 Growth is a REGULAR

process
Direction of Growth
include:

- CEPHALOCAUDAL
- PROXIMODISTAL
- GENERAL TO SPECIFIC
 Every individual grow at
its OWN RATE

 Growth and development

are influenced by
MANY FACTORS

 Development
CONTINUES
Throughout LIFE

I’m a Tattooist sir, not a MICRO-surgeon!

“ D ont W et D baby!”
 SIGN 0 1 2
“BEAT- 1.Heart Rate absent < 100 >100

2. Respiratory absent Weak cry Strong Cry

BREATHE-
effort
Limp,flaccid Some flexion Well
FLEX- 3. Muscle tone flexed

No response Weak cry Strong cry

REFLEX- 4. Reflex
Irritability

COLOR-” Pale, blue Blue Pink all

5. Color extremities over
Pink body
 Intensive
0- RESUSCITATION
SUCTIONING
4- OXYGENATION
BEST POSSIBLE
7- HEALTH
Baby Maria, a neonate is born with heart rate
of 130 bpm, with well- flexed extremities,
and her body is pink but the extremities are
blue. She’s crying strongly.

APGAR score?
Interpretation?
PRESENCE OF:
o LANUGO
o VERNIX CASEOSA
o MONGOLIAN SPOTS
o MILIA
oMOTTLING
o DRYNESS/ PEELING

COLOR: ACROCYANOSIS
 FONTANELLES
- CLOSURE?

-BULGING?
- SUNKEN?

 CAPUT SUCCEDANEUM VS.

CEPHALHEMATOMA
Normal:

Helix (top of the ear) on

same plane as eye

Abnormal:

Low-set ears: Normal:

•EPSTEIN PEARLS

Abnormal:

•ORAL THRUSH:
 RHYTHM:

Normal: - Shallow and irregular

- Diaphragmatic
ENGORGEMENT:
- Periodic breathing
WITCH’S MILK

Infants may have 5-15

second period without
respiration!
•CYLINDRICAL shape
•LIVER
•KIDNEYS
•Umbilical Cord

Infants are at risk

for bleeding and Normal
dehydration! BRICK RED DUST
•Female : PSEUDOMENSTRUATION
•Male : Testes in Scrotal sac
Central urethral opening
Normal:

10 fingers, 10 toes
No fractures and paralysis

Abnormal:

•With extra digits:

•Fused digits:
 BEST DONE:
72 hours after birth BUT
before the 6th day
Congenital Hypothyroidism

•Congenital Adrenal Hyperplasia

TECHNIQUE:
•Glucose-6-Phosphate Heel-stick method
Dehydrogenase (G6PD) Deficiency

•Galactosemia (Gal)

•Phenylketonuria (PKU).
1. Gather Equipments

2. Complete ALL
information.

3. Hatched area indicates

safe areas for puncture site

4. Warm site with soft cloth,

moistened with warm water
5. Cleanse site with alcohol prep.
Wipe DRY with sterile gauze pad. 7. Lightly touch filter paper to
LARGE blood drop.

6. Puncture heel.

9. Dry blood spots on a dry, clean,

flat non-absorbent surface.

10. Mail the collection.

•Do not contaminate filter paper
circles

•Warm the heel of the baby:3-5

minutes

•Do not Pinch!

( VERY GENTLE intermittent
pressure may be applied to area
surrounding puncture site)

• Mail collection within 24 hours!

- WEIGHT LOSS
10 % of birth weight during the 2nd to 4th DAY OF LIFE
1st 7-10 days Normal Losses
due to loss of ECF and meconium DHN
-DOUBLES AT 6 MONTHS
-TRIPLES IN 1 YEAR

WITHIN 24 HOURS:
NEONATAL SEPSIS

2nd to 10th DAY OF LIFE

Sun Exposure WITHIN 24 HOURS:
Decrease PATHOLOGIC
Breastfeeding JAUNDICE
RAISES HEAD SLIGHTLY FROM PRONE

