ESSENTIAL NEWBORN CARE and Pediatric care

Mrs. Aurisita M. Delos Reyes, RN, MAN

FOUR PRIORITIES
y 1. AIRWAY y 2. TEMPERATURE MAINTENANCE y 3. TIMELY CUTTING OF THE CORD y 4. UNINTERRUPTED BREASTFEEDING

1. Establish and maintain patency of the airway

y Do a quick assessment on breathing y Stimulate to cry by rubbing the skin particular

attention on back and chest y Suctioning ( optional ) y = duration- 5-10 sec or < 5 secs in preterm y = mouth before nose

Positioning
y
y y y y y y y

A. Side lying
Purposes 1. promotes drainage of secretions 2. prevents increase ICP 3. R side lying- increase pressure L side of the heart which favor the closure of Ductus Arteriosus and Foramen Ovale 4. Promotes gastric emptying thereby prevent reflux of gastric contents and aspiration B. Supine (recommended for infants above 3 mos. ) C. Prone- ( maybe a cause in SIDS )

2. Maintain appropriate temperature

y y

= Temp of the NB at birth- 36.4- 37.2 o C = usually unstable and takes 6-8 hours to stabilize

Factors affecting temperature of the NB

y 1. The thermoregulating center is immature y 2. Shivering mechanism of the NB is

underdeveloped. y 3. Inadequate adipose tissues (Brown fat) y 4. Neonates are prone to heat loss thru evaporation, radiation, convection, and conduction.

NURSING MANAGEMENT:
y y y y y y y y

1. SKIN TO SKIN CONTACT Transfers the following HEAT LOVE Normal Bacterial Flora 2. DRY and WRAP THE NEWBORN 3. EXPOSE TO DROPLIGHT ( if necessary) 4. Delay Bath until 6 hours

complications
y 1. HYPOGLYCEMIA results from utilization of

glucose in the form of glycogen y Normal blood sugary 35

60 mg% 2. METABOLIC ACIDOSIS- breakdown of fatsaccumulation of fatty acids 3. RESPIRATORY DISTRESS

III.
y y y y

Promote adequate circulation Factors that influence circulatory changes after birth Lung expansion Cutting of the umbilical cord

a. LUNG EXPANSION
y Increase pressure in the LEFT side Heart

y Closure of fetal structures (Foramen ovale and

Ductus Arteriosus)

Nursing care:
y 1. stimulate to cry y =except if Preterm ( Conserve energy) y 2. proper position y 3. administer INDOMETHACIN as ordered

b. Cutting of the umbilical cord

y Decrease pressure in the RIGHT side of the Heart

y Closure of the DUCTUS VENOSUS and UMBILICAL

BLOOD VESSSELS

4. Bonding
y

- a special mutual relationship between mother and infant. Ideally started on the FIRST PERIOD OF REACTIVITY.

METHODS:
y y y y y y

1. BREASTFEEDING = immediately after birth 2. EYE TO EYE CONTACT = Crede s Prophylaxis maybe delayed for 2 hours 3. ROOMING- IN 4. HUGGING, CUDDLING, and EMBRACING

PURPOSES OF BREASTFEEDING
y 1. BONDING y 2. FACILITATES RELEASE OF COLOSTRUM AND

BREAST MILK y 3.STIMULATES PRODUCTION OF PROLACTIN AND OXYTOCIN y 4.STIMULATES GASTROCOLIC REFLEX FACILITATING EARLY and MORE FREQUENT DEFECATION THUS PREVENT JAUNDICE

V.
y ASSESSMENT TOOLS

Apgar Screening Test authored by Dr. Virginia Apgar y Done twice at 1 and 5 min. respectively

y y y

Purposes: 1. To determine the degree of acidosis and the need for CPR 2. To evaluate ability of the NB to adjust extrauterinely and the prognosis

CRITERIA

CRITERIA:
y0 y APPEARANCE- BLUE y PR- ABSENT y GRIMACE- NO RESPONSE y MUSCLE TONE- LIMP y RESPIRATION- ABSENT

y ONE y ACROCYANOTIC y < 100 y GRIMACE y SOME FLEXION y WEAK CRY

y TWO y COMPLETELY PINK y >100 y STRONG CRY,SNEEZE, COUGH y ALL FLEXED y STRONG CRY

INTERPRETATION
y 0-3= y POOR,SERIOUS,SEVERELY DEPRESSED; CPR y 4-6 y FAIR,GUARDED, MODERATELY DEPRESSED y NEEDS SUCTIONING & FURTHER

