PEDIATRICS NORMALS ■ Theory of conservation - knows na equal laman ng baso

■ Theory of reversibility - clay babalik sa dating anyo

● Check age when answering, then base answer on age
○ ADOLESCENT
■ Formal operational
GROWTH AND DEVELOPMENT
■ Deductive thinking - general to specific
● Approach:
● Human beings -> System -> Organs -> Tissue -> Cell
○ Cephalocaudal (head to toe)
■ Hypothetical/ abstract
○ Proximo-distal
● KOHLBERG
○ Gross to fine
○ INFANT -----
○ General to specific
○ TODDLER - Pre-conventional (punishment and reward)
● Growth - physical
■ Necessary for obedience
● Development - psychological
■ Best punishment: time out to decrease stimulus of child
● 3 y/o - 3 mins
THEORIES
● 1 y/o - 1 min
● ERIKSON
○ PRESCHOOLER - pre-conventional (egocentric - self only)
○ INFANT (0-18 mos) - Trust vs mistrust
○ SCHOOL AGE - conventional
■ Trust is based on instinct (love, care)
■ Good to the eyes of others
○ TODDLER (18 mos - 3 y/o) - Autonomy vs Shame and doubt
■ Authority
■ Egocentric toddler
○ ADOLESCENT- post conventional
■ Simple decision making (autonomic)
■ Morals while growing up
■ Not allowed to make decisions -> shame and doubt
■ Know law
○ PRESCHOOLER (3-6 y/o) - Initiative vs Guilt
■ Responsible - develops during adolescence
■ High imagination
■ Initiate household chores
DEVELOPMENTAL MILESTONES
■ Not allow to help -> guilt
● Newborn
○ SCHOOL AGE (6 -12 y/o) - Industry vs Inferiority
○ Intact reflexes
■ Initiative -> industry
■ Moro reflex
■ Follows teacher than parents - INDUSTRY
● Normal: both hands raise
○ ADOLESCENT (12-20) - Identity vs Role Confusion
● 1 hand raised: brachial plexus paralysis d/t clavicular
■ Arranging hair in front of mirror - IDENTITY
fracture
● FREUD
○ Crying
○ INFANT
○ Needs soothing words/ hymns
■ Oral stage
● 1 month
■ Center of gratification: mouth
○ Head lag
● Breastfeeding, teethers, tooth eruption
○ Cooing
○ TODDLER
● 2 months
■ Anal stage
○ No head lag
■ Center of gratification: anus
○ Social smile
● Toilet training
● 3 months
○ PRESCHOOLER
○ Get hand on mouth
■ Phallic stage
○ Ability to respond to voices
■ Penis envy -> development of complexes
● 4 months
● Oedipal - baby boy likes mother
○ Chest, side to side
● Elektra - baby girl likes father
○ Play rattles
○ SCHOOL AGE
● 5 months
■ Latent stage
○ Can turn from abdomen to back (prone to supine)
■ Lax development (slow) -> growth gap
○ Googoo, gaga
■ Same sex orientation (female w/ female) (male w/ male)
● 6 months
○ ADOLESCENT
○ Sit w/ support
■ Genital stage - curious about genitals
○ 2x the birth weight
■ Common: unwanted pregnancy
○ First tooth eruption - teething rings
● PIAGET
■ Tx: Painful - anything that can soothe gums
○ INFANT & TODDLER
● 7 months
■ Sensorimotor stage
○ Hand to hand transfer
■ Develop through senses - touch, smell
○ Crude pincer grasp (start pincer grasp)
○ PRESCHOOLER
● 8 months
■ Preoperational stage
○ Sit w/o support
■ Egocentric
○ Peak of stranger anxiety
■ Can understand symbols (object as money, toy as car)
● 9 months
■ High imagination
○ Pincer grasp reflex
■ Teach swimming
○ Wave bye bye
○ SCHOOL AGE
○ Crawl
■ Concrete operational
● 10 months
■ Inductive thinking - specific to general
○ Peak of object permanence
● Cell -> tissue -> organ -> system -> human beings
● 11 months ● PRESCHOOLERS
○ Ability to cruise (walk but hold onto furnitures) ○ Shares
● 1 year old ○ Associative/ cooperative play - plays together, related play
○ 3x birth weight ■ Make believe plays - role play, kitchen set
○ 3-5 words ■ High imagination
○ Can stand ■ Develops gross motor skills - riding bicycle, seesaw, slide,
● 15 months swing
○ Stand w/o support ■ Develops fine motor skills - puzzles, age-appropriate
○ Can walk up stairs w/ support electronic games
● 2 years old ■ Develop creativity - coloring books w/ crayons, clay, legos
○ 300 word vocabulary ■ If ptx w/ cast, X lego (tiny object) -> compartment
○ Can draw circular, vertical strokes syndrome
○ Can draw perfect circles - autism ○ Fears:
● 3 years old ■ Body mutilation
○ Rides tricycle ■ Castration -> exhibitionism
○ Can draw/ copy circles ■ Dark (lights on for sleeping)
● 4 years old ■ Ghost
○ Peak of questioning ■ Thunder
○ Imaginary playmates ■ Tx: comfort child
○ Can draw squares ● SCHOOL AGE
○ Can stand w/ one foot ○ Competitive play - indoors
● 5 years old ■ Ball games, board games (chess, scrabbles), informative
○ 6x birth weight materials
○ Eruption of permanent teeth ○ Fears:
○ Can draw diamond and triangle ■ Death (punishment from boogeyman)
○ Can ride bicycle (5-6 y/o) ■ Rejection from teacher
● 6 years old ● ADOLESCENT
○ Lose first teeth ○ Competitive play - outdoors
● 7 year sold ■ Ball game: basketball, volleyball
○ Can jump w/ one foot ○ Fears:
■ Peer rejection
PLAYS AND FEARS ■ Body image
● INFANT ■ Acne
○ Solitary play - plays alone
○ Toys - promote sensory development NEWBORN
■ See: Colors - red, white, black ● APGAR scoring
■ Hear: w/ sounds ○ Done 1 min after delivery and 5 mins after
■ Touch: Soft stuffed toys (X to asthma) ○ Results
● WOF eyes of stuffed toy (buttons) ■ 8-10: normal
● RF aspiration ■ 4-7: clear airways (suction)
■ Ex: rattle, musical mobiles, squeeze toys ■ 1-3: start CPR/ resuscitation
■ 1-3 mos - Rattles, music box
■ 4-6 mos - Squeezed toys
0 1 2
■ 7-9 mos - Large box, large balls
■ 10-12 mos - Books with large pictures
Appearance Blue Acrocyanosis Pink
○ Significant person: mother
○ Fears: stranger anxiety
Pulse (-) <100 >100
■ Onset: 7 mos
■ Peak: 8 mos Grimace (-) Grimace (+) sneeze/ cough
■ End: 9-12 mos
● TODDLER Activity flaccid some Well flexed
○ Parallel play - plays together but not related, can't get other toy
○ Toys - for physical development Respiratory (-) Weak Loud