HOLDS HEAD IN MIDLINE, LIFT

CHEST OFF TABLE

SUPPORTS ON FOREARMS IN PRONE

HOLDS HEAD UP STEADILY
ROLLS FRONT TO
BACK
GRASP OBJECTS AND
BRING TO MOUTH

ROLLS BACK TO
FRONT
TRANSFERS OBJECTS

Keep small objects out

of reach
Raise side rails
SITS UPRIGHT
WITH PELVIC
SUPPORT
6
SITS, LEANING
FORWARD ON BOTH
HANDS

SITS STEADILY
WITHOUT
SUPPORT
CRAWLS
•GOOD HAND-MOUTH
COORDINATION
•NEAT PINCER GRASP
WALK WHEN LED
W/ BOTH HANDS

WALK WHEN LED

W/ ONE HAND
HELD

WALKS WITH
MINIMAL HELP
SOLITARY

•Cuddly toys
•Rattles
•Teething rings

Stranger Anxiety
PARALLEL •POUNDING
PEGS
•PUSH-PULL
TOYS

Separation Anxiety
 •Fingerpaints
ASSOCIATIVE •Housekeeping
toys
•Coloring books
•Playground
Equipment
Body Mutilation
 •Video Games
Competitive •Collecting
Objects
•Board Games
•Puzzles

• Intrusion of Privacy
•Death
 It's because
 EXCESS FLUID IN THE the liquid that
CRANIUM is in my head
does not drain
 Altered CSF correctly then
I must be
-Flow treated!
-Absorption
-Product

TYPES
-Communicating
-Non-communicating
 abnormal increase in
head circumference
 bulging fontanelles
 dilatation of the veins
on the surface of the
cranium
 vomiting
 sunsetting eyes
 Skull
X-Ray
 TRANSILLUMINATION
 The liquid must be
removed, but not too
CSF SHUNTING much;
then I will no longer
suffer from
headaches!
 Vital signs
 Proper positioning:

 Meticulous Skin Care

and Eye Care

 Observe for signs of IICP

 Observe for signs of

Infection
a. Prodromal a. Loss/ change of a. Sudden momentary
b. Aura muscle tone loss of muscle tone
c. Tonic b. Loss of
d. Clonic consciousness b. Loss of
- Appears to be consciousness
- Loss of consciousness daydreaming
- seizure - TEMPORAL seizure
confined to - Periods of altered
specific area behavior that the
client is not aware
- NO loss of of
consciousness - loss of consciousness
 DURING
Ensure airway patency
Ease the child on the floor
Place pillows under the
head
Loosen restrictive clothing
Clear area of any hazards
 AFTER
Suction
Oxygenate
Document
 SURGERY
WITHIN 24-48 HOURS
Prevent infection and

RUPTURE of the sac

Replace contents that are

replaceable, close the skin

defect
 PROTECT THE SAC!

- POSITION: Prone
-Cover with sterile, moist, non-adherent
dressing
- Change every 2 hours

 OBSERVE FOR SIGNS OF INFECTION

 Redness
 Purulent discharge
 Fever
 Irritability
 disability that affects
movement and body position.

 comes from brain damage that

control BODY MOVEMENTS
 At birth a baby with cerebral palsy is often
limp and floppy

 Slow development
 • Hearing and sight
 Feeding problems

 Communication difficulties

• He may not use his hands

 SPASTIC
yperactive
ypertonic
yperirritable
yperelastic

 ATHETOSIS
Hand or the toes may move for no
reason.
 ATAXIA
 has difficulty beginning to sit and stand
 Priority: SAFETY
 Prevent FALLS
 Provide safe environment

 Provide Good Nutrition

 Place food at back of the tongue
 Finger foods
1. Nurse Kris is performing an admission
assessment on baby James with a
diagnosis of meningomyelocele. The nurse
assesses for a major symptom associated
with this type of spina bifida when the
nurse:

a. Checks for responses to painful stimuli

from the torso downward.
b. Palpates the abdomen for masses
c. Checks the capillary refill of the nailbeds
of the upper extremities
d. Tests the urine for blood
2. Baby James is now scheduled for surgical
closure of the sac. In the preoperative
period, the priority nursing action of
Nurse Kris would be to monitor the:

a. Blood pressure
b. Anterior fontanel for depression
c. Moisture of the normal saline dressing
covering the sac
d. Specific gravity of urine
3. Nurse Marc has provided discharge
instructions to the parents of an infant who
had a (VP) shunt. Which statement if made
by the parents indicates correct
understanding of the presence of a shunt
malfunction?