OBSERVATION y 7-10 y GOOD, HEALTHY

SILVERMANN AND ANDERSON

y PURPOSE: y TO DETERMINE THE DEGREE OF RESPIRATORY

DISTRESS y HIGH RISK BABIES y AS NECESSARY

y CRITERIA: y NASAL FLARING y UPPER AND LOWER CHEST y XIPHOID RETRACTIONS y EXPIRATORY GRUNT

y INTERPRETATION: y 0-3 y Good or healthy; no respiratory distress y 4-6 y Fair, Guarded with mild respiratory distress y 7-10 y Poor, serious with severe respiratory distress

Dubowitz/Ballard Exam for Gestational Age

Done on the first 24 hours and twice y Used by MD y Two criteria: y Neuromuscular y Physical Maturity

Neuromuscular

PHYSICAL MATURITY
y y y y y y y y y y y y y y

PREMATURE SKIN GELATINOUS, TRANSPARENT, VISIBLE BLOOD VESSELS EAR CARTILAGE ABSENT/ PLIABLE BREAST NODULE 1-2 mm GENITALS MALE- TESTES- UNDESCENDED SCROTUM- LESS SWOLLEN, FEW RUGAE FEMALE- CLITORIS AND MINORA- PROMINENT SOLE CREASES- ANETRIOR TRANSVERSE LANUGO ABUNDANT

TERM
y SMOOTH, PINK,SUPERFICIAL CRACKING, LESS

VISIBLE VEINS y FORMED AND FIRM WITH INSTANT RECOIL y 3-5 mm y PARTIALLY DESCENDED y MORE SWOLLEN AND RUGAE y PARTIALLY COVERED BY MAJORA y 2/3 OF THE SOLE WITH CREASES y LESS LANUGO

POST TERM
y PARCHMENT,DEEP CRACKING, DESQUAMATES, NO VISIBLE BV y THICK CARTILAGE AND STIFF y 6 TO 10 mm y FULLY DESCENDED; PENDULOUS y MARKED SWOLLEN; EXTENSIVE RUGAE y MAJORA COMPLETELY COVERS MINORA and CLITORIS y ENTIRE SOLE with CREASES y NO LANUGO

MATURITY RATING SCALE

y y y y y y y y y y y y y y

TOTAL SCORE -10 -5 0 5 10 15 20 25 30 35 40 45 50

AOG (weeks) 20 weeks Below 35= PRETERM 22 24 35-45 = TERM 26 28 ABOVE 45= POSTERM 30 32 34 36 38 40 42 44

Newborn Screening test RA 9288-NBS Act 2004

y Purposes: y Prevent MR y Prevent Physical defects y Prevent Death

Diseases included in the NBS

y 1. Phenylketonuria- inborn error of CHON metabolism y 2. Galactosemia- inborn error of CHO metabolism y 3. Cretinism- inborn error of metabolism y 4. Glucose 6 phosphatase Dehydrogenase deficiency y 5. Congenital Adrenal hyperplasia

y Done bet. 48-72 hours y Blood heelprick ( 4 drops blotted on paper y Results 2 to 3 weeks y Php 600

VI.
y y y y

IDENTIFICATION- preferably in the presence of the parents = include: Double banding Finger and footprints Birthmarks- HEMANGIOMA

STRAWBERRY MARKS

STRAWBERRY MARKS-(Nevus vasculosus)

y Elevated areas formed by immature capillaries and

endothelial tissues y PORTWINE STAINS-(Nevus Flammeus )

y a macular purple or dark red lesion or patches y Can be seen face, buttocks, thigh and genitals

TELANGIECTASIS NEVI
y =flat , red areas of capillary dilatation commonly seen

at the glabella, upper eyelid, and upper lip

PORTWINE STAINS(Nevus Flammeus)

COMMON MARKS (not to be use in ID)

y MONGOLIAN SPOTS

MILIA

VERNIX CASEOSA

NEWBORN RASH/FLEABITE RASH ( Erythema Toxicum)

ERYTHEMA TOXICUM
=Pink papules with superimposed vesicles =Seen in the face ,nape, back, and buttocks =Disappears 3rd week =Self limiting

