PEDIATRIC NURSING ABNORMAL MAY 31  Avoid cough trigger (smoking, dust)

 Nutrition = small frequent feeding (vomits after

RESPIRATORY DISORDER
cough)
Pertussis – causative agent; Bordetella pertussis-  Oxygenation
bacteria
Watch Out For: Ayaw mangyare
(MOT- direct and indirect contact) P, E, D, A, S
Incubation period; 5 – 21 days --symptoms  Pneumonia
Most communicable: Catarrhal Stage  Emphysema/ Epistasis
 Dehydration
Immunity:
 Alkalosis, Atelectasis (collapse air sac)
 -Lasting Immunity: katawan na ang gagawa ng  Seizure-Subarachnoid bleeding
anti body; natural immunity-
PHARYNGITIS – Sore throat 5-15 years old
 Active Artificial- vaccination: DTaP vax
 -Vaccination period: 2 months, 4 months, CAUSATIVE AGENT - STREPTOCOCCAL
6months booters for 12-15 months GROUP A BETAHEMOLYTICS (GABHS)
4-6 years old before school More severe, more sudden
11-12 years old/ every 10 years old
THROAT
Passive artificial Immunity – Serum
immunoglobulin para di passive ang symptoms  Temperature is high >38 degrees.
 Headache
3 Stages of Pertussis
 Rash: Sandpaper like” scarlatiniform rash
Catarrhal Stages  Optics: Redness
1 mild rhinitis / common cold  Appears Ill
1-2 weeks  Throat is inflamed.
Paroxysmal Stage DIAGNOSTIC TEST
paroxysmal cough (tunog na whooping cough *high
pitch)  Rapid antigen / Throat culture
5-10 rapid short cough followed by rapid DRUG OF CHOICE
inspiration
2-6 weeks Penicillin cepalistirin
if injected – shorter stages. Watch out for/WOF.
Convalescence Stage  Acute rheumatic fever (ARF) *inflamed heart.
gradual cessation of coughing
 Acute glomerulonephritis. *Inflamed kidney

Management
<3 months = admit 48hrs
Macrolide – Azithromycin (droplet precaution for 5
days)
Symptoms (kapag viral)
 Suction PRN
Mild, enlarge lymph nodes.
 Proper Hydration no diagnosis
 Treatment: Defects

 Oral analgesic Diseases (infection, Kawasaki)

 Acetaminophen / ibuprofen
Disorder (metabolic disorder)
 Gargle with warm water.
Dysfunction (due to surgery)
RETROPHARNGEAL ABSCESS
(pus formation at the back of the throat) Right Side 5Es Left Side – LUNGS
RRR
Impacts airway – life emergency Edema: Lung symptoms:
Extremities Use accessory muscle
Symptoms: Eyes Nasal Flaring
Fever, refuse to eat, drooling, snoring, swelling in one Enlarged Liver Grunting
side of the neck. Engorged Jugular vein Shortness of breath
Rales: Crackles(moisture)
Diagnostic: Radiograph: Retraction of chest
do not insert tongue blade RR increase: tachypnea
do not initiate gag reflex
Treatment: Management

IV antibiotic Triad: DAB

hydration / respiratory status Digoxin (oral) No Food when administer. – baka isuka
Tonsillectomy – surgical treatment (thru laser or 1hr before meal, 2hrs after feeding.
ligation *no suture – but cause bleeding led to if vomited, we do not repeat dose
hemorrhage) if vomited the next dose again, report!

Tonsillectomy + inotropic- increase contractility of the heart

- Chronotropic- decrease bradycardia
Risk AHA Watch Avoid: Allowed:
CARS Treatment range: narrow madalaling mapuno kaya
out for: PIE
SSS! bantayan
Aspiration Sever pain. Carbonated Popsicle Toxicity: Dizziness, Diarrhea, Decrease PR,
Hemorrhage Swallowing Acidic Ice Chips headache, Nausea/vomiting.
frequently
Anesthesia Signs of Red Foods Experience: Ace- Inhibitors / ARBs (angiotensin receptor blockers)
bleeding mild pain
(1week) -Baba ang Bp, watch for low bp
Sport:
competitive Beta Blockers

Congenital Heart Defects (CHD)