■ Promote walking and talking
■ W/o rules
■ Push or pull toys, ball, tricycle/ tribike, walkie talkie ● HEAD
■ No detachable part (RF aspiration) - X clay, lego ○ Head circumference: 33-35 cm
○ Fear: separation anxiety ■ Use tape measure
■ 3 stages: ■ Landmark: level of eyebrows
● Protest - crying, temper tantrums ■ > 35 cm: macrocephaly -> hydrocephalus
● Despair - stopped crying, withdrawn ● Macrosomia - big body d/t GDM
● Denial - deny presence of mother ■ < 33 cm: microcephaly
● Decreased IQ d/t small brain -> mental retardation
● Down syndrome
 ● Zika virus
○ Prone to teratogenic effect @ 1st trimester
(organogenesis)
○ Fontanels
■ Anterior (BADS 12-18)
● Other name: sinciput, bregma
● Shape: diamond
● Closes at 12-18 mos
■ Posterior (PTLOV 2-3)
● Other name: occiput, vertex, lambda
● Shape: triangular
● Smaller fontanel
● Closes at 2-3 mos
■ Early closure (craniosynostosis)
● Brain ceases devt early -> Mental retardation
● RF ICP
● Cause: idiopathic - unknown
○ Syphilis
■ Late closure: hydrocephalus (fluids prevents closure)
■ Sunken fontanel d/t DHN
● Tx: increased breastfeeding
■ Bulging fontanel d/t increased ICP
● Hydrocephalus - no. 1 cause of increased ICP
● Normal in episodes of crying and defecation
● Not N in pain but when baby cries, becomes normal
● Tx: mannitol (osmotic diuretic)
○ Sac formation
■ Common in Normal Spontaneous Delivery (NSD),
primipara (narrowed passageway -> increased pressure)
■ Caput succedaneum
● Fluid accumulation
● Resolves in 3-6 days
■ Cephalhematoma
● Blood accumulation
● Resolves in 3-6 weeks
○ Natal teeth: lower central incisor (normal)
■ Cause: during pregnancy, increased Ca to prevent
hypoglycemia and leg cramps
■ Abnormal: loosened natal teeth
● WOF aspiration
● Tx: removal
○ Eyes
■ Normal visual acuity: nearsighted (myopia) - 20/100
■ First attracted to red color
■ First vision color: black and white
■ Color blindness: green and red -> grey (X license)
● CHEST
○ Chest circumference: 31-33 cm
■ Landmark: nipple line
■ Expected to be smaller than HC
○ Nipple assessment
■ Count: 2
● >2 nipples: Supernumerary nipples
○ Birthmark only, non-functional
■ Secretions:
● Normal: witch’s milk (white)
● During pregnancy, hormones (progesterone)
increases
● Resolves in 3-5 days after delivery
■ Appearance:
● Normal: swollen, edematous
● Increased estrogen retains fluid
● Resolves in 3-6 days (like caput succedaneum)
● Excreted thru urine
○ Respiration rate: 30-60 bpm
■ Normal: irregular, apnea (5-10 s)
● ABDOMEN
○ Abdominal circumference: 31-33 cm
■ Same w/ chest circumference
■ Landmark: above umbilicus
○ Normal shape: globular (relaxed abdominal muscles)
■ Flat: missing organ (usually kidneys)
○ Umbilical cord
■ Blood vessels
● Normal number: 3 (AVA)
● Small diameter: artery (unoxygenated)
● Bigger diameter: vein (oxygenated)
● In adults
○ Artery: oxygenated
○ Vein: unoxygenated
■ O2 (maternal blood) -> placenta -> umbilical vein ->
ductus venosus (to bypass immature fetus liver near
umbilicus) -> inferior vena cava -> RA
● -> heart circulation (70% of blood) - foramen ovale ->
LA -> aorta (ascending to head, descending to
extremities) -> ascending (all 70% O2) for brain devt
-> brain -> unoxygenated (CO2) blood -> superior
vena cava -> RA
● -> retained in RA (30% of blood) + 70%
unoxygenated (CO2) blood - heavier -> LV -> PA ->
ductus arteriosus -> aorta (descending) ->
extremities (30% oxygen) -> acrocyanosis
(NORMAL)
■ Infection (omphalitis)
● Drying before removal: 7-10 days
● >10 days: infection
● EXTREMITIES
○ Amelia: absence of total extremities
○ Phocomelia: absence of distal extremities
○ Polydactyly: >10 fingers
○ Oligodactyly: <10 fingers
○ Syndactyly: finger webbing
○ Hypertonia: excessive muscle spasm in tetany
○ Jaundice - yellowish discoloration
■ Physiologic (normal): >24H (3-5 days)
■ Pathologic (abnormal): <24H
■ 6th day -> check up (ALT, AST)
● GENITALIA
○ Male
■ Phimosis - constricted/ no opening at foreskin -> urine
cant get out -> RF infection @ glans penis (balanitis)
● Tx: early circumcision to remove foreskin
■ Balanitis - infection of the glans penis
■ Hypospadias - ventral part (urethral meatus)
● Causes infertility and shortened urethra
● Tx: Repair of urethra (urethroplasty) & circumcision
○ Foreskin will be formed as tube then connected
to urethra to extend it to the glans penis
● Cause: idiopathic (unknown)
■ Epispadias - dorsal part (urethral meatus)
■ Cryptorchidism - undescended testes
● RF testicular Ca
○ Female
■ Pseudomenstruation - red vaginal discharge
● Normal: d/t increased progesterone in pregnancy
● Resolves in 3-5 days
 ■ Imperforate hymen ■ Language
● Hymen- where mens come out ● First language at birth: cry
● Menstruation will accumulate if stays closed ● Use of gadget - no 1 cause of language impairment
● Tx: incision of hymen ■ Social skills
● Psychosocial theory - Erikson
INFANCY ● Psychosexual theory - Freud
● Age: 1-12 mos
○ Neonate: 0-28 days
○ Psych: until 18 mos (freud) GROSS MOTOR SKILLS
● Fear: Stranger anxiety
● Fastest Growth At birth - Head lag
1 mo - due to immature neck muscles
○ Changes in size - measurable
Support head
○ Other name: quantitative changes
○ Parameters:
2 mos Lift head
■ Weight - most sensitive growth parameter - If stil w/ head lag -> hydrocephalus (or autism)
● Used to determine drug dosage
● N BW: 2,500 - 3,500 g (2.5- 3.5 kg) 4 mos Lift head and chest
○ Foreign child: 2.5- 4.5 kg - Decreased RF SIDS (pronation) bec they can
○ > 3,500 g: Large for Gestational Age (LGA) d/t already lift their head and chest
GDM (macrosomia)
○ < 2,500 g: Small for gestational age (SGA)/ low 5 mos Roll over
birth weight - prone -> supine -> prone -> supine
- WOF falls
