Essential Intrapartum and Newborn Care Duration of suctioning: 10 sec

Four Priorities Stimulated reflex when the baby is

suctioned in the nose: REFLEX
A. FOUR PRIORITIES OF EINC INHALATION
● Immediate and Thorough Drying of the Skin
● Early Skin to Skin Contact Prolonged suctioning result to hypoxia and vagal
● Properly Timed Cord Clamping stimulation
● Non-separation of the Newborn from the - Suction mouth 1st before nose
Mother for Early Breastfeeding (90 minutes) Reason: to remove the secretions found in
the throat of the baby so that the secretions
Board Q. will not get inside trachea and will prevent
● What is the most rapid period? Infancy ASPIRATION
● What is the slowest period? School Age
● RA 7600 - AN ACT PROVIDING Babies are NOSE BREATHERS (reflex
INCENTIVES TO ALL GOVERNMENT AND inhalation)
PRIVATE HEALTH INSTITUTIONS WITH
ROOMING-IN AND BREASTFEEDING ● Position NB prone on top of Mom
PRACTICES AND FOR OTHER Purpose: In order to drain secretion, to
PURPOSES facilitate breastfeeding
● EO 51 - milk code Sign that the baby is ready for BF:
crawling reflex
Neonate - first 28 days
Antepartum (during pregnancy), intrapartum Prone positioning in infant below 6 mos is linked to
(during labor and delivery) and postpartum (after the development of SIDS (sudden infant death
delivery) syndrome)

_________________________________________ LUNG EXPANSION

● INCREASE PRESSURE IN THE LEFT
Immediate and Thorough Drying of the Skin
SIDE HEART (rationale: this will promote
● Rubbing 30 secs or until the NB responds
the CLOSURE OF FETAL STRUCTURES
by crying
(FORAMEN OVALE AND DUCTUS
- Rubbing should be vigorous
ARTERIOSUS)
- Purpose: to expand the lungs by
shifting the oxygen to the baby
If di nagsara ang foramen ovale, it will lead to
because their lungs are
ATRIAL SEPTAL DEFECT (may butas in between
ATELECTATIC (naka collapse)
atria)

● Stimulates lung expansion in order to

Board Q.
receive airway
● How many hours does ductus arteriosus
close? 24 hrs.
● Assess Breathing (if may airway, no need to
suction)
● First to close: Foramen Ovale

● Suction if Necessary/optional (mouth before

● Pano paiyakin ang baby: galawin yung
nose x 5 to 10 secs.)
talampakan/pitik
- Who to suction? Those infants who
developed ASPHYXIA NEONATORUM
Early Skin to Skin Contact
Asphyxia Neonatorum - failure of the baby
to breathe in 60 seconds (di nag respond or
Purpose:
umiyak in 60 seconds)
 - To prevent hypothermia (desired temp: 36.5 c. Transfer love to the NB (Bonding)
to 37.5 c)
- To transfer normal bacterial flora _________________________________________
(STAPHYLOCOCCUS AUREUS) that
Properly Timed Cord Clamping
serves as the protection of the baby against
● done after 1 to 3 minutes or after placental
bacteria and to stimulate produce own
pulsation has stopped
antibodies.
Benefits:
- To transfer love and initiate bonding (one
● additional 50 to 100 ml of blood (it contains
way to promote bonding is by skin to skin
more Fe, more antibodies - IGG, hormones,
contact)
enzymes)
What regulates the metabolism of the
● Place a Bonnet over head
newborn on the 1st 24 hrs? MATERNAL
THYROXINE
Board Q.
● Rationale for placing a bonnet/cap in the
● decrease pressure in the R side of the heart
head and bakit sa ulo lang at di buong
promotes closure of fetal accessory
katawan: Kasi yun yun largest part ng
structures
baby, kaya if expose yan, magkaka heat
loss by evaporation
● apply cord clamp 2cm from base
● Initial bath at 6 to 8 hours after birth
● apply forcep 5cm from base
Board Q.
● cut just after cord clamp (no milking)
● How many hours should it take you before
Why no milking? Ma force yung blood at
you can give a bath to the baby? 6-8 hrs
mag dedevelop ng circulatory overload.
Madedestruct rbc that will contribute to the
● Prevention of hypothermia: by delaying the
development of JAUNDICE
bath by 6-8 hrs (bakit dinedelay? Para mag
STAY yung vernix caseosa because it acts
Cutting of the umbilical cord can cause
as an insulator and it has bacteriostatic that
DECREASE PRESSURE IN THE RIGHT SIDE OF
prevents the multiplication of bacteria)
THE HEART -> CLOSURE OF THE DUCTUS
nawawala rin vernix in 24 hours
VENOSUS AND UMBILICAL BLOOD VESSELS
● DONT use soap when bathing the baby
PROMOTE ADEQUATE CIRCULATION
(alkaline kasi yung soap, use non-alkaline
FACTORS THAT INFLUENCE
solution instead)
CIRCULATORY CHANGES AFTER
BIRTH:
● Ginagamit minsan ang oil in giving bath to
- LUNG EXPANSION
preterm babies kasi konti lang vernix
- CUTTING OF THE UMBILICAL
caseosa nila
CORD
Good to know lang: kaya maasim daw minsan
Remember: what communicates veins? Ductus
yung panty kasi merong lactic acid (yung lactic acid
venosus, umbilical vein, inferior vena cava
nag pprevent sa infection)

