PEDIA Presentation

ESSENTIAL NEWBORN CARE and Pediatric care

Mrs. Aurisita M. Delos Reyes, RN, MAN

FOUR PRIORITIES1. AIRWAY

2. TEMPERATURE MAINTENANCE

3. TIMELY CUTTING OF THE CORD

4. UNINTERRUPTED BREASTFEEDING

1. Establish and maintain patency of the airway

Do a quick assessment on breathingStimulate to cry by rubbing the skin

particular attention on back and chestSuctioning ( optional )= duration- 5-10 sec or < 5 secs in

preterm= mouth before nose

Positioning

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

= 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 NB1. The thermoregulating center is

immature2. Shivering mechanism of the NB is

underdeveloped.3. Inadequate adipose tissues (Brown fat)4. Neonates are prone to heat loss thru

evaporation, radiation, convection, and conduction.

NURSING MANAGEMENT:1. SKIN TO SKIN CONTACTTransfers the following HEAT LOVE Normal Bacterial Flora2. DRY and WRAP THE NEWBORN3. EXPOSE TO DROPLIGHT ( if necessary)4. Delay Bath until 6 hours

complications1. HYPOGLYCEMIA results from utilization

of glucose in the form of glycogenNormal blood sugar-

35 – 60 mg%2. METABOLIC ACIDOSIS- breakdown of fats-

accumulation of fatty acids3. RESPIRATORY DISTRESS

III. Promote adequate circulation Factors that influence circulatory

changes after birth Lung expansion Cutting of the umbilical cord

a. LUNG EXPANSIONIncrease pressure in the LEFT side Heart

Closure of fetal structures (Foramen ovale and Ductus Arteriosus)

Nursing care:1. stimulate to cry=except if Preterm ( Conserve energy)2. proper position

3. administer INDOMETHACIN as ordered

b. Cutting of the umbilical cordDecrease pressure in the RIGHT side of the

Heart

Closure of the DUCTUS VENOSUS and UMBILICAL BLOOD VESSSELS

4. Bonding - a special mutual relationship

between mother and infant. Ideally started on the FIRST PERIOD OF REACTIVITY.

METHODS:1. BREASTFEEDING= immediately after birth2. EYE TO EYE CONTACT= Crede’s Prophylaxis maybe delayed for 2

hours 3. ROOMING- IN4. HUGGING, CUDDLING, and EMBRACING

PURPOSES OF BREASTFEEDING1. BONDING2. FACILITATES RELEASE OF

COLOSTRUM AND BREAST MILK3.STIMULATES PRODUCTION OF

PROLACTIN AND OXYTOCIN4.STIMULATES GASTROCOLIC REFLEX

FACILITATING EARLY and MORE FREQUENT DEFECATION THUS PREVENT JAUNDICE

V.ASSESSMENT TOOLS

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

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:0APPEARANCE- BLUEPR- ABSENTGRIMACE- NO RESPONSEMUSCLE TONE- LIMPRESPIRATION- ABSENT

ONEACROCYANOTIC< 100GRIMACESOME FLEXIONWEAK CRY

TWOCOMPLETELY PINK>100STRONG CRY,SNEEZE, COUGHALL FLEXEDSTRONG CRY

INTERPRETATION

0-3= POOR,SERIOUS,SEVERELY DEPRESSED;

CPR4-6FAIR,GUARDED, MODERATELY DEPRESSEDNEEDS SUCTIONING & FURTHER

OBSERVATION7-10GOOD, HEALTHY

SILVERMANN AND ANDERSONPURPOSE:TO DETERMINE THE DEGREE OF

RESPIRATORY DISTRESSHIGH RISK BABIESAS NECESSARY

CRITERIA:NASAL FLARINGUPPER AND LOWER CHESTXIPHOID RETRACTIONSEXPIRATORY GRUNT

INTERPRETATION:0-3Good or healthy; no respiratory distress4-6Fair, Guarded with mild respiratory

distress7-10Poor, serious with severe respiratory

distress

Dubowitz/Ballard Exam for Gestational Age

Done on the first 24 hours and twiceUsed by MDTwo criteria:NeuromuscularPhysical Maturity