- Cause: smoking (nicotine) ->
vasoconstriction of BV in umbilical cords ->
6 mos Sit w/ support
decreased nutrients to baby
- Needs chair with back support
● At birth, boy has larger body mass
○ 1st male child - RF autism 7 mos Bouncing
○ 2nd child - RF schizophrenia - Foot towards the mouth
● Formulas: - To strengthen muscles as preparation for
○ 5-6 mos: BW x 2 standing and walking
○ 1 y/o: BW x 3
○ 2 y/o: BW x 4 8 mos Sit w/o support
○ 3 y/o: BW x 5
○ 4 y/o - growth gap -> BMI 9 mos Crawl and creep
○ 5 y/o: BW x 6
○ 6 y/o - growth gap-> BMI 10 mos Stand w/ support
○ 7 y/o: BW x 7
■ Height - linear growth 11 mos Cruising
- 2 hands held by mother/ supported by walking
● N BL: 45-55 cm
● At birth, boy has longer linear growth
12 mos Stand w/o support
● Equipment: tape measure Walk w/ support
● Position: supine for accurate measurement - 1 hand held by mother
● Pattern: head to toe (zero at head)
● Unit: cm (most specific ) 15 mos Walk w/o support
●
Formulas: 18 mos Jumping
○ 1 y/o = BL x 1.5
○ 4 y/o = BL x 2 3 y/o Running
○ 13 y/o = BL x 3 Tricycle/ tri-bike
● Fastest Development
○ Maturation 4 y/o Stand w/ 1 leg
○ Changes in skills
○ Other name: Qualitative changes FINE MOTOR SKILLS
■ Uses assessment tool
■ Not readily measurable 1-3 mos Closed fist w/ thumb inside
■ Assessment tools:(by health practitioner)
● Denver developmental screening test (DDST) - 5 mos Close and open fist Rattles
foreigner Able to hold an object - for sensory dev’t
● Metro Manila Developmental Test (MMDST) - Filipino
○ Early development -> High IQ 7 mos Crude pincer grasp
- Can transfer objects to other hand
○ Late development -> Low IQ/ Mental retardation
○ IQ of baby usually comes from mother
9 mos Neat/ fine pincer grasp
○ Parameters - can control thumb, pointing finger
■ Gross motor skills - Cephalocaudal - RF aspiration, choking, poisoning
■ Fine motor skills - proximo-distal
12 mos Able to throw ball which promotes walking (reward)
Able to hold spoon (during feeding only) - Industry = creativity

2 y/o Draw vertical, horizontal lines (unorganized) Adolesc Identity vs Role confusion
- circle: early sign of autism ent - sexual identity
- career
3 y/o Draw circle, curve, cross (organized lines)
Early Intimacy vs Isolation
4 y/o Draw square, rectangle adult - serious relationship
- females mature faster by 2 years
5 y/o Draw triangle, diamond, star
● Feeding
6 y/o Draw all shapes ○ Cereals, Vegetables, Fruits, Meat, Table foods
○ Start solid foods at 6 mos
LANGUAGE DEVELOPMENT ○ Last table food given: egg (allergen)
○ < 6 mos - breastfeeding
At birth Cry - 1st language of the child ○ Breastfeeding is low in iron
- Loud: Normal ○ Determine swallowing reflex before giving the next food in
- High-pitched: increased ICP (hydrocephalus)
CVFMT
- early sign ICP: bulging fontanels -> cry
(headache) ○ Allergic reactions: diarrhea, rashes
- late sign ICP: widening of PP ● Hazards
○ Falling off beds and downstairs
1-2 mos Cry (open mouth) ○ RF aspiration, overdose of meds
○ Suffocation
3 mos Cooing ○ RF vehicular accidents -> infant car seat
Bubbling - playing w/ saliva ● Nursing management
○ Do not leave child unattended - RF falls
4 mos Vowel sounds ○ Keep hazardous objects out of reach
○ Proper dosage computation
5 mos Consonant sounds (gugu, gaga) ○ Use car seat
■ < 3 y/o - rear facing
7 mos Cry (closed mouth) - mmm cry ■ > 3 y/o - front facing

9 mos 2 words TODDLERS

- mama, papa/ dada
● Age: 1-3 y/o
● Ritualistic - routine activities
12 mos 4 words
- Mama + dada + 2 words (depends on enviro) ○ Purpose: sense of security
○ Security objects - blankets
2 y/o 50 words ○ If misplaced -> anxiety -> temper tantrums (head banging) ->
RF injury
3 y/o 100 words ■ d/t not well developed speech -> acting out
■ Tx: (PRIO) safety then ignore
4 y/o 200-300 words ■ Helmet/ headgear/ pillow
● Egocentric - “mine”
SOCIAL DEVELOPMENT ○ self-centered
○ Id - devil: pleasure (INFANT)
Psychosocial theory (Erikson) Ego - human (TODDLER)
Superego - angel: conscience (PRESCHOOL)
Infant Trust vs Mistrust ○ Play: parallel
- to develop: breastfeeding (consistency) ● Negativism
- console w/in 30 mins to X distress ○ “NO”
○ Tx: offer choice to develop sense of autonomy
Toddler Autonomy vs Shame/ doubt ● Tooth brushing
- to develop: provide choices ○ Start: 30 mos (2 ½ y/o)
- Negativism (NO)
■ D/t complete milk teeth
- Play: parallel
■ w/ assistance
Pre- Initiative vs Guilt ● Swallowing toothpaste -> amoebiasis
school - to develop: reward good deeds,appreciate ○ DECIDUOUS TEETH
- sharing ■ Other name: milk, temporary teeth
- Initiative = self-confidence ■ Natal teeth
Play: cooperative ● Deciduous teeth at birth
● d/t increased Ca intake of mother during pregnancy
School Industry vs Inferiority ● Check if loosen or intact
age - develop self-confidence by appreciation ● WOF aspiration if loosened -> extraction
 ■ Epstein pearl ○ Lock all toxic substances -> poisoning
● Sac formation at buccal area of the baby ● Discipline measures
● Not a teeth ○ Consistent
● Cause: increased Ca intake during pregnancy ■ Will bring confusion if inconsistent
● Ca Deposits in the baby ○ Initiated after misbehavior
● Disappears after 3-5 days d/t absorption ○ Planned in advance
■ 1st eruption: 6 MONTHS ○ Oriented to the behavior and not the child
● 2 lower central incisors -> solid food ○ Do it in private
● Pain/ fever caused by inflammation of eruption ○ Non-shame inducing
○ Tx: TSB & Paracetamol for fever, teether (cold) ○ Best punishment: time out
for anesthetic effect (pain) ■ Safe and non-stimulating (face the wall)
● Inc Ca -> inc motility -> Diarrhea ■ 1 min/ yr of age
○ Tx: increased BF and oral fluid ■ Timed (use of timer)