What communicates arteries? Ductus arteriosus,

pulmonary artery, aorta
Benefits from Skin to Skin contact:
After cutting the cord, check the umbilical cord’s
a. Transfer heat
blood vessel: there should be 2 arteries and 1 vein
b. Transfer of normal bacterial flora
(if may kulang - indication na may congenital pag bf kasi sufficient na yung breastmilk for
defect) hydration)

Bawal na takpan ng bigkis yung cord, expose lang ● stimulates the release of Prolactin by the
sa air APG (milk production) and Oxytocin by the
Posterior Pituitary gland (happy hormone
How many days will it take for the umbilical cord to and let down reflex)
fall? 7-10 days (first it will turn blue then brownish Hormone that stimulates milk
black) production: prolactin
Hormone that is responsible for milk
Do not apply betadine because it contains iodine, ejection/let down reflex: oxytocin
and can cause allergy
● stimulates uterine contraction post-partum
Nursing Responsibilities: to prevent bleeding
● Observe for s/s of infection
Infection ng pusod: OMPHALITIS ● promotes uterine involution - yung pagbalik
First sign of Omphalitis: REDNESS ng organs sa normal condition
(rubor), tumor (swelling) , calor (heat) , dolor How many weeks will it take to go back to
(pain) and presence of puss, drainage pre-pregnant condition? 4-6 weeks
Management of Omphalitis: antibiotic IV
● stimulates the baby to pass out meconium
_________________________________________ early and more frequently which may
promote excretion of bilirubin (it stimulates
Non-separation of the Newborn from the Mother
gastrocolic reflex/peristalsis)
for Early Breastfeeding (90 minutes)
● promotes special mutual relationship
● promotes infant’s brain development and
between mother and baby (Bonding)
intellect (Taurine)

● stimulates the release of Colostrum and

● boosts baby’s immune system (WBC,
Breastmilk
Macrophages, IgA, Lactoferrin)
- As early as 5th month of
pregnancy, mother is producing
● economical and readily available
colostrum
- Antibody in breastmilk: IgA
Note: If exclusive for the first 6 months, a natural
- Mas mataas protein ng colostrum
contraceptive by inhibiting ovulation (LAM)
kesa breastmilk
Protein in colostrum: lactoglobulin
MGA BAWAL SA BUNTIS
Protein of breastmilk: lactalbumin
- Mas mataas carbohydrates ng
breastmilk kesa colostrum
- Carb of milk is called: LACTOSE

Milk is the poorest source of iron

Breast Milk has 2 parts:

Unang lumalabas: foremilk - rich in
protein, carb, fats
Dulong lumalabas: hindmilk: sufficient in
water (kaya di binibigyan ng water ang baby
Advise to eat Galactogogues and drink a lot of - PHYSIOLOGIC
water HYPOPROTHROMBINEMIA - this will
develop due to decrease synthesis of vit k
Galactosemia - common error in n.b
DOSE = 1 mg Term (0.1 ml), 0.5 mg Pre term (0.05
- an inherited metabolic disorder that makes your ml)
body unable to process a sugar called galactose
Route: IM