a. “If the infant has a high-pitched cry, I

should call the doctor.”
b. “I should position my infant on the side with
the shunt when sleeping.”
c. “My infant will pass urine more often now
that the shunt is in place.”
d. “I should call my doctor if my infant refuses
baby food.”
4. In the plan of care of a child with tonic-
clonic seizure, the Nurse Gabby initiates
seizure precautions and documents that
which items need to be placed at the
child’s bedside?

a. Suctioning equipment and Oxygen

b. Oxygen with a tracheotomy set
c. Emergency chart
d. Airway and a tracheotomy set
5. The parents of the child with cerebral
palsy ask the nurse about the disorder.
Nurse Sharon bases her response on the
understanding that cerebral palsy is:

a. An infectious disease of the central

nervous system
b. A chronic disability characterized by
impaired muscle movement and posture
c. An inflammation of the brain as a result
of a viral illness
d. A congenital condition that results in
moderate to severe retardation.
6. Nurse Sharon develops a plan of care for
the child with cerebral palsy. The nurse
includes interventions in the plan of care,
understanding that a primary goal is to:

a. Eliminate the cause of the disorder

b. Prevent the occurrence of emotional
disturbance
c. Maximize the child’s assets and minimize
the limitations caused by the disorder
d. Cure the disorder
 foreign object lodged in eye

 eyes are struck by a blunt

object

 objects penetrate

 corrosive chemicals burn the

delicate tissues of the eye
 pain
 tear production
 redness
 impaired visual
acuity
 signs of injury
•Remove offending body

•Patch the affected eye

•cold compress
•head should be elevated

NEVER REMOVE a
penetrating object !

Flush with water

 Frequent swimming
 Formula Fed
 Insertion of objects
 Acute Respiratory
Infection
 ETare:
Shorter
Wider
Straighter
 signs of infection
-fever
-irritability
-pain
-purulent discharges
 hearing

 POPPING
SENSATION
Antibiotics
Analgesics Blowing of nose
Swimming

Myringotomy Ear plugs

 HEALTH TEACHINGS

Feed infants in upright position

Provide local heat
Treat respiratory infections
promptly
Drug administration:
• Antibiotics – emphasize that 10-14 day period
is necessary to eradicate organisms
• Otic medications
 persistent sore throat
 difficulty in swallowing
 unpleasant mouth odor
 fever
Tonsillectomy & Adenoidectomy

 PRE-OP
 Assess – active infection
- bleeding/clotting
- loose tooth

 Atropine Sulfate : secretions

 POST-OP
 Position : Prone/Side lying
 Monitor signs of hemorrhage
- FREQUENT SWALLOWING
- pallor
- BP, PR
 Icecream : vasoconstriction
carbonated drinks
red liquids
milk products
suctioning
1. The nurse provides discharge instructions to the
parents regarding the administration of the
antibiotics to a child with otitis media . Which of
the following statements indicates that the
parents understood the instructions?

a. “Administer the antibiotics if the child has a

fever.”
b. “Administer the antibiotics until the child feels
better.”
c. “Administer the antibiotics until they are gone.”
d. “Begin to taper the antibiotics after 3 days of a
full course.”
2. A nurse provides discharge instructions
to the mother of a child after a
myringotomy. Which of the following is
not included in the instructions?

a. Be sure the child uses soft tissues to blow

his nose
b. Place earplugs with petroleum jelly in the
ears during baths and showers
c. Swimming in deep water is prohibited
d. Swimming in lake water needs to be
avoided
3. A nurse is reviewing the laboratory
results for a child scheduled for
tonsillectomy. The nurse determines that
which of the following laboratory values is
most significant to review?

a. Prothrombin time (PT)

b. Sedimentation rate
c. Blood urea nitrogen (BUN)
d. Creatinine
4. After a tonsillectomy, a nurse reviews the
physician’s postoperative orders. Which of
the following physician’s orders does the
nurse question?