■ 2nd eruption: 7 MONTHS ● Separation anxiety
● 2 upper central incisors
■ 3rd eruption: 9 MONTHS PRESCHOOLER
● 2 upper lateral incisors ● Age: 4-6 y/o
● After 9 mos, diff. nutritional intake -> diff eruption ○ Toddler: exact 3 y/o, PS: 3+ y/o
pattern ● Magical thinking
■ Complete mild teeth: 30 mos -> toothbrushing & first ○ Imaginary friend
dental check up ○ No 1 fear: Body mutilation and castration
● Permanent: 32 teeth (16 up, 16 down) ○ Tx: band aid
● Milk: 20 teeth (10 up, 10 down) ○ X circumcision (best time: school age, 10-12 y/o)
■ Start to loosen to permanent: 6-7 YEARS OLD ○ May lead to exhibitionism if w/ castration
● Delayed loosening -> sungki (crooked) ● Imitative
● Better if early to loosen ○ Role playing
■ PEAR - fruit to promote good oral health if child does not ● Sharing
want to toothbrush (tiny fibers) ○ Play: Cooperative-Associative
● 2nd choice: GREEN MANGO ● Curious
● APPLE: stains teeth, fibers darkens, for asthmatic ptx ○ “Why” - 200-300 questions/ day
(hypoallergenic) ○ Infantile masturbation
● PAPAYA: decreased libido ■ For exploration
● VANILLA: toxic to sperm/ testes -> infertility ■ Divert attention
● VIT C & OYSTER: to increase libido ■ X spanking
○ Soft toothbrush (no toothpaste) ● Conscience develops (initiative vs guilt)
○ Fluoride is harmful when swallowed ● Brain reaches adult size at 5 y/o
○ Decrease sweets and candies (glucose weakens enamel) ● Common fears:
● Toilet training ○ Dark -> proper lighting
○ Start: 18 mos (1 ½ y/o) ○ Being alone esp. at bedtime
■ D/t maturation of sphincters to control urination and ○ Animals (large dogs)
defecation ○ Ghost
○ First: bowel control (anal sphincter maturation) ○ Body mutilation, pain
2nd: daytime bladder control ● Family teaching
Last: nighttime bladder control ○ Night light
○ Failure in toilet training ○ Play out fears on dolls and other toys (therapeutic use of play
■ Too relaxed -> antisocial personality d/o for procedures)
■ Too rigid -> OCD ○ Gradual exposure to the feared object (desensitization)
○ Signs of readiness
■ Can sit and squat SCHOOL AGE
■ Remain dry for 2 hrs - w/ bladder control already ● Age: 7-12 y/o
■ Verbalize desire to void or defecate ● Latency (Freud) - rest period of life
■ Show willingness to please parents ● Decreased growth and development
■ Want soiled diaper to be changed immediately ● Winner and loser
● Food preferences: ○ Play: competitive
○ Prefer to feed self (autonomy) ○ Ball games, board games
○ One food at a time -> no food mixtures (allergy) ● Afraid/ fear of death
○ Use finger when eating ○ Death:
● 18 mos -> FOOD JAGS ■ 1-6 y/o: sleeping (reversible)
○ Picky eater ■ 7-9 y/o: punishment (by boogeyman/grim reaper)
○ One meal only ■ >10 y/o: irreversible- end of life
○ Tx: offer them choices ○ Fear
● Family teaching ■ Infant: stranger anxiety
○ Limit milk to 1L/ day ■ Toddler: separation anxiety
○ Encourage to use utensils ■ Preschool: mutilation
○ Frequent nutritious snacks ■ School age: death
● Teacher ○ S/sx:
○ Significant person: ■ Bulging fontanels
■ Infant: mother ● D/t pressure pushing fontanels upwards
■ Toddler: mother and father (parents) ● Anterior
■ Preschool: family (mother, father, siblings) - role playing ○ Bregma
■ School age: teacher ○ Diamond shape
■ Adolescent: peers ○ Closes 12-18 mos
● Motor development ● Posterior
○ Engagement and interest in sports ○ Lambda
○ Cursive writing at 8 years old (fine motor skills) ○ Triangular shape
● Cognitive abilities ○ Closes 2-3 mos
○ Able to read time ■ High pitched cry (Early sign)
○ Knows months of the year ■ Increased head circumference
○ Collect and sort object ● Bed side: tape measure (N: 33-35 cm)
○ Sense of humor developed @ 10 y/o ■ Early signs by age group
● Language - figurative speech ● Infant: high pitched cry
● Socialization ● Child: irritability, agitation
○ Same sex pairs or groups ● Adult: restlessness
○ Competition ● Geria: confusion
■ Severe headache
ADOLESCENTS ● d/t compression of nerve fiber
● Age: 13-18 y/o ■ Projectile vomiting
○ Freud: up to 21 y/o (psych) ● d/t compression of medulla where chemoreceptor
● Puberty - secondary sex development trigger zone (CTZ) located -> vomiting
○ Secondary sex characteristic ● RF F&E imbalance: metabolic alkalosis
■ Female: ■ HTN, hyperthermia
● Thelarche - breast budding ● Affects hypothalamus that controls BP (hypertension)
● Adrenarche - pubic hair and temperature (hyperthermia)
○ Armpit before pubic area ■ Bradypnea, bradycardia
● Menarche - first mens ● Affects pons and medulla -> breathing -> bradypnea
● Cause: increased estrogen (hormones) -> bradycardia
■ Male ■ Diplopia (double vision)
● Adrenarche from base of penis (pattern: front to ● d/t increased IOP -> vision blurring -> blindness
back) ■ Pupillary changes
● Body image/ changes: fear of adolescents ● Anisocoria (uneven pupils) - brain damage
○ Increased sebaceous gland -> acne ● Constricted pupils - narcotic overdose
○ Protect body image ● Dilated pupils - shock
● Early adolescence (10-13 y/o) ● Sunset eyes - hydrocephalus
○ Secondary sexual characteristics ○ D/t brain pressure pushes pupils down
○ Rapid growth ■ Anorexia, nausea, wt loss
○ Sexual: interest greater than activity ■ Seizures
● Middle adolescence (14-16 y/o) ● Increased neuronal firing -> irritation of nerves ->
○ Peak of growth seizures
○ Body shape ● Vomiting -> DHN -> increased temp -> seizures
○ Acne, body odor, menarche, spermarche ○ Management
○ Sexual: ■ Position: semi-fowler’s position
■ Sexual drive ● To drain ICP by gravity
■ Experimentations ■ Coughing and sneezing is avoided
■ Questions of sexual orientations ● Can increase ICP
● Late adolescence (17-20 y/o) ● If will do, open mouth
○ Slower growth ■ Limit fluid (1,200 - 1,500 ml)