Site: Thigh muscle: Vastus lateralis, Rectus

B. OTHER PRIORITIES Femoris

1. IDENTIFICATION Board Q.

- preferably in the presence of the parents include: ● Bakit hindi ginagamit ang buttocks as site
Double banding ng injection? Kasi maraming brown fast at
hindi developed ang muscle
Birthmarks are called HEMANGIOMA ● Kelan pwede ang buttocks? When the baby
is walking - indication na may muscle na
_______________________________________ (hindi totoo na baka tamaan yung sciatic
nerve kaya hindi ginagamit yung buttocks
2. CREDE’S PROPHYLAXIS as site)

- Application can be delayed for max 2 hours _________________________________________

- Application of ophthalmic medication to
prevent OPHTHALMIA NEONATORUM 4. ANTHROPOMETRIC MEASUREMENTS
(neonatal sore eyes)
BIRTHWEIGHT: 2.5-3.4 kg or 5.5-7.8 lbs
MEDICATIONS:
● macrosomia - above normal BW
1. SILVER NITRATE - One percent, 1 drop / eye, ● Microsomia - below normal
Lower conjunctival sac ● HPL (Human placental lactogen) - is a
2. OINTMENTS: Terramycin, Gentamicin, hormone released by the placenta when
Erythromycin, Penicillin (apply inner to outer you're pregnant at 5th month. It helps
canthus to prevent contamination) prepare your body for breastfeeding. It also
________________________________________ regulates metabolism and insulin sensitivity
to make sure the fetus gets enough
3. VITAMIN K INJECTION nutrients. Reason kaya yung ibang baby
medyo mataba
PURPOSE: TO PREVENT BLEEDING

Risks if e.coli is absent: prone to bleeding and Board Q.

jaundice
● At what age do you expect the baby’s birth
CAUSES of bleeding weight to double? At 6th month
● Triples at 1yr
- absence of Normal Bacterial flora (E. coli) ● Quadruples at 2 yrs
Functions of E. Coli
BIRTH LENGTH: 48-54 cm or 18-22 in
- E coli enhances the conversion of bilirubin
to urobilinogen ● Average: 50 cm/20 inches
- DECREASE SYNTHESIS OF VITAMIN K ● Increases by 50% at 1 yr
(vitamin k is important in the production of ● It doubles at the age of 2 yrs: 50% of his/her
PROTHROMBIN) adult height (example 50cm sya ngayon, sa
adult height nya ay 200 cm)
 ● Best way to accurately obtain the length of - CAH
the baby is by starting from the ramp to the - MSUD
crown
Purposes of RA 9288
HEAD CIRCUMFERENCE: 33-35 cm or 13-14 in
- Prevent Mental retardation
● Along eyebrows - Prevent physical abnormalities
● Microcephaly - below 33 cm r/t small brain - Prevent Death
● Macrocephaly - above 35 cm and can be a
- first drop of blood in heel is disposed (2nd, 3rd,
sign of hydrocephalus 4th & 5th drop of blood lang ang collected)
● Hanggang 3 yrs minomonitor head
circumference Newborn hearing test - Can be done anytime

CHEST CIRCUMFERENCE: 31-33 cm or 12-13 in Board Q.

- Along nipple When is the best time to do a newborn hearing
test? When the baby is asleep
ABDOMINAL CIRCUMFERENCE: 29-31 cm or 11-
Pulse oximeter - to obtain oxygen saturation in
12 inches baby’s feet (either right or left), pag kamay (right
- Along the umbilicus only) to detect if may congenital disease
_________________________________________
Interpretation:
5. IMMUNIZATION Below 95%, ranges 90-94 - borderline
Below 90 - abnormal
If the difference of two o2 sat in right hand and foot
is less than 3% - normal
If the difference of two o2 sat in right hand and foot
is greater than 3% - abnormal (the doctor will most
likely order a 2d echo)

Board Q.
When is the best time to obtain a congenital heart
disease screening test? Between 24-48 hrs (1st
two days after baby is born
________________________________________

C. ASSESSMENT TOOLS

1. APGAR SCREENING TEST – by DR. VIRGINIA

_________________________________________ APGAR - DONE TWICE AT 1 AND 5 MINUTES
RESPECTIVELY
6. NEWBORN SCREENING TEST
PURPOSES:
RA 9288 NEWBORN SCREENING ACT 2004
- TO DETERMINE THE DEGREE OF
- Test should be done in 48 TO 72 HOURS ACIDOSIS AND THE NEED FOR CPR
- Specimen is taken in HEEL STICK
- Test result after 2 TO 3 WEEKS
- PHP 600