Neuromuscular

PHYSICAL MATURITYPREMATURESKIN GELATINOUS, TRANSPARENT, VISIBLE BLOOD VESSELSEAR CARTILAGEABSENT/ PLIABLEBREAST NODULE1-2 mmGENITALSMALE- TESTES- UNDESCENDEDSCROTUM- LESS SWOLLEN, FEW RUGAEFEMALE- CLITORIS AND MINORA- PROMINENTSOLE CREASES- ANETRIOR TRANSVERSELANUGOABUNDANT

TERMSMOOTH, PINK,SUPERFICIAL

CRACKING, LESS VISIBLE VEINSFORMED AND FIRM WITH INSTANT

RECOIL3-5 mmPARTIALLY DESCENDEDMORE SWOLLEN AND RUGAEPARTIALLY COVERED BY MAJORA2/3 OF THE SOLE WITH CREASESLESS LANUGO

POST TERMPARCHMENT,DEEP CRACKING,

DESQUAMATES, NO VISIBLE BVTHICK CARTILAGE AND STIFF6 TO 10 mmFULLY DESCENDED; PENDULOUSMARKED SWOLLEN; EXTENSIVE RUGAEMAJORA COMPLETELY COVERS MINORA and

CLITORISENTIRE SOLE with CREASESNO LANUGO

MATURITY RATING SCALETOTAL SCORE AOG (weeks) -10 20 weeks Below 35= PRETERM - 5 22 0 24 35-45 = TERM 5 2610 28 ABOVE 45= POSTERM15 3020 3225 3430 3635 3840 4045 4250 44

Newborn Screening testRA 9288-NBS Act 2004Purposes:Prevent MRPrevent Physical defectsPrevent Death

Diseases included in the NBS1. Phenylketonuria- inborn error of CHON

metabolism2. Galactosemia- inborn error of CHO

metabolism3. Cretinism- inborn error of metabolism4. Glucose 6 phosphatase Dehydrogenase

deficiency5. Congenital Adrenal hyperplasia

Done bet. 48-72 hours

Blood heelprick ( 4 drops blotted on paper

Results 2 to 3 weeks

Php 600

VI. IDENTIFICATION- preferably in the

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

STRAWBERRY MARKS

STRAWBERRY MARKS-(Nevus vasculosus)Elevated areas formed by immature

capillaries and endothelial tissuesPORTWINE STAINS-(Nevus Flammeus )

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

TELANGIECTASIS NEVI=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)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 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

RR- 80 breaths/min at birth; stabilize bet. 30-60 breaths/ min

= rapid, irregular, with normal physiologic apnea of <15 sec. per min

= shallow but quiet= abdominal and diaphragmatic

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

low if asleep= sites= Apical pulse Brachial Femoral- if weak or absent

suggest COA Pedal

TEMPERATURE

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

X. PHYSICAL ASSESSMENTInfant and young childrenCHEST first before headBeginning School period=

CEPHALOCAUDAL

A. CHESTASSESS :

1. retractions2. BREATH SOUNDSa. absence- inexpansion of the lungs as

in RDS = assymetrical- DIAPHRAGMATIC

HERNIAb. 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

a birth defect resulting to crowding of the abdominal organs in the chest cavity thus leading to collapse of the lungs