○ Consolidation of sexual identity ● Na=H2O
● Increase in fluid = increase pressure
PEDIATRICS ABNORMALS ○ Pharmacotherapy
■ Dependent nursing function
■ Diuretics
NEUROLOGIC DISORDERS ● To decrease fluid and pressure
● INCREASED ICP ● Osmotic diuretic (mostly used)
○ N: 5-15 mmHg ○ Pull pressure (generalized)
○ Cushing’s triad ○ Mannitol
■ Hypertension ● Loop diuretic (supportive only)
■ Bradycardia ○ Loop of Henle (specific)
■ Bradypnea ○ Lasix furosemide
 ■ Decadron ○ WOF pinkish red urine (BEST)
● Dexamethasone - Inform SO about this
● Prevents cerebral edema and decreased LOC ● Benzodiazepines (“pam/ lam”)
● Steroids - GI irritant ● Iminostilbenes - Carbamazepines (Tegretol)
■ Anticonvulsants for seizure ○ For refractory/ recurring seizures
■ Antacids ● Valproic acid
● To prevent GI irritation from decadron ○ Last resort - Hepatotoxic (immature liver)
● Magnesium hydroxide ○ X pregnant -> neural tube defects
○ SE: diarrhea ■ Surgery (3)
● Aluminum hydroxide ● Neurectomy - surgical removal/ resection of cranial
○ SE: constipation nerve involved in seizure
■ Anticoagulants
● Increased pressure causes damage in lining of BV -> ● BACTERIAL MENINGITIS
bleeding -> clotting -> dislodged clotting -> ○ Infection of meninges
thromboembolism ○ Meninges - supports and nourishes brain
● Heparin ○ Dx: lumbar puncture
○ IV, SQ ■ L3-4/ L4-5
○ Check PTT ■ Get 5-10 ml CSF sample for analysis
● Warfarin ■ Position: C/ fetal position, Genu pectoral (knee-chest
○ Oral position)
○ Check PT ■ CSF analysis
■ Opiates and sedatives ● Bacterial meningitis
● Contraindicated to increased ICP ○ Cloudy CSF d/t increased CHON, WBC
● Depressants (decreased VS) ○ CHON - byproduct of bacteria
○ CA: (+) Neisseria Meningitidis
● SEIZURE DISORDER (EPILEPSY) ○ “Never let monkey’s eat bananas”
○ Characterized by contraction and relaxation - Neutrophils
○ Types: - Lymphocytes
■ Grand Mal - Monocytes
● Generalized seizure - Eosinophils
● Tonic clonic - Basophils
○ During seizure ○ CLAN
○ Dyspnea, salivation, urination - Chronic Lymphocytes
○ Position: supine/ flat - Acute Neutrophils
● Post ictal ○ Granulocytes
○ Exhaustion phase - BEN 10k
○ After seizure - Basophils
○ Position: side-lying - Eosinophils
■ Petit Mal - Neutrophils
● Blank/ absence seizure - N: 10, 000
● Blank facial expression ■ S/sx:
● Automatism (repetitive purposeless behavior): lip ● Kernig’s sign
smacking ○ Knee flex -> pain at thigh/ hamstring/ back
■ Jacksonian seizure muscles (+)
● Tonic clonic (one part) -> grand mal (whole body) ● Brudzinki’s sign
■ Psychomotor seizure ○ Batok
● Mental clouding/ intoxication ○ Flex nape -> pain at neck/ back muscles (+)
■ Febrile seizure ● Hallmark: kernig’s and brudzinki’s sign
● Most common: < 5 y/o seizure ● Nuchal rigidity
● >38.5 C temp ● Seizures
● Not fully developed hypothalamus to control temp ● Opisthotonus - arching of the back
■ Status epilepticus ○ Position: Side-lying
● Seizure that lasts for 30 mins (on/ off seizures) ■ Management
● Bronchospasm -> breathing affected ● Antibiotic therapy
● Brain damage d/t cerebral hypoxia
● Emergency ● HEAD TRAUMA
○ Dx: EEG to determine source of seizure episode ○ Concussion
○ Management ■ Jarring of the head d/t forceful contact
■ Initial: Positioning ■ May lead to loss of consciousness
■ Pharmacotherapy (2) ■ Brain damage if severe
● Hydantoins (Phenytoin) ■ Naalog ang utak
○ WOF gingival hyperplasia ○ Contusion
- Soft bristled toothbrush ■ Bruising
- Meticulous oral care ■ Extravasation of blood (bukol)
 ○ Management ■ DOC: Indomethacin to close PDA
■ Safety ○ ATRIAL SEPTAL DEFECT (ASD)
● Wear bike helmets ○ VENTRICULAR SEPTAL DEFECT (VSD)
● Seat belts ■ S/sx:
● Safe driving ● Fatigue
● Infant car seat ● Poor feeding -> poor weight
○ < 3 y/o - rear facing ● Dyspnea on exertion
○ > 3 y/o - front facing booster seat ● Failure to thrive
■ Assess for cerebral functioning ○ Delayed developmental milestone
● GCS ○ d/t decreased oxygenation and tissue perfusion
● PERRLA (pupil, equally round and reactive to light ■ Management
and accommodation) ● Dacron patch
○ Unequal -> anisocoria (brian damage) ○ Tissue dacron patch
■ Assess for cervical injury - Decreased rejection rate
● Neck - Easily destroyed
● (+) injury -> immobilize patient - More favorable to use, just prevent to be
○ X sudden movements to prevent further easily destroyed
damage ○ Plastic dacron patch
● (-) injury -> HOB elevated to decreased ICP by - Increased rejection rate
gravity - Durable
■ COARCTATION OF AORTA
CARDIOVASCULAR DISORDERS ● Narrowing of descending aorta
● Layers of the heart ● Causes increased pressure -> decreased blood
○ Endocardium - inner layer output
○ Myocardium - muscle layer ● Different VS in UE and LE
■ Responsible for pumping mechanism of heart ○ UE: Inc. BP, bounding pulse
○ Pericardium - outermost layer ○ LE: dec. BP, weal/ absent pulse
■ Visceral - inner part ● Rib notching
● Pericardial space ○ The stronger, the more narrow the aorta is
○ Contains pericardial fluid ● Surgery: Balloon angioplasty w/ coronary stenting
○ N pericardial fluid: < 20 ml ○ Stent - form of scaffold made of mesh for
○ Pericardial effusion: > 20 ml support
○ Cardiac tamponade: > 50 ml ○ Prevents the aorta from going back to its form
■ Parietal - outer part
● Chambers of the heart ● CYANOTIC
○ Flow of blood’s heart: one way ○ 2 or more problems in the heart -> mixing of blood
○ Two way flow: regurgitation ○ Unoxygenated > oxygenated
● Blood vessels
○ Arteries ○ TETRALOGY OF FALLOT
■ Contains oxygenated blood ■ Pulmonary artery valve stenosis, RV hypertrophy,
■ Spurting/ Pressurized Overriding of aorta, VSD
■ From the heart ■ Cause: teratogenic drugs
○ Vein ■ What is the primary problem?