DISEASES: all of these are genetically acquired

- PHENYLKETONURIA
- GALACTOSEMIA
- G6PDD
- CRETINISM
 - TO EVALUATE ABILITY OF THE NB TO - Used AS NECESSARY
ADJUST EXTRAUTERINE AND THE
PROGNOSIS INTERPRETATION

● 0-3: GOOD, HEALTHY, NO

RESPIRATORY DISTRESS
● 4-6: FAIR, GUARDED, MILD
RESPIRATORY DISTRESS
● 7-10: POOR, SERIOUS, SEVERE
RESPIRATORY

_________________________________________

3. BALLARD TOOL

- To determine gestational maturity

- Used on the 1st 24 hrs, twice
INTERPRETATION - NEUROMUSCULAR MATURITY
- PHYSICAL MATURITY
● 0-3: POOR, SERIOUS, SEVERELY
DEPRESSED; CPR
● 4-6: FAIR, GUARDED, MODERATELY
DEPRESSED, NEEDS SUCTIONING &
FURTHER OBSERVATION
● 7-10: GOOD, HEALTHY

Sequence:
1st - pulse
2nd - respiration
3rd - activity
4th - grimace
5th - appearance/color

Acrocyanosis is NORMAL on the 1st 28-48 hrs.

_________________________________________

2. SILVERMANN AND ANDERSON

PURPOSE:

- TO DETERMINE THE DEGREE OF

RESPIRATORY DISTRESS
- For HIGH-RISK BABIES
 ● Genitals (Female): Labia majora partially
covering the labia minora.
● Sole of Feet: 2/3 of the sole has creases.
● Lanugo (fine body hair): Less lanugo
compared to preterm babies.

POST TERM

● Skin: Parchment-like, with deep cracking,

desquamation (peeling), and no visible
blood vessels (BV).
● Ear Cartilage: Thick and stiff.
● Breast Nodule: 6 to 10 mm.
● Genitals (Male): Fully descended and
pendulous testes.
● Genitals (Female): Labia majora
completely covering the labia minora and
clitoris.
● Sole of Feet: Entire sole has creases.
● Lanugo (fine body hair): No lanugo
(lanugo is typically shed in utero as the
fetus matures).

MATURITY RATING SCALE

PHYSICAL MATURITY

PRETERM/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 D. VITAL SIGNS
● Genitals (Female): Clitoris and minora -
Prominent - Sequence: 1st - rr, 2nd - pulse, 3rd temp,
● Sole creases: Anterior transverse 4th bp (optional)
● Lanugo: Abundant
Respiratory rate:
TERM
● 80 breaths per minute at birth
● Skin: Smooth, pink, with superficial ● Stabilizes between 30 to 60 breaths per
cracking, and less visible veins. minute
● Ear Cartilage: Formed and firm with instant ● Rapid, irregular, with normal physiologic
recoil. apnea of <15 sec per minute.
● Breast Nodule: 3-5 mm. ● Shallow but quiet.
● Genitals (Male): Partially descended ● Abdominal and diaphragmatic.
testes, with more swollen scrotum and ● Observe for rise and fall of abdomen
rugae (folds). ● Normally high at birth because the baby is
trying to adjust extrauterine; will stabilize
 during or at the 2nd period of reactivity Blood Pressure (optional)
about 6-8 hrs after birth
● 80/46 mmHg at birth.
Nursing Responsibility: Observe s/s of ● At 10 days, it may be 100/50 mmHg.
respiratory distress ● Higher in the lower extremities and lower in
the upper extremities.
_________________________________________ ● May be measured by Doppler or Flush
methods.
Pulse Rate:
Note: Blood pressure is no longer optional
● 180 beats per min, stabilizes between 120- beginning at 3 years of age.
160 bpm.
● Rapid and irregular.
● Usually increased when crying and low if
asleep.

Sites: Apical pulse (best site/3rd -4th

intercostal space left MCL), Brachial,
Femoral (if weak or absent, suggests
coarctation of aorta), Pedal.