DESQUAMATION

ANTHROPOMETRIC MEASUREMENTS
y y y y y

BIRTHWEIGHT- 2.5- 3.4 kg or 5.5-7.8 lbs BIRTHLENGTH- 48-54 cm or 18-22 im HEAD CIRCUMFERENCE- 33-35 cm or 13-14 in CHEST CIRCUMFERENCE- 31-33 cm or 12-13 in ABDOMINAL CIRCUMFERENCE- 29-31 cm or 11-12 in

IX. VITAL SIGNS

y RR- 80 breaths/min at birth; stabilize bet. 30-

60 breaths/ min y = rapid, irregular, with normal physiologic apnea of <15 sec. per min y = shallow but quiet y = abdominal and diaphragmatic

y PR- 180 beats per min y = stabilizes between 120-160 bpm y = rapid and irregular y = usually increased when crying and low if

asleep y = sites= Apical pulse y Brachial y Femoral- if weak or absent suggest COA y Pedal

TEMPERATURE
y BLOOD PRESSUREy = 80/46 mmHg at birth y = at 10 days maybe 100/50 mmHg y = higher in the LE and lower in the UE y = maybe by Doppler or Flush methods

X. PHYSICAL ASSESSMENT
y Infant and young children y CHEST first before head y Beginning School period= CEPHALOCAUDAL

A. CHEST
y ASSESS :

1. retractions

2. BREATH SOUNDS a. absence- inexpansion of the lungs as in RDS = assymetrical- DIAPHRAGMATIC HERNIA b. wheezes- bronchospasm ( Bronchiolitis and Asthma ) c. stridor= laryngospasm ( Croup and Epiglotittis)

c. rales or crackles=pulmonary congestion 2. Witch milk- colorless or transparent fluid caused by maternal hormones

Diaphragmatic Hernia

y a birth defect resulting to crowding of the

abdominal organs in the chest cavity thus leading to collapse of the lungs y = Two types y Left sided- BOCHDALEK HERNIA y Right sided-MORGAGNI HERNIA

Signs and Symptoms

y difficulty breathing y fast breathing y fast heart rate y cyanosis (blue color of the skin) y abnormal chest development, with one side

being larger than the other y abdomen that appears caved in (concave) y A baby born with a Morgagni hernia may or may not show any symptom

Treatment may include:

y neonatal intensive care y Mechanical ventilator y Extra corporeal membrane oxygenator y surgery

RESPIRATORY DISTRESS SYNDROME

=also known as HYALINE MEMBRANE DISEASE cause: unknown Basic defect: lack or deficiency of surfactant Predisposing factors: 1. Prematurity 2. LBW/ SGA 3. Born CS 4. LGA

MANAGEMENT
y 1. CPAP/ CPPB( Continues + a y Airway Pressure) aims to keep alveoli open thus prevent atelectasis y 2. O2 therapy- kept at 40 % to prevent blindness ( Retrolental

Fibroplasia ) and Emphysema ( Bronchopulmonary Dysplasia ) 3. INCUBATION= purposes a. Provide warm environment to conserve energy = temp- 34.4oC and humidity @ 55-65% b. Prevent Infection thru Reverse Isolation 4. Medications: a. Steroid ( Betamethasone )= promote surfactant maturation b. Surfactant ( Beractant ) given intratracheal c. Na HCO3- correct acidosis d. Gamma/ Immunoglobulin

y 4. MINIMAL HANDLING y 5. TOUCH THERAPY y 6. Watch for Complications like y a. ANEMIA results from smaller mass of RBC and

frequent extraction of blood y Management: BT with PRBC ( 50 ML ) y b. HYPERBILIRUBINEMIA managed by phototherapy and exchange transfusion y c. MALNUTRITION related to too much utilization of Oxygen resulting to poor growth and development y Management: y 1. TPN y 2. Gavage y 3. Breastfeeding

Factors affecting prognosis

y 1. AGE y 2. AVAILABILITY OF TREATMENT y 3. RESPONSE TO TREATMENT

BRONCHIOLITIS
y Self- limiting; Acute phase 1st 48 to 72 hrs y A viral infection y Inflammation of the bronchioles causing obstruction

of the entrance and egress of air leading to overdistention of alveoli y Common to infants below 18 mos y Signs and symptoms y Wheezes, fever, respiratory distress

Management
y 1. Mist or Croup tent ( O2 8 to 10 l/min) y = decrease Airway resistance y = keep child dry at all times y = monitor VS y 2. Proper positioning = head elevated during acute

distress y 3. Aspiration precaution y 4.Medications:

Bronchodilators and mucolytics b. Antiviral- Ribavirin ( Virazole via SPAG )
a.

