Upload
katrina-lao-lim
View
166
Download
4
Embed Size (px)
Citation preview
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.