= Two typesLeft sided- BOCHDALEK HERNIARight sided-MORGAGNI HERNIA

Signs and Symptomsdifficulty breathingfast breathingfast heart ratecyanosis (blue color of the skin)abnormal chest development, with

one side being larger than the otherabdomen that appears caved in

(concave)A baby born with a Morgagni hernia

may or may not show any symptom

Treatment may include:neonatal intensive care Mechanical ventilatorExtra corporeal membrane oxygenator

surgery

RESPIRATORY DISTRESS SYNDROME=also known as HYALINE MEMBRANE

DISEASEcause: unknownBasic defect: lack or deficiency of

surfactantPredisposing factors:1. Prematurity2. LBW/ SGA3. Born CS4. LGA

MANAGEMENT1. CPAP/ CPPB( Continues + aAirway Pressure) aims to keep alveoli open thus prevent

atelectasis2. O2 therapy- kept at 40 % to prevent blindness (

Retrolental Fibroplasia ) and Emphysema ( Bronchopulmonary Dysplasia )3. INCUBATION= purposesa. Provide warm environment to conserve energy= temp- 34.4oC and humidity @ 55-65%b. Prevent Infection thru Reverse Isolation4. Medications:a. Steroid ( Betamethasone )= promote surfactant maturationb. Surfactant ( Beractant ) given intratrachealc. Na HCO3- correct acidosis

d. Gamma/ Immunoglobulin

4. MINIMAL HANDLING5. TOUCH THERAPY6. Watch for Complications like a. ANEMIA results from smaller mass of

RBC and frequent extraction of bloodManagement: BT with PRBC ( 50 ML ) b. HYPERBILIRUBINEMIA managed by

phototherapy and exchange transfusion c. MALNUTRITION related to too

much utilization of Oxygen resulting to poor growth and development

Management:1. TPN2. Gavage3. Breastfeeding

Factors affecting prognosis

1. AGE2. AVAILABILITY OF TREATMENT3. RESPONSE TO TREATMENT

BRONCHIOLITISSelf- limiting; Acute phase 1st 48 to 72 hrsA viral infectionInflammation of the bronchioles causing

obstruction of the entrance and egress of air leading to overdistention of alveoli

Common to infants below 18 mosSigns and symptomsWheezes, fever, respiratory distress

Management1. Mist or Croup tent ( O2 8 to 10 l/min)= decrease Airway resistance = keep child dry at all times= monitor VS2. Proper positioning = head elevated during

acute distress3. Aspiration precaution4.Medications:

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

CroupInflammation of the bronchi, trachea , and

larynxMaybe caused by bacteria or virusCommon to infants and young childrenMost severe type EpiglotittisNever inspect throat = precipitate complete

airway obstructionHave tracheostomy set always available at

bedside

Signs and Symptoms1. Inspiratory stridor2. Tripod position3. Respiratory distress4. cherry red epiglottisManagementSame as BronchiolitisMedication include anti bacterial

B. HEAD 1.Fontanels

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

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

HYDROCEPHALUS and CRETINISM= it closes 12 to 18 months

Posterior fontanelCharacteristicsTriangle in shapeLocated between lambdoidal and sagittal

suturesMeasures 2 cm long and 1 cm wideCloses between 2 to 3 mos

craniosynostosis or craniostenosisPremature closure of the fontanels and

suturesComplications1. INCREASE ICP2. MENTAL RETARDATION3. BRAIN HERNIATION4. DEATH

CAPUT SUCCEDANEUM

Caput SuccedaneumSwelling of the scalpCaused by prolong second stage of laborIt crosses the suture line thereby affect both

sidesDisappears in 2 to 3 days

CEPHALHEMATOMA

cephalhematomaCaused by increase pressure of birthleading to rupture of capillariesDoes not cross the suture line thereby affects

one sideDisappears in 3 to 4 weeksA birth injury and may aggravate jaundice

craniotabesLocalized softening of the cranial bonesCause= early lightening ( descent of the

presenting part in the pelvic brim )Common to firstborn babiesDisappears 6 weeks

MOLDING

B. FaceAssess for BELL’S PALSY

A birth injury caused by FORCEPS

managementFeed baby with droppers and syringe and

connect to artificial nippleRATIONALE: TO PREVENT PREMATURE

DISAPPEARANCE OF THE SUCKING REFLEX

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

accomodation= if keyhole COLOBOMA= lacrimal duct= immature ( tearless )TEST x BLINDNESS1. DOLL’S EYE2. GLABELLAR’ TAP TEST= best done first ten days