Radial pulse is normally weak, if strong and

boundy -> indication na may patent ductus
arteriosus

Below 3yrs, apical pulse. 3 yrs above- radial

Maintain Appropriate Temperature

● Temperature of the NB at birth: 36.4°C to

37.2°C.
● Usually unstable and takes 6-8 hours to
stabilize.

Factors Affecting Temperature of the Newborn: E. PHYSICAL ASSESSMENT OF THE

NEWBORN
1. The thermoregulatory center is immature.
2. The shivering mechanism of the newborn is ● Start with the chest instead of the head.
underdeveloped. ● Cephalocaudal direction usually starts in
3. Inadequate adipose tissues (Brown fat). preschool.
4. Neonates are prone to heat loss through
evaporation, radiation, convection, and _________________________________________
conduction.
5. Neonates have a large surface area. ASSESSMENT OF THE CHEST

Complications: Assess:

1. Hypoglycemia results from the utilization of 1. Retractions

glucose in the form of glycogen. 2. Breath Sounds:
○ Normal Blood Sugar: 35 – 60 mg ○ a. Absence of breath sounds:
%. Inexpansion of the lungs.
2. Metabolic Acidosis due to the breakdown ○ b. Wheezes, stridor, rales, or
of fats and accumulation of fatty acids. crackles: Suggests obstruction.
3. Respiratory Distress 3. Witch's milk: Colorless or transparent fluid
caused by maternal hormones.
_______________________________________
________________________________________
FONTANELLES _________________________________________

Types of Fontanelles: CEPHALHEMATOMA

1. Paired: Characteristics:
○ Anterolateral (Sphenoid)
○ Posterolateral (Mastoid) ● Collection/accumulation of blood caused by
2. Single: the rupture of periosteal capillaries due to
○ Anterior (Bregma) increased pressure during birth process.
○ Posterior (Lambda) ● Does not cross the suture line, thus affects
only one hemisphere.
Characteristics: ● Disappears in 3 to 4 weeks.
● Classified as birth injury and a contributing
1. Anterior Fontanelle: factor to jaundice
○ Diamond-shaped.
○ 3-4 cm long and 2-3 cm wide. _________________________________________
○ If >5 cm, it may be a sign of
hydrocephalus or cretinism. CRANIOTABES
○ Closes between 12 to 18 months.
2. Posterior Fontanelle: ● Localized softening of the cranial bones
○ Triangular-shaped. (Parietal).
○ Located between the lambdoidal and ● Cause: Early lightening (descent of the
sagittal sutures. presenting part in the pelvic brim).
○ Measures 2 cm long and 1 cm wide. ● Common to first born babies.
○ Closes between 2 to 3 months. ● Disappears in 6 weeks.
○ flat , has pulsations
○ If sunken = dehydrated, hungry _________________________________________
○ If tense/bulging = presence of
increased icp MOLDING

_________________________________________

Craniosynostosis / Craniostenosis:

● Premature closure of the fontanels and

sutures.

Complications:

1. Increase in intracranial pressure

(ICP).
2. Mental retardation.
3. Brain herniation.
4. Death. _________________________________________

_________________________________________ ASSESSMENT OF THE FACE

- Symmetrical.
CAPUT SUCCEDANEUM
● Facial asymmetry may indicate Bell’s Palsy
Characteristics: or facial nerve paralysis (Cranial Nerve 7).

● Swelling of the scalp caused by prolonged Bell’s palsy

second stage of labor.
● It crosses the suture line, thus affects both - is a birth injury and r/t to an outlet forcep
sides. extraction.
● Disappears in 2-3 days. No special tx is - Resolves within 24 hrs, disappears on its
necessary own
 - Sucking reflex is affected COLOBOMA - congenital anomaly

Management of Bell’s Palsy:

● Feed the baby with droppers and syringes.