■ Unoxygenated blood ● Pulmonary Artery valve stenosis
■ Oozing ■ What is the compensatory mechanism?
■ To the heart ● RV hypertrophy
■ What allows mixing of blood?
● ACYANOTIC ● Overriding of aorta
○ 1 problem in the heart -> mixing of blood ■ What keeps the patients alive?
○ Oxygenated > unoxygenated ● VSD - relieves pressure in RV
■ S/sx:
○ PATENT DUCTUS ARTERIOSUS (PDA) ● Cyanosis - unoxygenated> oxygenated
■ PDA did not close/ remained open for days ● Squatting
■ Must be closed once the lungs started working (right after ○ To decreased venous return -> release heart
birth) ○ To conserve oxygen to the upper body area
■ Connects PA and aorta (vital organs)
■ S/sx: ● Tet spells
● Machinery-like murmur (Pathognomic) ○ Group of s/sx that depicts decreased
● Heart failure if not tx oxygenation
● Poor feeding d/t decreased oxygenation ○ Irritability, pallor, blackouts, convulsions
● Easy fatigability ● Cardiomegaly
● Poor weight gain ○ Due to overworked heart
○ 6 months 2x birth weight ● Clubbing
○ 1 yr 3x birth weight ○ Spoon shaped fingernails
● Irritability d/t cerebral hypoxia ○ Indicates chronic hypoxia
 ○ Schamroth window test ○ Antibiotic therapy for 10 yrs
● Pansystolic murmur ● If w/ allergy: Erythromycin, Clindamycin as
■ Dx: 2D echo: boot-shaped heart substitutes
■ Management ■ Salicylates for pain and swelling
● Allow child to squat to decreased venous return -> ■ Corticosteroids to relieve carditis
relaxation of heart
● Surgery ● HEART FAILURE
○ Palliative (Blalock Taussig shunt) ○ R SIDED HF
- Relieves s/sx ■ Backflow
- Anastomosis of pulmonary artery and aorta ■ Systemic S/sx:
(subclavian artery) for reshunting/ rerouting ● Peripheral edema
of blood ● Wt gain d/t fluid retention
- Used for maturation of heart -> brock’s ● Distended neck veins
procedure in future ● Hepatomegaly
○ Curative (Brocks procedure) ● Portal HTN - increase pressure in central part of
- Intracardiac surgery body
- 2 operations involved: ● Ascites
- Balloon angioplasty for PA valve ● Body weakness
stenosis -> X RV hypertrophy ● Anorexia
- Insertion of dacron patch to close ● Nausea
VSD -> X overriding aorta ○ L SIDED HF
■ Pulmonary S/sx:
○ TRANSPOSITION OF THE GREAT ARTERIES (TOGA) ● Crackles
■ RV connected to aorta ● Pulmonary edema
■ LV to PA ● Dyspnea
■ What keeps patients alive? ● Orthopnea
● PDA ● Cough
■ s/sx: ● Tachycardia (early sign)
● Severe respiratory depression ○ Dx:
● Failure to thrive ■ CXR: cardiomegaly
● Easy fatigability ■ 2D echo: hypokinetic heart/ bradycardia (LATE)
● (-) murmur d/t switching of aorta and PA ■ Pulse oximetry: dec O2 sat (90-100 normal)
■ Management ■ PCWP (pulmonary capillary wedge pressure)
● Prostaglandin E to keep PDA open ● Represents LSHF
● Surgery: arterial switch ■ CVP (central venous pressure)
○ Should be done on first week of life ● Represents RSHF
○ After first wk of life and X tx -> death ○ Management
■ Foler’s (HOB elevated) position to maximize oxygenation
● RHEUMATIC HEART FEVER ■ Administer high O2 using venturi (accurate)
○ Cause: GABHSI ■ Inotropic
■ Also causes sore throat & Acute Glomerulonephritis ● Strengthens contraction of heart to increase cardiac
○ Jones criteria output
■ 2 major + Hx / ■ Lanoxin (digoxin)
■ 1 major + 2 minor + Hx ● (+) inotropic - increase heart contraction
■ MAJOR (SPECC) ● (-) chronotropic - decrease PR (bradycardia)
● SQ nodules on knees, knuckles, elbows ○ Assess PR before giving
● Polyarthritis (inflammation of joints w/ swelling) ● Monitor for Digoxin toxicity
● Erythema marginatum on trunk ○ NAVDA
● Carditis (heart inflammation d/t GABSHI) ○ Nausea, Anorexia, Visual disturbances,
● Chorea (St. Vitus dance - involuntary movements of Diarrhea, Abdominal cramps
fingers and arms) ○ Tx: stop digoxin, administer digibind (antidote;
■ MINOR (FEAAC) digoxin immune fab)
● Low grade fever ● Given after meals to X GI disturbance
● ESR (erythrocyte sedimentation rate) - RBCs dying ● Give full glass of water
d/t infection ■ UO and intake monitoring
● Arthralgia (painful joints w/o swelling) ■ Record daily weight - same time, clothes, weighing scale,
● ASO titer (Antistreptolysin O titer) - not RHF specific patient
(also in sore throat and AGN) ■ Administer diuretics - to decrease fluid and pressure
● C reactive protein - released in inflammatory
response ● KAWASAKI DISEASE
○ Management ○ Lymph node syndrome
■ DOC: Penicillin ■ Decreased immune system
● Broad spectrum ○ Multi Systemic vasculitis
● Finish duration for 5-10 days ■ Swelling BV
● Exacerbation and remission ○ S/sx:
 ■ High spiking fever ■ Avoid spicy foods, tobacco, alcohol, caffeine-containing
■ Strawberry red tongue (hallmark) products
■ Photophobia - extreme sensitivity to light ■ Meds
● Dark colored glasses ● Antacids
● Large brim hats (sun visors) ● H2 blockers “tidine”
■ Polymorphous rashes - rashes w/ diff shapes ● Proton pump inhibitors “prazole”
● From trunk to extremities ■ HOB elevated 6-8 inches during sleep
■ Palmar desquamation - d/t vasoconstriction -> death of