a. Clear, cool liquids when awake

b. No milk or milk products
c. Monitor for bleeding
d. Suction every 2 hours
5. After Tonsillectomy, a child begins to
vomit bright red blood. The most
appropriate initial nursing action would be
to:

a. Administer the prescribed antiemetic

b. Turn the child to the side
c. Notify the physician
d. Maintain a nothing-by-mouth (NPO) status
 Nasal Flaring
 Cough
 Retractions
 Restlessness
 Cyanosis/ Pallor
ack in tent

nsure accurate O2 Concentration!

ot allow clothing- WET

ent: CLEAR
 Thoracentesis
 Oxygen
 Antibiotics
 Suction
RESCUE MEDS
 Albuterol (Ventolin)
 Terbutaline Sulfate (Bricanyl)
 Short-acting beta 2 agonist
 Aminophylline
 Side effect: HYPOTENSION
 Monitor for BP
 Used at home to measure
gross changes in peak
expiratory flow rate over
time
 Method:
 Take adeep breath
 Place meter in the mouth
 Blow as hard as possible
 Interpretation
 Green: Best
 Yellow: Caution
 Red: ASTHMA
 Eliminate allergens
 Use of nebulizer, MDI
 Increase OFI
 Adequate rest, sleep and
balanced diet
 Bronchodilators,
Antibiotics
 CPT
 Pulmozyme
 ThAIRapy vest
device
1. Baby Venice is placed in a cool mist tent. Mother
Ruffa becomes concerned because the child is
consistently crying, and trying to climb out of the
tent. The most appropriate nursing action would
be to:

a. Call the physician and obtain an order for a mild

sedative
b. Tell the mother that the child must stay in the
tent
c. Place a toy in the tent to make the child feel
more comfortable
d. Let the mother hold the child and direct a cool
mist over the child’s face
2. An ER nurse is caring for a child
diagnosed with epiglottitis. Assessing the
child, the nurse monitors for which
indication that the child may be
experiencing airway obstruction?

a. Nasal flaring and bradycardia

b. The child is leaning backward, supporting
himself with the hands and arms
c. A low-grade fever and complaints of a
sore throat
d. The child is leaning forward with the chin
thrust out
3. A 10-year-old child with asthma is
treated for acute exacerbation in the
emergency room. A nurse reports which
of the following knowing that it is not an
indication that the condition is
improving?

a. Increased wheezing
b. Decreased wheezing
c. Warm, dry skin
d. A pulse rate of 90 beats per minute
4. The mother of an 8-year-old child being treated
for right lower lobe pneumonia at home calls
the clinic nurse. The mother tells the nurse that
the child complains of discomfort on the right
side and that the pain reliever is not very
effective. The nurse most appropriately tells
the mother to:

a. Increase the dose of the pain reliever

b. Increase the frequency of the pain reliever
c. Encourage the child to lie on the right side
d. Encourage the child to lie on the left side
5. A sweat test is performed on a child with
a suspected diagnosis of cystic fibrosis
(CF). The nurse reviews the test results
and determines that which of the
following is a positive result for CF?

a. Chloride level of 20 mEq/L

b. Chloride level of 30 mEq/L
c. Chloride level of 40 mEq/L
d. Chloride level of 10 mEq/L
6. Which of the following respiratory
conditions is always considered a
medical emergency?

a) Laryngotracheobronchitis (LTB)
b) Epiglottis
c) Asthma
d) Cystic Fibrosis (CF)
- Provide Blood flow to the pulmonary
arteries from left or right subclavian artery
A physician has prescribed oxygen PRN for
an infant with Tetralogy of Fallot. In
which situation would the nurse plan to
administer the oxygen to the infant?