Croup
y Inflammation of the bronchi, trachea , and larynx y Maybe caused by bacteria or virus y Common to infants and young children y Most severe type Epiglotittis y Never inspect throat = precipitate complete airway

obstruction y Have tracheostomy set always available at bedside

Signs and Symptoms

y 1. Inspiratory stridor y 2. Tripod position y 3. Respiratory distress y 4. cherry red epiglottis y Management y Same as Bronchiolitis y Medication include anti bacterial

B. HEAD 1.Fontanels

FONTANELS
y TYPES: y 1. PAIRED y = ANTEROLATERAL ( SPHENOID ) y = POSTEROLATERAL ( MASTOID ) y 2. SINGLE y = ANTERIOR ( BREGMA ) y = POSTERIOR ( LAMBDA )

CHARACTERISTICS:
y ANTERIOR FONTANELS y = diamond shape y = 3-4 cm long and 2-3 cm width y = if > 5cm maybe a sign of HYDROCEPHALUS and

CRETINISM y = it closes 12 to 18 months

Posterior fontanel
y Characteristics y Triangle in shape y Located between lambdoidal and sagittal sutures y Measures 2 cm long and 1 cm wide y Closes between 2 to 3 mos

craniosynostosis or craniostenosis
y Premature closure of the fontanels and sutures y Complications y 1. INCREASE ICP y 2. MENTAL RETARDATION y 3. BRAIN HERNIATION y 4. DEATH

CAPUT SUCCEDANEUM

Caput Succedaneum
y Swelling of the scalp y Caused by prolong second stage of labor y It crosses the suture line thereby affect both sides y Disappears in 2 to 3 days

CEPHALHEMATOMA

cephalhematoma
y Caused by increase pressure of birth y leading to rupture of capillaries y Does not cross the suture line thereby affects one side y Disappears in 3 to 4 weeks y A birth injury and may aggravate jaundice

craniotabes
y Localized softening of the cranial bones y Cause= early lightening ( descent of the presenting

part in the pelvic brim ) y Common to firstborn babies y Disappears 6 weeks

MOLDING

B. Face
y Assess for BELL S PALSY y A birth injury caused by FORCEPS

management
y Feed baby with droppers and syringe and connect to

artificial nipple y RATIONALE: TO PREVENT PREMATURE DISAPPEARANCE OF THE SUCKING REFLEX

EYES
y =maybe slate blue or gray y =pupils equal, round, reactive to light and

accomodation y = if keyhole COLOBOMA y = lacrimal duct= immature ( tearless ) y TEST x BLINDNESS y 1. DOLL S EYE y 2. GLABELLAR TAP TEST y = best done first ten days

COLOBOMA

EXOTROPIA STRABISMUS

ESOTROPIA STRABISMUS

MANAGEMENT
y Immediate treatment for non physiologic strabismus y 1. Occlussion therapy y 2 Surgery- SQUINT Operation y 3. Corrective Glasses y 4. Laser therapy

y Assessment of the Ears y Note: y Infant and below three years y PULL PINNA DOWN and BACK y Above three y PULL PINNA UP and BACK

EARS (PINNA ) ASSESSMENT

y Note: if set lower- abnormal y Chromosomal defects- Down syndrome y = Patau syndrome y = Edward disease y Kidney defects y Craniofacial defects

DOWN SYNDROME/TRISOMY 21
AGE y Basic defect= presence of three ( 3) chromosome 21 ( trisomy ) y Total no. 47 y Dx tests y 1. Alpha feto protein = low y 2. Chorionic villi sampling y 3. Karyotyping y LIFE SPAN= VARIABLE

y Cause = unknown y Predisposing factor=ADVANCE PARENTAL

CHARACTERISTICS

y Microcephaly y Low set ears y Saddle nose y Small mouth with large tongue ( macroglossia ) y Short neck y Short and stubby digits with single transverse

line ( SIMIAN CREASE ) y Hypotonic musculature y Protuberant abdomen y Small penis with undescended testes ( Cryptoorchidism ) y MENTAL RETARDATION