● Encourage breastfeeding.
● Aspiration precaution: To prevent
premature disappearance of the sucking
reflex.
● Suckling is better than sucking kasi sa
suckling, included yung areola. Purpose of
including areola is to stimulate the milk
● If nipple lang, nagkaka nipple soreness
STRABISMUS - squint defect

2 types of Strabismus:

Exotropia/Strabismus: Eye deviates outward

ASSESSMENT OF THE EYE (muscle is the problem and not the eyes)
- needs to be treated to prevent AMBLYOPIA
● Slate blue or gray in color.
● Some eye color doesnt change due to the Amblyopia - blindness r/t strabismus
production of melanin/melanocytes by the
posterior pituitary gland. Esotropia/Strabismus: Eye deviates inward.
Disease is: phenylketonuria - resolves in 6 mos, kusang nawawala
s/s of PKU:
- sobrang maputi Management:
● Pupils: Equal, round, reactive to light and
accommodation. Immediate treatment for non physiologic strabismus
● Keyhole defect: Coloboma.
● Tearless: Immature lacrimal duct. 1. Occlusion therapy - tinatakpan yung isang
Infant shed tears at 2 mos mata to limt stimulus so that the brain will
interpret 1 stimulus
Tests for blindness: 2. Surgery: Squint operation.
3. Corrective glasses - prevents further
1. Doll's eye reflex. damage of eyes
4. Laser therapy - only for 12 y/o and above
- Hold the chin, turn the head of the baby to
one side. (dapat maiiwan yung tingin ng _________________________________________
baby sa object)
ASSESSMENT OF THE EARS (Pinna)
Positive result: infant remains looking at the
object even if the head is turned - Must be aligned at the level of outer canthus
Infant: positive = normal - Low seat of ears = organ na affected is
Negative = abnormal kidney
-Adult: Positive = abnormal ● Note: If set lower than usual, it may indicate
Negative = normal chromosomal defects such as Down
syndrome (trisomy 21) , Patau syndrome
- Best time to do this is at the first 10 days (chromosome 13 is affected), Edward's
following the birth of the infant disease (chromosome 18 is affected) ,
kidney defects, or craniofacial defects.
2. Glabellar tap test (tap in between ● Genetic - patau and edward
eyebrows) : Best done during the first ten ● unknown/idiopathic - down syndrome
days.
Blink reflex = glabellar reflex Board Q.
Ano raw problem na organ pag mababa tenga?
________________________________________ Kidney
________________________________________ ● Assess for nasal flaring, which may indicate
respiratory distress.
DOWN SYNDROME (TRISOMY 21) ● Causes:
1. Obstruction of nose
● Cause: Unknown. Known as CHOANAL ATRESIA
● Predisposing factor: Advanced parental ■ a. Secretions
age. ■ b. Bone or membrane
● Basic defect: Presence of an extra commonly blocking the
chromosome 21 (trisomy 21), leading to a choana or posterior nares
total of 47 chromosomes. (choanal atresia).
● Diagnostic tests: 2. Lack of surfactant - surfactant
1. Alpha-fetoprotein (low). provides alveolar expansion. Kaya
2. Chorionic villi sampling. pag may lack of surfactant, nagkaka
3. Karyotyping. ATELECTASIS
● Life span: Variable.
_________________________________________
Characteristics of Down Syndrome:
RESPIRATORY DISTRESS SYNDROME (RDS)
● Microcephaly.
● Low-set ears. ● Also known as Hyaline Membrane
● Saddle nose. Disease.
● Small mouth with a large tongue ● Most common morbidity in premature
(macroglossia). babies
● Short neck. ● Cause: Unknown.
● Short, stubby digits with a single transverse ● Predisposing Factors:
line (Simian crease). 1. Prematurity.
● Hypotonic musculature. 2. Low birth weight (LBW) or small for
● Protuberant abdomen. gestational age (SGA).
● Small penis with undescended testes 3. Born via cesarean section (CS).
(Cryptorchidism). 4. Large for gestational age (LGA).
● Mental retardation.
Management:
Common Problems:
1. Continuous Positive Airway Pressure
1. Cardiac defects. (CPAP) to keep alveoli open, preventing
2. GIT defects: Esophageal atresia. atelectasis.
3. Gut defects. 2. Oxygen therapy kept at 40% to prevent
blindness (retrolental fibroplasia) and
_________________________________________ emphysema (bronchopulmonary dysplasia).
3. Incubation:
CRANIOFACIAL DEFECTS ○ Purpose: Provide a warm
environment to conserve energy.
○ Temperature: 34.4°C and humidity
at 55-65%.
4. Medications:
○ a. Steroids (Betamethasone) to
promote surfactant maturation.
○ b. Surfactant (Beractant) given
intratracheally.
○ c. Sodium bicarbonate (NaHCO3) to
correct acidosis.
○ d. Gamma/Immunoglobulin.