COLOBOMA

EXOTROPIA STRABISMUS

ESOTROPIA STRABISMUS

MANAGEMENT Immediate treatment for non physiologic

strabismus1. Occlussion therapy2 Surgery- SQUINT Operation3. Corrective Glasses4. Laser therapy

Assessment of the EarsNote:Infant and below three yearsPULL PINNA DOWN and BACKAbove threePULL PINNA UP and BACK

EARS (PINNA ) ASSESSMENT

Note: if set lower- abnormal Chromosomal defects- Down

syndrome= Patau syndrome= Edward diseaseKidney defectsCraniofacial defects

DOWN SYNDROME/TRISOMY 21Cause = unknownPredisposing factor=ADVANCE

PARENTAL AGEBasic defect= presence of three ( 3)

chromosome 21 ( trisomy )Total no. 47Dx tests1. Alpha feto protein = low2. Chorionic villi sampling3. Karyotyping LIFE SPAN= VARIABLE

CHARACTERISTICSMicrocephalyLow set earsSaddle noseSmall mouth with large tongue

( macroglossia )Short neckShort and stubby digits with single

transverse line ( SIMIAN CREASE )Hypotonic musculatureProtuberant abdomenSmall penis with undescended testes

( Cryptoorchidism )MENTAL RETARDATION

COMMON PROBLEMS1. CARDIAC DEFECTS2. GIT DEFECTS- ESOPHAGEAL ATRESIA3. GUT DEFECTS

CRANIOFACIAL DEFECT

NOSE

noseAssess nasal flaring/ respiratory distressCauses1. OBSTRUCTIONa. secretionsB.. bone or membraneCommonly blocking the choana or posterior

nares CHOANAL ATRESIA2. LACK OF SURFACTANT

mouthassess1. EPSTEIN PEARLSWhite glistening epithelial cysts at the

palate and gums, caused be extra load of Calcium

2. TOOTHNeeds extraction to prevent ASPIRATIONCaused by too much intake of vitamins3. excessive drooling of saliva

ESOPHAGEAL ATRESIA4. CLEFT LIP AND PALATE5. ORAL CANDIDIASIS

vomitingNon-projectile- non obstructive1. infection2.chalasia or GERDPROJECTILE- obstructive1. pyloric stenosis2. intussusception3. hirchsprungs disease

GASTROINTESTINAL DISORDERS

CLEFT PALATE

Causes:geneticFolic acid deficiencySteroidExposure to TORCH

Common problems:feeding difficultyinfections- upper respiratory and

earspeech defect ( cleft palate )dental defect ( nasal twang )altered normal body imagerespiratory distress

Pre operative care Proper positioning especially during and after 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 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

surgeryRule of 1010 weeks old10 grams hemoglobin10 lbs weightPalatoplastyBefore speech developmentBetween 8 to 18 monthsWatch for Respiratory Distress and

Hemorrhage

CHEILOPLASTY AND PALATOPLASTY

ESOPHAGEAL ATRESIA failure of the esophagus to form a

continuous passage between the mouth and the stomach

= a congenital defect = often associated with other defects = assessment include VACTERL V- ertebral defects A- norectal defects C- ardiac like PDA ( most

common ) T- rachea and E- sophagus R- enal defects L- imbs Cause: unknown but common in

children with Down Syndrome

Signs and Symptoms 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-raysTreatment: Surgery- depends on the type

of defect Creation of gastrostomy and cervical

esophagostomy Division of Fistula and Esophageal

Anastmosis Closure of the gastrostomy

Nursing care: 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= introduction of hypertonic solution

into the SVC thru a central line inserted in the neck, arm, and groin veins

= the solution contains sugar, fats ,protein, minerals and vitamins

ORAL MONILIASIS /CANDIDIASIS

MONILIASIS/ CANDIDIASISAcquired by the baby during passageCause: Candida AlbicansManagement:Antifungal ( Nystatin ) spread with gloved

finger

neckShort THYROID GLAND- not palpable test for CRETINISM –T3 T4 detMENTAL RETARDATIONTx- SYNTHROID