COMMON PROBLEMS
y 1. CARDIAC DEFECTS y 2. GIT DEFECTS- ESOPHAGEAL ATRESIA y 3. GUT DEFECTS

CRANIOFACIAL DEFECT

NOSE

nose
Assess nasal flaring/ respiratory distress Causes 1. OBSTRUCTION a. secretions B.. bone or membrane Commonly blocking the choana or posterior nares CHOANAL ATRESIA y 2. LACK OF SURFACTANT
y y y y y y

mouth
y assess y 1. EPSTEIN PEARLS y White glistening epithelial cysts at the palate and gums, caused be extra load of Calcium y 2. TOOTH y Needs extraction to prevent ASPIRATION y Caused by too much intake of vitamins y 3. excessive drooling of saliva ESOPHAGEAL ATRESIA y 4. CLEFT LIP AND PALATE y 5. ORAL CANDIDIASIS

vomiting
y Non-projectile- non obstructive y 1. infection y 2.chalasia or GERD y PROJECTILE- obstructive y 1. pyloric stenosis y 2. intussusception y 3. hirchsprungs disease

GASTROINTESTINAL DISORDERS

CLEFT PALATE

Folic acid deficiency Steroid Exposure to TORCH

y Common problems: y feeding difficulty y infections- upper respiratory and ear y speech defect ( cleft palate ) y dental defect ( nasal twang ) y altered normal body image y respiratory distress

Pre operativeespecially during and after y Proper positioning care

y y y y y

feeding- Upright position Burp or bubble the NB more often Feed baby with the use of cross cut large holed nipple or Breck feeder technique Observe for signs of complications- Otitis media, etc For dental defects-m Orthodontic exercise and surgery Speech therapy

Post operative care

y y y

y y y y

Proper positioning= PRONE x Cleft palate and SUPINE or SIDE LYING x Cleft lip Apply elbow restraint and release every 2 hours Give feeding with rubber tipped medicine dropper after Cleft lip and paper cups and soup spoon after cleft palate Cleanse the wound with hydrogen peroxide Give post operative meds which include analgesic and antibiotic Avoid sucking, suctioning, blowing, pointed and sharp objects ( spoon, fork, and straw ) Make sure baby does not suck the LOGAN S BAR or BOW

surgery
y Rule of 10 y 10 weeks old y 10 grams hemoglobin y 10 lbs weight

Palatoplasty y Before speech development y Between 8 to 18 months y Watch for Respiratory Distress and Hemorrhage

CHEILOPLASTY AND PALATOPLASTY

ESOPHAGEAL ATRESIA
y failure of the esophagus to form a continuous passage between the mouth and the stomach y = a congenital defect y = often associated with other defects y = assessment include VACTERL y V- ertebral defects y A- norectal defects y C- ardiac like PDA ( most common ) y T- rachea and y E- sophagus y R- enal defects y L- imbs y Cause: unknown but common in children with Down Syndrome

Signs and Symptoms

y y y y y y y

excessive drooling of saliva choke after initial feeding resistance on NGT insertion respiratory distress abdominal distention cyanosis, tachypnea hx of hydramnios ( antepartum )

Diagnostic tests: X-rays

y Treatment: Surgery- depends on the type of defect

Creation of gastrostomy and cervical esophagostomy y Division of Fistula and Esophageal Anastmosis y Closure of the gastrostomy
y

Nursing care:
y y y y

Proper positioning- elevate head at 20-30 degrees angle Regular suctioning Administer Oxygen if cyanotic Administer TPN- primary source of nutrition

Total Parenteral Nutrition or IV hyperalimentation

y = introduction of hypertonic solution into the

SVC thru a central line inserted in the neck, arm, and groin veins y = the solution contains sugar, fats ,protein, minerals and vitamins

ORAL MONILIASIS /CANDIDIASIS

MONILIASIS/ CANDIDIASIS
y Acquired by the baby during passage y Cause: Candida Albicans y Management: y Antifungal ( Nystatin ) spread with gloved finger

neck
y Short y THYROID GLAND- not palpable y test for CRETINISM T3 T4 det y MENTAL RETARDATION y Tx- SYNTHROID

CONGENITAL TORTICOLLIS

y = also known as wry neck y = contraction of the sternocleidomastoid

muscle y = maybe treated by: y EXERCISE y APPLICATION OF WARM PACKS OR COMPRESS y TENOTOMY- surgical release of contracted muscle