skin cells ● PYLORIC STENOSIS
○ Dx: Elevated ESR (increased amount of RBCs dying) ○ Problem: Narrowing of pyloric sphincter
○ Management ○ Complication: obstruction
■ Immunoglobulin as it is autoimmune ○ S/sx:
■ Aspirin as ordered ■ Projectile vomiting w/o bile d/t buildup of pressure
● < 8 y/o -> RF Reye’s syndrome ■ DHN
○ (+) flu/ chicken pox + aspirin ■ Metabolic alkalosis
■ Clear liquid diet - to check bleeding in stool ● Bile in the lower intestines makes intestines alkaline
■ CPR - RF coronary heart disease -> cardiac arrest ■ Olive-shaped mass (PATHOGNOMONIC)
● Location: RUQ
GASTROINTESTINAL SYSTEM ● Normal location of stomach is left but when
● CLEFT LIP AND CLEFT PALATE distended, it shifts to the right
○ Heredity, maternal smoking (CO affecting development) ■ Appetite: increased d/t obstruction
○ Both w/ risk for aspiration, URTI ● Duodenum - primary digestive organ
○ Cause: warfarin ● If food does not get to the duodenum, the nutrients
○ Cleft lip - males won't be absorbed, body will be starved
■ Management ■ Malnutrition
● Large nipple - breastfed but transferred to bottle with ○ Dx: Barium swallow to determine GIT obstruction
bigger nipple ■ X-ray to confirm obstruction
● Cheiloplasty ● (+) String sign - confirmatory sign
○ Rule of 10 ■ Insertion of NGT to take in barium
- 10 wks ● Measure: tip of the nose to xiphoid
- 10 lbs ○ Management
- 10,000 WBC ■ Monitor feeding patterns, assess vomitus
- 10 g/dL Hgb ■ PRIO: DHN/ F&E
○ Post-op: Unaffected side ● Sunken/ flat fontanels (mild DHN)
○ Mitten restraint ○ Bulging fontanel normal in crying infants
○ Cleft palate - female ● Skin turgor @ abdomen
■ W/ speech defect ○ Sternum/ forehead for geriatrics
■ Management ■ WOF chalk-like stool and constipation
● Cup, medicine dropper to decrease RF aspiration ■ Increase OFI to hasten digestion
● Palatoplasty ■ Prevent aspiration by feeding slowly
○ Rule: not too early, not too late ■ Burp frequently to prevent gas formation and bloating
- Too early - may reopen again ■ High-fowler’s position to aid in gastric emptying time
- Too late - speech problem ■ Surgery: pyloromyotomy
- 18-24 mos ● Fredet-Ramstedt procedure
○ Post-op: Prone w/ head to side ● Incision that splits muscle layer causing obstruction
● Post-op
● GASTROESOPHAGEAL REFLUX DISEASE (CHALASIA) ○ NGT for pressure decompression
○ Cause: incompetent/ weak lower esophageal sphincter (LES)/ ○ Small frequent feeding if w/ bowel movement
Cardiac sphincter already
○ s/sx: ○ Pacifier to promote oral gratification
■ Forceful vomiting
■ Heartburn ● CELIAC SPRUE/ CELIAC DISEASE
■ Bitter taste in mouth ○ Gluten sensitive enteropathy
■ Dysphagia ○ Cause: malabsorption of gluten
■ Odynophagia (painful swallowing) ○ S/sx:
■ Hoarseness d/t laryngeal damage ■ Acute diarrhea
○ Dx: ■ steatorrhea/ foul fatty feces
■ Barium swallow ■ Anorexia
● Barium can stay upto 2 days in body ■ Vomiting
○ If more than 2 days, can cause obstruction ■ Severe abdominal distension
○ Increase OFI ■ Body wasting (Cachexia)
○ Laxative ■ Retarded growth d/t gluten being a staple food in the body
○ Management ■ Failure to thrive
■ Low fat, high fiber diet
■ SFF
 ○ Dx: ● Descending colostomy
■ Bowel biopsy: ○ w/ odor
● Flat mucosal surface with hyperplastic villous atrophy ○ solid/ formed
(villi to absorb did not develop) ○ Irrigate to prevent obstruction
● Confirmatory ○ Not need continuous appliance of bag
■ IgG and IgA elevation (inborn) ● Assess characteristics of stoma
○ Management ○ Color: pinkish
■ X gluten containing products - brick-red/ bluish -> notify
● Barley ○ Elevated
● Rye ○ Moist
● Oat - Dry -> notify
● Wheat ● Avoid foods that can obstruct stoma: gas-forming
■ Allow meat, eggs, milk products, cream, cheese, all foods (peanuts)
vegetables and fruits, rice, corn, corn flakes ● Foods to allow
■ Birthday party - bring own cake ○ Spinach
● Almost all cake are with gluten ○ Parsely
■ Gluten free diet for life ○ Yogurt
○ Broccoli
● HIRSCHSPRUNG'S DISEASE ● Sport: swimming
○ Congenital aganglionic megacolon ○ Non-contact sport that enhances abdominal
○ Cause: aganglion (inborn absence of ganglion) muscles
■ Cells/ nerve responsible for peristalsis ● Stool softener after surgery as ordered
■ Aganglion - absence of peristalsis
■ Affected large intestine will be constricted ● INTUSSUSCEPTION
○ Complication: failure to pass meconium for the 1st 24-48 hours ○ Telescoping/ invagination of the small intestines
d/t obstruction ○ Complication: obstruction
■ Along w/ imperforate anus ○ One part of the colon enters the other part
○ Dx: ○ S/sx:
■ Barium enema w/ x-ray - megacolon ■ Colicky pain - gas formed pain
● To determine obstruction ■ Sausage shaped mass (PATHOGNOMONIC)
● Constriction at descending colon ■ Bile-stained/tinged vomitus
● (+) pig’s tail sign ■ Metabolic alkalosis
■ Rectal biopsy ■ DHN
● Determines absence of ganglion cells ■ Currant jelly-like stool (PATHOGNOMONIC)
● Confirmatory test ● Bloody mucoid stool d/t intestinal bleeding
