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                            PEDIATRIC NURSING
I. Growth & Development
	*Stages Of Cognitive Development*
		B. Preoperational Thought---- 2-7 y/o
		C. Concrete Operational Thought------ 7-12 years
			*Stages of Moral Development*
2. Toddler:
a. Play: Parallel play- 2 toddlers playing separately
	4. School Age:
Signs of Increased ICP
	3. Control of Body Temperature : Temp Regulation
4. Establish Adequate Nutritional Intake
A. Important Considerations:
1. if client is new born, cover areas not being examined to prevent hypothermia
Congenital Heart Diseases:
		d. To Diagnose RHD uses the Jones Criteria
		*Jones Criteria*
	Fibrine Hyaline : Sx----definite with in 1st 4 hrs. of life ---d/t lack of surfactant
5. Senses
	How? School age : Pull pinna up & down
Document Text Contents
Page 1


I. Growth & Development

*Growth - Increase in physical size of a structure or whole.
- Quantitative change.

Two parameters of Growth

1. Weight- Most sensitive measure of growth, especially low birth rate.
6 months-----BW doubles
12 months----BW triples
2-2 ½ yrs-----BW quadrupled

2. Height - Increase by 1”/mo during 1st 6 months, 7-12 months by 1 ½ inch.
- Average increase in height - 1st year = 50%
Stoppage of ht coincide with eruption of wisdom tooth.

*Development - Increase skills or capability to function
- Qualitative

How to measure development:
1. Observe child doing specific task.
2. Role description of child’s progress
3. DDST- Denver development screening test except mental, its I.Q. Test

MMDST (Phil) Metro Manila Developmental Screening Test.

4 Main Rated Categories of DDST
1. Language communication
2. Personal social-interaction
3. Fine motor adapting- prehensile ability to use hand movement
4. Gross motor skills- large body movement

*Maturation- same with development “readiness”

*Cognitive Development –ability to learn and understand from experience, to acquire and retain knowledge, to
respond to a new situation and to solve problems. *Learning---change of behavior

IQ Test- test to determine cognitive development * Average IQ – 90-100
Formula: Mental age x 100 = IQ * Gifted child- > 130 IQ

Chronological age

II. Basic Divisions of Life

1. Prenatal stage from conception- birth

2. Period of Infancy
a. Neonate- 1 st 28 days or 1st 4 weeks of life
b. Formal infancy- 29 day – 1 year

3. Early Childhood
a. Toddler – 1-3 yrs
b. Pre school 4-6 years

4. Middle Childhood
a. School age- 7 – 12 yrs

5. Late Childhood
a. Pre adolescent 11 – 13 yrs
b. Adolescent 12 - 18 – 21

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b.) Epistaxis
c.) Blood in urine & emesis

Signs of Anemia :
a.) Pallor , body malaise , constipation

2. From invasion of body organ:
a. Hepatosplenomegaly
b. Abdominal pain

c. CNS affectation & increase ICP
Dx Tests:

1. PBS- peripheral blood smear – determine immature WBC
2. CBC – determine anemia, leukocytosis, thrombocytopenia neutropenia

>done weekly during maintenance phase of therapy
3. Lumbar puncture (LP) – determine CNS involvement. Before LP, Fetal position

Best: Avoid flexion of neck – will cause a/w obstruction.“C” position or shrimp.
4. Bone marrow aspiration – determine blast cells or immature WBC

> *Common site for BMA = Iliac crest
> Post BMA s/effect – bleeding apply pressure.
Put pt on affected side to prevent hemorrhage

5. Bone scan – determine bone involvement
6. CT scan – determine organ involvement, CNS affectation

Therapeutic Mgt:

1. Surgery
2. Irradiation
3. Chemotherapy

Focus Nsg Care: Prevent infection

4 LEVELS OF CHEMOTHERAPHY---Goal of Tx: Achieve remission
1. Induction: every level is 1 session

Meds: IV vincristine
L- agpariginase
Oral prednisone

2. Sanctuary- Treat leukemic cells that invaded testes & CNS
*Give: Methotrixate- adm. intrathecally via CNS or spine

cytocine, Arabinoside, steroids with irradiation

3. Maintenance- to continue remission
Give: Oral Methotrisate – check WBC/ CBC order 1st before administering drug

Adm. of methotrisate – do weekly WBC check

4. Reinduction – treat leukemic cells after relapse occurs. Meds – same as induction

Give antigout agents: allopurinol or Zyloprim- treat or prevent hyperurecemic nephropathy.

Nsg mgt: Outstanding Nsg Dx: 1. High risk for infection
2. Alteration in nutrition less body requirement.
3. Alteration in Body image
4. Anticipatory grieving for family & parents

Based on Maslow’s hierarchy
S/E of Chemotherapy

1. N/V – adm anti-emetic drugs 30 mins before chemo until 1 day after chemo
2. Ulcerations / stomatitis / abscess of oral mucosa: Nsng. Dx: Altered oral mucus membrane

> Oral care – alcohol free mouthwash , betadine mouthwash
> Don’t brush – use cotton pledgets
> Topical xylocaine before meals
> Diet- soft, bland diet according to child’s preference

Temporary S/E of Chemo:
Alopecia – altered body image
Hirsutism – abnormal growth of hair to other body parts

-give emotional support to parents, always repeat instructions
Irradiation Management:

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3 principles: 1. Time
2. Distance
3. Shielding

> with visitors but not more than 10

New Management: Chemotherapy or Bone Marrow Transplant

8. Hemolytic Disorders: Hemolysis = destruction of RBC

a. Rh Incompatibility
> “Rhesus” means foreign body
> mother (-), fetus & father (+)
> 4th baby severely affected
> if (-) or no antigen : CHON factor
> (+) has antigen : CHON factor

Erythroblastosis Fetalis = hemolysis or destruction of RBC d/t O2 carrying capacity

S & Sx: Intrauterine growth retardation w/ pathologic jaundice w/in 24 hrs.

b. ABO Incompatibility
Most common incompatibility – ( mom) O – ( fetus) A
Most severe incompatibility (Mom) O– (Fetus) B

Assessment: Can affect 1st pregnancy
RBC - 20 days lifespan
O = universal donor
AB = universal recipient

Dx: Coomb’s Test
Indirect: mother ----- normal result is (-)
Direct : from baby---normal result is initially (-)

Drug Of Choice: Rhogam Vaccine given to mothers (-) w/in 72 hrs. post-exposure to fetal RBC’s to
destroy fetal RBC’s, then preventing Rh sensitization or antibody formation
> given only w/in 72 hrs. once only 1st pregnancy

9. Hydrops (h20) Fetalis – edematous on lethal state with pathologic jaundice
Within 24 h

Mgt. for both:
1. Initiate feeding
2. Temporary suspension of breastfeeding to prevent kernicterus

>content breast milk pregnanedioles – that delays action of glucoronyl
transferase—a liver enzymes that converts indirect bilirubin to become
direct bilirubin

3. Needs phototherapy
4. Needs exchange therapy

10. Hyperbilirubinemia - > 12 mg/dL of indirect bilirubin among full term *Normal Value: 0-3 mg/dL
- bilirubin encephalopathy

11. Kernicterus - > 20 mg/dL among full term & >12 mg /dl of indirect for pre-term----lead to cerebral palsy

*Physiologic Jaundice –(Icterus Neonatorum) jaundice within 48 -72 h (2-3 days)------ NORMAL
-- just expose to morning sunlight

*Pathologic Jaundice – (Icterus Gravis) jaundice w/n 24h or Jaundice during delivery
d/t small Rh/edematous ABO

*Breastfeeding Jaundice—caused by pregnanediole (6-7th day)

Pathophysiology: ------------------- Destroyed RBCs

Heme Globin

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