ABDOMEN
y DOME and CYLINDRICAL y SCAPHOID- DIAPHRAGMATIC HERNIA y LIVER= 2-3 cm BELOW RIGHT COSTAL MARGIN y KIDNEYS= 1-2 cm above umbilicus y SPLEEN= left quadrant

OMPHALOCELE

GASTROSCHISIS

OMPHALOCELE organs thru the umbilicus y Protrusion of the abdominal

y Usually contained in a sac y Prone to infection y Management: y Cover the defect with sterile saline dressing and

preferably change every two hours

GASTROSCHISIS thru a defect or a hole y Protrusion of abdominal organs

in the abdominal wall y Very prone to Infection y Management: y 1. Reduction Process thru a Silastic Silo y 2. Use overhead warming unit y 3. Prophylactic antibiotic y 2. Surgery

Pyloric Stenosis

Narrowing of the pylorus due to thickening of the pyloric muscle

ySigns and Symptoms y1. projectile vomiting ( maybe

bloody ) y2. visible peristalsis y3. palpable olive shaped mass y4. irritable and restless

NURSING CARE
y 1. Give thickened formula y = Rice Cereal and Milk thru gavage y 2. Prevent and correct dehydration y = IV fluids y 3. Measure I and O y 4. Monitor for Complications such as: y a. Metabolic alkalosis and acidosis y b. Dehydration

Surgical mgt
y FREDET RAMSTED PROCEDURE y ( PYLOROMYOTOMY ) y = separation of the hypertrophied muscle of the

pylorus without mucosal incision y LAPAROSCOPY

INTUSSUSCEPTION

y = invagination or the telescoping of the small

bowel into the large bowel y = may occur as early as 3 weeks old manifested by y abdominal pain y projectile vomiting with bile or fecaloid y sausage shaped mass y passage of CURRANT jelly- bloody and mucoid stool

DX: LGIS or Barium Enema- revels a Coiled Spring or Staircase sign

y TX: BARIUM ENEMA y SURGERY: BOWEL RESECTION with END to

END ANASTOMOSIS y BOWEL MILKING

HIRSCHPRUNGS DISEASE

Hirchsprungs/ Aganglionic Megacolon

y Absence of ganglion nerve cells resulting to the

absence of peristalsis in the affected segment y Accumulation of intestinal materials leading to y MEGACOLON

Signs and symptoms:

y y y y y

non passage of meconium vomiting and abdominal distention chronic constipation passage of ribbon-like or pellet stool anorexia, shortness of breath

Diagnostic tests:
y y y

Barium Enema Rectal exam Anorectal biopsy- most reliable

Treatment:Surgery
y Colostomy y Swenson and Soave y Closure of Colostomy

1.Daily enema- for retention olive oil or diluted antibioti i. for non retention- isotonic saline solution 2.Small but frequent meals of low residue 3.Measure abdominal circumference daily 4.Position with head elevated to ease breathing 5.Administer drugs as ordered. Ex. Stool softeners 6.Oral hygiene 7.Psychosocial support

Nursing care: Pre operative

ANOGENITAL
y THREE TYPES OF STOOLS y MECONIUM- green black , sticky,

odorless, passed 4X per day y TRANSITIONAL- yellow-green, slimy, 6X or more y MILK y a. Breast fed baby stool y B. Bottle fed baby stool

BREAST FED BABY STOOL

y Characterisitics:
y Golden yellow y Mushy and soft y Sweet odor y Passed every after breastfeeding

BOTTLE FED BABY STOOL

y Characteristics: y Pale yellow y Hard and formed y Offensive, foul odor y Passed once/ day

IMPERFORATE ANUS

Signs and Symptoms

y absence of anal opening y misplaced anal opening y anal opening very near the vaginal opening in the

female y no passage of first stool within 24 to 48 hours after birth y stool passed by way of vagina, base of penis or scrotum, or urethra y abdominal distention

Treatment: Surgery
y Stage I: Colostomy ( newborn) y Stage II: Pull thru y Stage III: Closure of colostomy

Voiding
y =expected to void 6 to 8x on 1st 24 hours y = failure may suggest dehydration or

absence of urinary meatus y =After 24 hrs= 12 to 20X/ day y = failure means renal agenesis

GENITOURINARY DEFECTS
y ASSESS: y 1.