CARDIOVASCULAR DISEASE
Cyanotic Heart Disease (bluish discoloration * lack
Inability of the heart to pump/supply adequate
of oxygenation) * hypoxemia
oxygenated blood thru the body
Increase pressure to the left!
Cause. DDDD
Right > Left blood flow.
 Left to oxygenated blood. PDS management
Acyanotic heart disease Bukas because of Prostaglandin – pag hindi nag
sara bibigyan ng prostalgladin – Indomenthacin –
Left > Right > Lungs.
inhibitor*pampababa
Assessment:
Diuretics
 Auscultation - heart always use diaphragm first Surgery - cardiac cath lab
then repeat and use bell
Atrial Septal Defect (ASD) Acyanotic
Patent DUCTUS Arteriosus (PDA)
Right atrium and Left atrium are connected
Di nag close ang malalaking arteries
Septum does not close.
Open-Duktong-Arteries
Assessment:
Major Arteries
ASD
Biggest – Aorta from lungs (oxygenated)
 Asymptomatic, activity intolerance
Big – Pulmonary Artery to heart (unoxygenated)  Systolic murmur
 Difficulty of breathing, feeing, gaining
weight.

Diagnostic: Echocardiogram – structure of heart

Management: DDD

 Diuretics (decrease pulmonary congestion)

 Device place temporary in septal defect
 Defect Closure using surgery. (Median
sternotomy)

Ang PET Mo Ventricle Septum Defect (VSD) Acyanotic

Aortic * Most common Congenital defect in pediatric
Pulmonary
Erb * Closes spontaneously in 2years
Tricuspid > Mitral
PDS - Assessment Assessment: HHTT
Pulmonary Congestion - rales or crackles ang
 Heart Failure symptoms
maririning -
 Harsh/ Holosystolic murmur
Difficulty of breathing, feeding
 Tachypnea – increase respiratory rate.
Systolic Murmur – malakas na pressure sa puso
 Thriving failure (FTT) Failure to try
2nd ics Left upper sternal border
Diagnosis:
Echocardiogram WOF: Apnea, Low BP in 1-2hrs of infusion
Management: NR: Newborn on room air
ensure spontaneous breathing
 Diuretics
ventilator if need initiate if not breathing.
 Device place- Dacron patch
 Calory increase. 2. Enlarge Atrium - balloon atrial septostomy
> ICU until ready for surgery within 14 days
Atrioventricular Septal Defect (ADSD)
* Most common defect in trisomy 21 ( down 3. Corrective surgery – Atrial Switch – Jatene
syndrome) Procedure

Assessment: Tetralogy of Fallot

 Heart failure 4 components

Diagnosis: 1. right ventricular outflow tract obstruction

(Stenosis or kumakapal)
 Echocardiogram
2. Overriding of aorta in ventricle
Management: ABCD
3. VSD
 ACE inhibitors
4. RV Hypertrophy (kakapal)
 Band (pulmonary artery)
 Closure
 Digoxin/ diuretics

Transposition of the Great Arteries (ToGA)
Cyanotic upon delivery
reversal of two artery
*2nd most congenital heart defect
Assessment:
Systolic murmur- turbulence heart flow
Hyper cyanotic spell “Tet Spell” – Knee Chest to
kink increase syntenic vascular resistance if di kaya
goes to emergency room while traveling to ER
continue to knee chest at itodo and oxygen.

Napalitan nag position nung mga arteries (aorta, management

Pulmonary Artery)
Hindi oxygenated and napupunta sa aorta kaya di
rin sa katawan
Noted immediately after birth.
Management:
1. Pampabukas ng ductus arteriosus para ma mix
ang blood (Prostaglandin) PGE1 – IV infusion –
- drugs: Alpha adrenergic agonist AAA
(phenylephrine – activate sympathetic nervous
system) fight or flight resistance > vasoconstrictor
- Repair during 3-6 months of age
Cyanotic, distress, irritable
-seizure > death
Coarctation of Aorta (CoAo)
obstruction, narrowing.  Sub-Acute phase (2-3 weeks)
 Edema, erythema in hands and feet peeling.
*More on Male than females
 Lips, tongue = strawberry tongue
*Increase blood pressure on right arm  Rashes = trunk/body > extremity
 Red eyes
*Unequal bp and pulse on upper and lower
extremities (>10mmHg difference) Management:
Assessment: RUM  Serum: IV immunoglobulin – immune
system wag masyado mag react with 7 -10
 Right Arm has High blood pressure.
days
 Unequal Bp and Pulse rate on lower and
 High doses of aspirin – anti-inflammatory/
upper extremities
anti platelet para di mag clog
 More on males
DELAY VACCINE! – IT DOESN’T AFFECT
Management:

 Balloon / Tent angioplasty.