a. During the feeding

b. When the mother is holding the infant
c. When changing the infant’s diaper
d. When drawing blood for electrolyte values
MAJOR S/Sx
MINOR S/Sx
J-oints
F-ever
O- shaped heart
E-lectrocardiogram
N-odules
abnormalities
E-rythema
E-vidence of Group A
marginatum
Strep. Infection
S-t. Vitrus dance
L-ab abnormalities
P-revious RF/Heart
Disease
A-rthralgia
•Foul Aftertaste
•Black stools
•Constipation
•CUTTING OF CORD
•GUM BLEEDING
•EPISTAXIS
•HEMATURIA
1. A clinical instructor asks a nursing student to
describe the cause of the clinical manifestations
that occur in sickle cell disease. The student
responds correctly by telling the instructor that:

a. Sickled cell increase the blood flow through the

body and cause a great deal of pain
b. Sickled cell mix with the unsickled cells and cause
the immune system to become depressed
c. Bone marrow depression occurs because of the
development of sickled cells
d. Sickled cells are unable to flow easily through the
microvasculature and their clumping obstructs
blood flow
2. A nurse instructs the mother of a child
with sickle cell disease regarding the
precipitating factors related to pain
crisis. Which of the following, if
identified by the mother as a
precipitating factor, indicates the need
for further instructions?

a. Infection
b. Trauma
c. Fluid overload
d. Stress
3. A nurse is instructing the parents of a
child with iron deficiency anemia
regarding the administration of a liquid
oral iron supplement. The nurse tells the
mother to:

a. Administer the iron through a straw

b. Administer the iron at mealtimes
c. Add the iron to the formula for easy
administration
d. Mix the iron with cereal
4. A nurse is providing home care
instructions to the mother of a 1o-year-
old child with hemophilia. Which of the
following activities would the nurse
suggest that the child could safely
participate in with peers?

a. Basketball
b. Swimming
c. Soccer
d. Field hockey
5. A nurse instructs the parents of a child
with leukemia regarding measures related
to monitoring for infection. Which
statement if made by parent indicates a
need for further education?

a. “I will perform proper handwashing

techniques.”
b. “I will take a rectal temperature daily.”
c. “I will inspect the skin daily for redness.”
d. “I will inspect the mouth daily for
lesions.”
6. A 4-year-old child with leukemia is
admitted to the hospital because of
pneumonia. Which of the following is
the most likely cause of his current
condition?

a) Anemia
b) Thrombocytopenia
c) Leukopenia
d) Eosinophilia
After feedings, place your baby on his/her
stomach with the upper body elevated at least 30
degrees

Add rice cereal to feeding (thicken feedings)

Burp your baby several times during bottle feeding

or breastfeeding. Your baby may reflux more often
when burping with a full stomach.

Make sure your baby's diaper is loose.

1. A nurse provides instructions to the
mother of an infant of cleft palate
regarding feeding. Which statement if
made by the mother indicates a need for
further instructions?

a. “I will use a nipple with a small hole to

prevent choking.”
b. “I will stimulate sucking by rubbing the
nipple on the lower lip.”
c. “I will allow the infant time to swallow.”
d. “I will allow the infant to rest frequently
to provide time for swallowing what has
been placed in the mouth.”
2. An infant has just returned to the
nursing unit following a surgical repair
of a cleft lip located on the right side
of the lip. The nurse places the infant in
which most appropriate position?

a. On the right side

b. On the left side
c. Prone
d. Supine
3. A nurse admits a child to the hospital
with a diagnosis of pyloric stenosis. On
admission assessment, which data would
the nurse expect to obtain when asking
the mother about the child’s symptoms?

a. Vomiting large amounts of bile

b. Watery diarrhea
c. Increased urine output
d. Projectile vomiting
4. A nurse provides home care instructions
to the parents of a child with celiac
disease. The nurse teaches the parent to
include which of the following food items
in the child’s diet?

a. Rice
b. Rye toast
c. Oatmeal
d. Wheat bread
5. A clinic nurse is taking care of a patient
with Hirschsprung’s disease. The nurse
reviews the assessment findings
documented in the record, knowing that
which symptom most likely led the
mother to seek health care for the
infant?

a. Diarrhea
b. Projectile vomiting
c. Regurgitation of feedings
d. Foul-smelling ribbon-like stools
6. A newborn’s failure to pass
meconium within the hours after
birth may indicate which of the
following?