LOCATION OF THE URINARY MEATUS, maybe y A. Epispadias- urinary meatus above or dorsal surface of the penis y B. Hypospadias- urinary meatus located at ventral surface or under penis y management: MEATOPLASTY

HYPOSPADIAS

CRYPTOORCHIDISM

UNDESCENDED TESTES
COMPLICATIONS: y 1. Inguinal Hernia y 2. Testicular cancer y 3. Sterility y Management: y 1. Hormonal tx- HCG & TESTOSTERONE y 2. ORCHIOPEXYor ORCHIDOPEXY

HYDROCELE

ACCUMULATION OF INTRAABDOMINAL FLUID IN THE SCROTUM

y TYPES: y 1. NON- COMMUNICATING y 2. COMMUNICATING needs elective

repair to prevent HERNIA y NOTE: Trans illumination may reveal fluid or loop of intestines

EXTREMITIES
y Assess for symmetrical movements y If absent suggests: weakness or paralysis y Note the following abnormalities y 1. Amelia- absence of entire limb y 2. Phocomelia- absence of arms or legs y 3. Hemimelia- absence of hands or feet

PHOCOMELIA

ERBS PALSY

SIGNS AND SYMPTOMS

OF MORO RERLEX IN THE AFFECTED SIDE y 2. INCOMPLETE TONIC NECK REFLEX y 3 DECREASE SENSORY AND MOTOR FUNCTION
y 1. ABSENCE

TREATMENT
y Abduction with external rotation of the

affected arm and immobilize with FIGURE EIGHT or AIRPLANE SPLINT

ORTOLANI TEST

HIP DISLOCATION/DYSPLASIA

PAVLIK HARNESS

HIP SPICA CAST

BRYANT S TRACTION

Management:
y 1. EXERCISE y 2. Application of LEG cast y check the following: y = Color y = Pulse y = Temperature y = Capillary refill

EQUINOVARUS

EQUINOVARUS
y Characterized by: y = plantar flexion ( toes pointing down ) y = inversion ( toes pointing inward ) y OTHER TYPES: y = eversion ( toes pointing outward ) y = calcaneus ( toes pointing upward )

Management:
y 1. Exercise y 2. Application of cast y 3. Arthrodesis y 4. Dennis Browne application

LEG CASTING

SCOLIOSIS

MILWAUKEE BRACE

POST HARRINGTON RODS APPLICATION

SPINA BIFIDA

Incomplete closure of the vertebrae

y Types: y 1. OCCULTA- HIDDEN; no protrusion of Spinal

contents tho manifested by tuft of hair, dimple and small mass y 2. Cystica- with protrusion of the spinal contents; maybe y A. Meningocele- protrusion of meninges and CSF y B. Myelomeningocele- protrusion of CSF, Nerve roots, Meninges, and Spinal cord y C. Rachischisis- protrusion of SC and Meninges

HYDROCEPHALUS

SIGNS and back y 1. SAC at the SYMPTOMS

y y y y y y y y y y y y

Management: A. Protect the sac from rupture thru = prone with hips abducted and head slightly elevated = apply sterile donut ring = cover with sterile saline dressing and change every two hours 2. Increase ICP related to Hydrocephalus w/c include a. MACEWEN- cracked pot sound b. BOSSING- protuberant forehead c. SUNSET- iris lower than sclera d. bulge and tense fontanel e. high pitch and shrill cry f. change in LOC g. change in VS

y 1. proper position y 2. avoid straining y 3. regulate flow rate of the IV accurately avoid

management

over infusion y 4. give drugs as ordered like:

y A. Mannitol- osmotic diuretic y B. Steroid- Dexamethasone

y C. Acetazolamide ( Diamox ) decreases production of

CSF temporarily 5. If possible avoid LP due to Brain herniation 6. Use or apply protective devices 7. Passive ROM 8. Intermittent straight catheterization to empty the bladder 9. Avoid constipation

surgery
1. Excision of the sac 2. Shunting- divert CSF to decrease and prevent increase ICP a. Ventriculoperitoneal

b. Ventriculo atrial Note: observe for signs of shunt malfunction

pr g

sis

y Depends on: y 1. location of the defect- the lower the defect the better chance y 2. Availability of treatment

SHUNTING

JAUNDICE

Sickle Cell Anemia

y Complications y Pain

Lethargy Lifelong anemia (low red blood count) Organ failure Stroke

HEMOPHILIA

y When a female with hemophilia has children, she will

pass the gene to each of her sons.