 Incision on left thoracotomy
 Permanent surgery (resection of the narrow
tissue connect end to end anastomosis – cut
narrow area dugtong sa cut area Rheumatic Fever – inflammation
inflamed joints, blood vessels, brain, heart
Auto immune

Kawasaki Disease mucocutaneous lymph node) *disadvantaged/ poor

syndrome (inflamed blood vessels; artery) Age: 6-15 years

WOF: Causative agents: GABHS

 Coronary Aneurysm 10 days after pharyngitis (sore throat)

 Thrombus formation > embolism Diagnostic test: No specific
 Myocardial Infarction
2 major symptoms if only 1 it should have 2 minor
Etiology: unknown / BELIVED autoimmune symptoms.
Age: <5 years old Major symptoms: JONES
Gender: Male Joints pain – arthritis
Race: Asian/ Pacific Island O: Carditis (inflamed) *most serious symptoms
Diagnosis: Nodules (subcutaneous)
Exclusion of Diagnosis no specific diagnostic test Erythema marginatum (trunk rashes): assess on
virtually definitive sign. *Not all have this
Assessment: Inflmmation all over the body
Sydenham Chorea: Sudden movement, dysfunction
 Acute phase (1 week)
speech, poor hand control
 Fever, > 39 degrees, 5 days or more *
IBUPROFEN LANG EFFECTIVE Minor symptoms: TAPE
  Temperature, >38 degrees feeding
 Oral rehydration
 Anti streptolysin titer high solution
 PR interval prolonged  Anti-emetic
 ESR, CRP High  Pedialyte
 IV fluid - PNSS
Management: (green) or D5NS
(yellow)
Breast feeding – every
 IM/ OR – Penicillin drug of choice for 30mins x 10mins duration
GABHS feeding.
 NSAID/ Steroid Antibiotic – bacteria

 Phenobarbital: chore (diazepam)

 Monitor Valve damage.

PYLORIC STENOSIS (Sphincter)

Stenosis is narrowing.
GASTROINTESTINAL DISORDERS
Hypertrophy
Acute Gastroenteritis (AGE) inflammation of the
stomach – intestine due to infection Hyperplasia – extra tissue

 Infection due to viral infection (75% - 90%)

 Due to Disease

DANGERS:
Fluid and electrolytes imbalances because of
vomiting and diarrhea
Dangerous to infants because they have more
fluids in the body.
Alkalosis - vomiting loose hydrochloric.
Acidosis – lose alkaline due to diarrhea.
Assessment: “STENOSIS”
Vomiting Diarrhea
Signs of dehydration – di nakakrating sa small
Time: Unrelated to Acute – infection:
feeding protozoa, virus, intestine
bacterial Tetany – muscle and reflex calcium low
Force: w/ force Chronic - disease
Character: sour smell Assessment: FES No bile in vomits kasi di nakakrating yung bile.
Distress: crying because of Dehydration
pain of fear Olive sized lump – palpate pyloric valve
 Fontanelle -
Duration: continuous w/
stomach empty (dry sunken
Sour – smelling vomits.
retching)  Eyes - sunken
Amount: full stomach  Skin turgor (2-3 Immediately post feeding vomits.
content sec): poor
Management: SOAPI Strong/forceful vomiting 3-4 feet (projectile)
*abdomen
 Small frequent
Diagnosis: Surgical Emergency

 Ultrasound  Reduction of intussusception

 Endoscopy  Water – soluble / barium enema
 Air installation (pneumatic insufflation) para
Management:
mabawasan ang invagination
 NPO w/ pacifier kasi gusto mag suck
 IV Fluid PNSS and D5NS
 IV: calcium, potassium (dangerous to heart –
incorporate *ensure that the child has
voided or ihi) tignan ang diaper
 Surgery- Phylorotomy – opening of muscle Hirschsprung Disease “megacolon, Aganglionic,
of pylorus. ribbon like stools”

Post op: infection kasi malpait sa diapher

always change diaper.
INTUSSUCEPTION – INVAGINATION
Portion of intestine into another (telescoping)
*Most common in distal illume and proximal colon

Chronic Constipation
Assessment:

 6-12 months of age – undernourished

6 moths – 2 years
 No bowel movement, >1 x week
Idiopathic> lead point
Diagnostic Test
Assessment: DDD – RR
 Rectal Exam: no stool on the finger of the
 Distended abdomen – malaki examiner
 Draw up legs - sa sobrang sakit namimilipit  Ultrasound/ Barium Enema (with caution)
(severe pain)
Confirmation:
 Disappears (happy)
 Reappears  Biopsy
 RED CURRANT JELLY STOOL – frank/
Management:
occult stool nakatago sa stool
 Surgery
Management