bleeding
(Treatment: Soft and Cold)
High Fever
Cardiomegaly
Weight Loss A 8 Von Willebrand Desmopressin
Arrhythmia
Anorexia B 9 Christmas Hepa B Vaccine
Chest pain
Leukocytosis C 10 Stuart – Prower Alphanate
Lymphadenopathy
Lymphedema (Anti-hemophilic
DOB Plasma Thromboplastic
D 11
Aspirin Intravenous Immunoglobulin Antecedent Drug)
 o Looks at image and smiles
o IMAGE (5 letters)
o 5 months
Nursing Management:
 B – Blood transfusion of PRBC for 30 mins. Months
 R – Razor, no shaver 0 – Crying
 A – No Aspirin 2 – Social smile
 N – Needles (Heplock, smallest gauge) 4 – Cooing (Jargon/Throaty sounds)
 D – Avoid direct sports (No ball games) 6 – babble (PA)
 I – Avoid insect bites 8 – mumble (PAPA)
10 – 3 – 5 words (PAPI)
12 – short phrases
2
Metro Manila Development Screening Test
3 Cephalocaudal
0 Head lag
4 2 Raise the head
4 Turn to sides
6 Roll over
8 Sit
5 10 Crawl
12 Stand and Walk

2 Types of Smile:
 Social
o Smile at the baby, baby smiles back
o 1+1
o 2 months.
 Self
 Proximodistal
0 Closed, flexed
3 Open, extended
6 Palmar
9 Pincer
12 Shoot
 GASTROSCHISI
CHEILOSCHISIS PALATOSCHISIS OMPHALOCELE PYLORIC STENOSIS
S
Exposure of abdominal organs
Cleft Lip Cleft Palate Cause: Definition: Narrowing of the pyloric canal and/or antrum.
Measles (Paramyxovirus) during pregnancy
Diagnostic test:
Boys Girls Without peritoneum With peritoneum
Barium Swallow
Lips fuse at 2nd tri. AOG Palates fuse at 3rd tri. AOG Cause of death: Cause of death: Signs and symptoms:
Before surgery: Priority: NUTRITION Sepsis Peritonitis Olive-shaped mass (RUQ)
E – Enlarge nipple hole Rigid abdomen (+) String Sign: X-ray
NUK Nipple (Multiple holes. Used for those with dysphagia or pureed foods.) Painful abdomen Projectile vomiting
S – Stimulate sucking Paralytic ileus Vomitus: Acidic, no bile
S – Stimulate swallowing Risk for Aspiration
R – Rest and burp Metabolic Alkalosis
Cheiloplasty Palatoplasty (Uranoplasty) Management:
Done: Done: Diet: Pureed (Thickened diet)
ASAP After 1 year (Speech development) Example: Lugaw
Post op position: Post op position: Feed upright
Lateral or Supine Prone or lateral
Restraint:  Monitor for bleeding Surgeries:
LOGAN BAR (Mouth guard) (Frequent swallowing) Pyloromyotomy (Fredet-Ramstedt)
Elbow restraint  Sipping Cup or Feeder Pyloromyomectomy
Mitten Diet: Endoscopic Balloon Stent
Feeding: Sugar water
Dropper Breastmilk
Diet:
Sugar water
Breastmilk