CONGENITAL TORTICOLLIS

= also known as wry neck= contraction of the

sternocleidomastoid muscle= maybe treated by: EXERCISE APPLICATION OF WARM PACKS

OR COMPRESS TENOTOMY- surgical release of

contracted muscle

ABDOMENDOME and CYLINDRICALSCAPHOID- DIAPHRAGMATIC HERNIALIVER= 2-3 cm BELOW RIGHT COSTAL

MARGINKIDNEYS= 1-2 cm above umbilicusSPLEEN= left quadrant

OMPHALOCELE

GASTROSCHISIS

OMPHALOCELEProtrusion of the abdominal organs thru the umbilicus

Usually contained in a sacProne to infectionManagement:Cover the defect with sterile saline dressing

and preferably change every two hours

GASTROSCHISISProtrusion of abdominal organs thru a defect or a hole in the abdominal wall

Very prone to InfectionManagement:1. Reduction Process thru a Silastic Silo2. Use overhead warming unit3. Prophylactic antibiotic2. Surgery

Pyloric Stenosis

Narrowing of the pylorus due to thickening of the pyloric muscleSigns and Symptoms1. projectile vomiting ( maybe bloody )

2. visible peristalsis3. palpable olive shaped mass4. irritable and restless

NURSING CARE1. Give thickened formula= Rice Cereal and Milk thru gavage2. Prevent and correct dehydration= IV fluids3. Measure I and O4. Monitor for Complications such as:a. Metabolic alkalosis and acidosisb. Dehydration

Surgical mgtFREDET RAMSTED PROCEDURE ( PYLOROMYOTOMY )= separation of the hypertrophied muscle of

the pylorus without mucosal incisionLAPAROSCOPY

INTUSSUSCEPTION

= invagination or the telescoping of the small bowel into the large bowel

= may occur as early as 3 weeks old manifested by

abdominal painprojectile vomiting with bile or

fecaloidsausage shaped masspassage of CURRANT jelly- bloody and

mucoid stool

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

TX: BARIUM ENEMASURGERY: BOWEL RESECTION with

END to END ANASTOMOSISBOWEL MILKING

HIRSCHPRUNGS DISEASE

Hirchsprungs/ Aganglionic MegacolonAbsence of ganglion nerve cells resulting to

the absence of peristalsis in the affected segment

Accumulation of intestinal materials leading to

MEGACOLON

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

Diagnostic tests: Barium Enema Rectal exam Anorectal biopsy- most reliable

Treatment:SurgeryColostomySwenson and SoaveClosure of Colostomy

Nursing care: Pre operative1.Daily enema- for retention olive oil or diluted antibiotic

i.– for non retention- isotonic saline solution2.Small but frequent meals of low residue3.Measure abdominal circumference daily4.Position with head elevated to ease breathing5.Administer drugs as ordered. Ex. Stool softeners6.Oral hygiene7.Psychosocial support

ANOGENITALTHREE TYPES OF STOOLSMECONIUM- green black , sticky, odorless, passed 4X per day

TRANSITIONAL- yellow-green, slimy, 6X or more

MILKa. Breast fed baby stoolB. Bottle fed baby stool

BREAST FED BABY STOOLCharacterisitics:

Golden yellowMushy and softSweet odorPassed every after breastfeeding

BOTTLE FED BABY STOOLCharacteristics:

Pale yellowHard and formedOffensive, foul odorPassed once/ day

IMPERFORATE ANUS

Signs and Symptomsabsence of anal opening misplaced anal opening anal opening very near the vaginal opening in

the female no passage of first stool within 24 to 48 hours

after birth stool passed by way of vagina, base of penis

or scrotum, or urethra abdominal distention

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

Voiding=expected to void 6 to 8x on 1st 24 hours

= failure may suggest dehydration or absence of urinary meatus

=After 24 hrs= 12 to 20X/ day= failure means renal agenesis

GENITOURINARY DEFECTSASSESS:

1. LOCATION OF THE URINARY MEATUS, maybeA. Epispadias- urinary meatus above or dorsal surface of the penis

B. Hypospadias- urinary meatus located at ventral surface or under penis

management: MEATOPLASTY

HYPOSPADIAS

CRYPTOORCHIDISM

UNDESCENDED TESTESCOMPLICATIONS:1. Inguinal Hernia2. Testicular cancer3. SterilityManagement:1. Hormonal tx- HCG & TESTOSTERONE

2. ORCHIOPEXYor ORCHIDOPEXY

HYDROCELE

ACCUMULATION OF INTRAABDOMINAL FLUID IN THE SCROTUMTYPES:1. NON- COMMUNICATING2. COMMUNICATING needs elective repair to prevent HERNIA

NOTE: Trans illumination may reveal fluid or loop of intestines

EXTREMITIESAssess for symmetrical movementsIf absent suggests: weakness or paralysis

Note the following abnormalities1. Amelia- absence of entire limb2. Phocomelia- absence of arms or legs

3. Hemimelia- absence of hands or feet

PHOCOMELIA

ERBS PALSY

SIGNS AND SYMPTOMS1. ABSENCE OF MORO RERLEX IN THE AFFECTED SIDE

2. INCOMPLETE TONIC NECK REFLEX

3 DECREASE SENSORY AND MOTOR FUNCTION

TREATMENTAbduction 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:1. EXERCISE

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

EQUINOVARUS

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

Management: 1. Exercise

2. Application of cast

3. Arthrodesis

4. Dennis Browne application

LEG CASTING

SCOLIOSIS

MILWAUKEE BRACE

POST HARRINGTON RODS APPLICATION

SPINA BIFIDA

Incomplete closure of the vertebraeTypes:1. OCCULTA- HIDDEN; no protrusion of

Spinal contents tho manifested by tuft of hair, dimple and small mass

2. Cystica- with protrusion of the spinal contents; maybe

A. Meningocele- protrusion of meninges and CSF

B. Myelomeningocele- protrusion of CSF, Nerve roots, Meninges, and Spinal cord

C. Rachischisis- protrusion of SC and Meninges

HYDROCEPHALUS

SIGNS and SYMPTOMS1. SAC at the backManagement: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 hours2. Increase ICP related to Hydrocephalus w/c

includea. MACEWEN- cracked pot sound b. BOSSING- protuberant foreheadc. SUNSET- iris lower than sclera d. bulge and tense fontanele. high pitch and shrill cryf. change in LOCg. change in VS

management1. proper position2. avoid straining3. regulate flow rate of the IV accurately

avoid over infusion4. give drugs as ordered like:

A. Mannitol- osmotic diureticB. Steroid- DexamethasoneC. Acetazolamide ( Diamox ) decreases

production of CSF temporarily5. If possible avoid LP due to Brain herniation6. Use or apply protective devices7. Passive ROM8. Intermittent straight catheterization to empty the

bladder9. Avoid constipation

surgery1. Excision of the sac2. Shunting- divert CSF to decrease

and prevent increase ICPa. Ventriculoperitonealb. Ventriculo atrial

Note: observe for signs of shunt malfunction

prognosisDepends on:1. location of the defect- the lower the defect the better chance

2. Availability of treatment

SHUNTING

JAUNDICE

Sickle Cell Anemia

ComplicationsPain

LethargyLifelong anemia (low red blood count)Organ failureStroke

HEMOPHILIA

When a female with hemophilia has children, she will pass the gene to each of her sons.