a) Hirschsprung disease
b) Celiac disease
c) Intussuception
d) Abdominal wall defect
1. Baby James is diagnosed with Wilms’s
tumor. During assessment, the nurse
expects to detect:

a) Gross hematuria
b) Dysuria
c) Nausea and vomiting
d) An abdominal mass
2. A nurse has provided discharge instructions to
the mother of a 2-year-old child who has had an
orchiopexy to correct cryptorchidism. Which of
the following statements made by the mother of
the child, indicates that further teaching is
necessary?

a. “I’ll check his temperature.”

b. “I’ll let him decide when to return to his play
activities.”
c. “I’ll give him medication so he’ll be comfortable.”
d. “I’ll check his voiding to be sure there’s no
problem.”
3. A nurse collects a urine specimen
preoperatively from a child with
epispadias who is scheduled for surgical
repair. When the nurse is analyzing the
results of the urinalysis, which of the
following would the nurse most likely
expect to note?

a. Hematuria
b. Proteinuria
c. Bacteriuria
d. Glucosuria
4. A nurse is reviewing a treatment plan with
the parents of a newborn infant with
hypospadias. Which statement by the
parents indicates their understanding of
the plan?

a. “Circumcision has been delayed to save

tissue for surgical repair.”
b. “Catheterization will be necessary when
the infant does not void.”
c. “Caution should be used when straddling
the infant on a hip.”
d. “Vital signs should be taken daily to check
for bladder infection.”
5. A nurse is caring for an infant with a
diagnosis of bladder exstrophy. To
protect the exposed bladder tissue, the
nurse plans to:

a. Cover the bladder with petroleum jelly

gauze
b. Keep the bladder tissue dry by covering it
with dry sterile gauze
c. Cover the bladder with a nonadhering
plastic wrap
d. Apply sterile distilled water dressings over
the bladder mucosa
6. When caring for a child awaiting surgery for
Wilms’ tumor, which of the following nursing
actions would be most important?

a) Handling the child with care, particularly

during bathing
b) Placing the child on low blood count
precautions and isolation.
c) Monitoring bowel sounds for vincristine-
induced ileus
d) Placing the child in high Fowler position
to facilitate breathing.
 STRUCTURAL
 NONSTRUCTURAL
1. A 1-month-old infant is seen in a clinic and is
diagnosed with unilateral hip dysplasia. A nurse
assess the infant, knowing that which of the
following findings would not be noted in this
condition?

a. An apparent short femur on the affected side

b. Limited range of motion (ROM) in the affected
hip
c. Asymmetric adduction of the affected hip when
the infant is placed supine with the knees and
hips flexed
d. Asymmetry of the gluteal skinfolds when the
infant is placed prone and the legs are extended
against the examining table
2. A clinic nurse provides instructions to the
parents of an infant with hip dysplasia
regarding care of the Pavlik harness.
Which of the following does the nurse
include in the instructions?

a. The harness should be worn 12 hours a day

b. The harness needs be removed for diaper
changes and for feeding
c. The harness should be removed only to
check the skin and for bathing
d. The infant should not be moved when out
of the harness
3. A nurse is providing instructions to the
parents of a child with scoliosis regarding
the use of a brace. Which of the following
is not a component of the instructions
given to the parents?

a. Apply lotion under the brace to prevent

skin breakdown
b. Encourage the child to perform
prescribed exercises
c. Avoid the use of powder because it will
cake under the brace
d. Have the child wear soft-fabric clothing
under the brace
4. A 2-year-old child is placed in Bryant
traction for treatment of a fractured
femur. The nurse develops a plan of care
for the child. Which of the following is
not a component of the plan?

a. Place the child in a supine position

b. Place the child supine with the legs flexed
slightly less than 90 degrees
c. Ensure that the sacrum is resting on the
mattress
d. Ensure the use of a footplate to keep the
traction straps away from the child’s
ankles
5. The nurse provides instructions to the
mother regarding cast care for the child.
Which of the following statements, if made
by the mother, indicates a need for further
education?

a. “The cast may feel warm as the cast dries.”

b. “If the cast becomes wet, a blow drier set
on the cool setting may be used to dry the
cast.”
c. “A small amount of white shoe polish can
touch up a soiled white cast.”
d. “I can use lotion or powder around the cast
edges to relieve itching.”