○ S/sx: ● WOF peritonitis (emergency)
■ Ribbon like stool/ pencil-like/ pellet-like stool ○ Dx:
(PATHOGNOMONIC) ■ Barium enema w/ x-ray
■ Fecaloid vomitus - vomit w/ fecal particles ● (+) Staircase/ spring sign
■ Halitosis ■ GUIAC’s test/ FOBT
■ DHN ● Dark colored food -> false + result
■ Metabolic alkalosis ● Vit C foods -> false - result
■ Delayed meconium (normal: <24 H) ○ Management
○ Management ■ Auscultate bowel sounds
■ Surgery: Swenson pull through with temporary colostomy ■ Assess for abdominal distension
● Resection and end-to-end anastomosis ■ PRIO: DHN
● If dinugtong kaagad and (-) colostomy -> gangrene ■ Air enema
formation ● Non-invasive
○ Temporary colostomy is needed to promote ● Rectal tube inserted and connected to asepto syringe
healing and X infection to pump air (300-500 ml air) to expand intestines and
● If w/o inflammation both parts -> will be placed X telescoping
together already ■ Swenson pull through (surgery)
● Recovery time: 1-2 mos until 6 mos ● Invasive for bleeding intestines, air enema already
■ Colostomy care not effective
● Habang lumalapit sa pwet bumabaho ● Resection and anastomosis of intestines
Habang lumalapit sa pwet tumitigas ■ NGT insertion (post-op)
● Ascending colostomy ● Functions
○ Liquid ○ Feeding
○ w/o odor ○ Irrigation
○ X irrigation ○ Decompression of abdominal distension
○ Needs continuous appliance of bag ○ Medications
● Transverse colostomy ■ Increase OFI
○ Slight odor ■ Pacifier to promote oral gratification
○ Semi-formed
RESPIRATORY DISEASES METABOLIC DISEASES
● CROUP ● PHENYLKETONURIA
○ Laryngotracheobronchitis ○ RA 9288 - Newborn Screening Act
○ Narrowing of airway d/t viral inflammation ○ Phenylalanine - byproduct of protein metabolism
○ s/sx: ■ Should be converted to amino acid to be excreted
■ Barking seal like cough (hallmark) ■ In PKU, phenylalanine is not converted to amino acid and
■ Inspiratory stridor instead built up in the blood
■ Dyspnea ■ CNS (brain) - primary organ affected
■ Cyanosis ● Phenylalanine is neurotoxic
■ No fever/ low grade fever ● Leads to mental retardation (IQ <70)
○ Management ■ Melanin affected
■ Increase humidity in the air ● For pigmentation of the skin
● By using cool mist ● Decreased
■ Inhale cool night air/ warm bathroom air for ○ S/sx:
bronchodilation ■ Blond hair, blue eyes, white skin
■ Tracheostomy set at bedside ● Albino has normal IQ
■ Meds ■ (+) musty odor urine (PATHOGNOMONIC)
● Antivirals ○ Dx:
● Prophylactic antibiotics ■ Guthrie blood test
● Bronchodilators ● Confirmatory test for PKU
○ SE: tachycardia ● Check phenylalanine in blood (<8 mg/dL)
○ Management
● CYSTIC FIBROSIS ■ X breastfeeding -> MR
○ Blockage of exocrine glands by mucus ● Lofenalac - formula milk
○ Organs affected: ● Close monitoring (alternate feeding of am and BF)
■ Pancreas -> pancreatitis ■ X protein (meat, dairy products, pork, beef) to X MR
■ Intestines -> meconium ileus ■ Can be given fruits and vegetables
■ Lungs -> DOB
■ Sweat glands -> salty sweat ● GALACTOSEMIA
○ Dx: Sweat chloride test ○ Galactose -> glucose
■ Increased chloride levels in the sweat ○ In galactosemia, galactose can’t be converted to glucose
■ Salty sweat (NaCl) ○ Increased galactose in the blood
○ Management ○ Affected organs:
■ Chest physiotherapy (CPT) ■ CNS (brain) -> MR, seizures
● Percussion, vibration, postural drainage ■ Eyes -> congenital cataract (PATHOGNOMONIC)
● Before meals on empty stomach ■ Liver -> jaundice
■ Pancreatic enzymes with meals ■ Kidneys -> acute renal failure
● Never double dosages -> autodigestion of pancreas ● Cause of death
● Amylase - CHO ● Early sign: oliguria
● Lipase - fats ○ Dx: Beutler test (enzyme test)
● Trypsin - CHON ○ Management
■ X breastmilk
● ASTHMA ● Nutramigen
○ Most common
○ Reversible
○ Cause: allergens (substances that causes allergic reactions)
■ Hyperresponsiveness -> bronchospasms
■ Common allergens: pollens, molds, dust, weeds, pet
danders, eggs, seafoods
○ Exacerbation caused by air pollutants, cold-heat weather
changes, strong odors, exercise, extreme emotions
○ s/sx:
■ Wheezes - expiratory
● (-) wheezes -> complete obstruction of airway
(STATUS ASTHMATICUS)
○ Management
■ Bronchodilators
■ Corticosteroids
■ O2 therapy
■ Avoid allergens
● GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY
(G6PD DEFICIENCY)
○ Other name: favism
○ Decreased G6P enzyme w/c protects the RBC
■ RBC lifespan: 120 days since protected by G6P enzyme
■ Hemolysis (X RBC) d/t decreased G6P -> increased
bilirubin
■ Bilirubin affects brain -> MR
○ Causes:
■ Fava/ baguio beans in pregnancy
■ exposure to mothballs
■ Heparin
○ s/sx:
■ Anemia d/t RBC destruction
■ Jaundice
■ Kernicterus
■ Mental retardation
■ Splenomegaly (metabolizes destroyed RBC)
○ Dx: Beutler test (enzyme test) - confirms GG (G6PD,
galactosemia)
○ Management:
■ Can continue breastfeeding
■ X soya (soya beans) - adobo w/ soy sauce, soya milk]
■ X blue food - allergy
■ X preservatives, artificial sugar - soft drinks
■ X legumes, beans