_________________________________________ Complications:

ASSESSMENT OF THE NOSE:

 1. Anemia: Results from a smaller mass of If vomit has bile = lower intestinal tract
red blood cells (RBCs) and frequent blood obstruction called HIRSCHSPRUNG
extraction. DISEASE
○ Management: Blood transfusion with
packed red blood cells (50 ml). HIRSCHSPRUNG DISEASE is the absence of
2. Hyperbilirubinemia: Managed by ganglia nerve cells (walang peristalsis kaya di
phototherapy and exchange transfusion. makaka poop at yun yung earliest sign)
3. Malnutrition: Related to too much oxygen
utilization, leading to poor growth and ○ Non-projectile (non-obstructive):
development. ■ Causes: Infection or chalasia
○ Management: (GERD).
■ Total parenteral nutrition ○ Projectile (obstructive):
(TPN). ■ Causes: Pyloric stenosis,
■ Gavage feeding. intussusception, or
■ Breastfeeding. Hirschsprung's disease.
■ Not a manifestation of
Factors Affecting Prognosis: increased icp among infants

1. Age. - spitting up occurs when you do not burp the

2. Availability of treatment. baby. They are prone to spit up because of
3. Response to treatment. the IMMATURITY OF THE CARDIAC
SPHINCTER
_________________________________________
- Burp the baby in between feeds and after
ASSESSMENT OF THE MOUTH feeding (ex. After ng isang breast, i burp na
bago yung isa pa ulit)
1. Epstein Pearls: White, glistening epithelial
cysts at the palate and gums, caused by an Frequent burping known as a condition called
extra load of calcium. ACHALASIA - reflux of gastric content
2. Tooth: May need extraction to prevent Management for achalasia: give a thickened
aspiration, often caused by excessive intake formula
of vitamins.
3. Excessive drooling of saliva: May Early symptom that the baby is suffering from an
suggest esophageal atresia. (NORMAL is abnormal condition is POOR SUCKING (except if
di dapat nag produce ng saliva kasi it takes preterm)
3-4 mos bago mag mature yung swallowing
reflex) _________________________________________
Esophageal Atresia - obstruction of the
esophagus CLEFT LIP AND CLEFT PALATE
4. Cleft lip and palate. - genetically acquired. Speech defect is r/t cleft lip
Cleft lip = more common to boys; palate =
more common to girls Causes:

Common cause of cleft lip & palate is FOLIC ACID 1. Genetic.

DEFICIENCY 2. Folic acid deficiency. (recommended is 0.8
mg for preg, 0.4 mg= non preg
IRON SUPPLEMENTATION should begin on the 3. Steroid exposure.
5th month of pregnancy until 6 weeks after 4. Exposure to TORCH (toxoplasmosis,
delivery. rubella, cytomegalovirus, herpes).

5. Oral candidiasis - not seen in the 1st 24 Common Problems:

hrs. The cause is acquiring some of
microorganism, not congenital 1. Feeding difficulty.
6. Vomiting or spitting up: 2. Infections (upper respiratory and ear
- pag sumuka it means may obstruction (if infections).
vomit has blood = upper GI obstruction 3. Speech defects (especially with cleft
called PYLORIC STENOSIS palate).
 4. Dental defects (nasal twang). ○ E: Esophagus.
5. Altered normal body image. ○ R: Renal defects.
6. Respiratory distress. ○ L: Limbs.
● Cause: Unknown but common in children
Preoperative Care for Cleft Lip/Palate: with Down syndrome.

● Proper positioning during and after feeding Signs and Symptoms:

(upright position).
● Burp the newborn more often. 1. Excessive drooling of saliva.
● Feed the baby with a cross-cut large-holed 2. Choking after the initial feeding.
nipple or Breck feeder technique. 3. Resistance to nasogastric tube (NGT)
● Observe for signs of complications (e.g., insertion.
otitis media). 4. Respiratory distress.
● For dental defects, orthodontic exercise and 5. Abdominal distention.
surgery are recommended. 6. Cyanosis, tachypnea.
● Speech therapy. 7. History of hydramnios (antepartum).

_________________________________________ Diagnostic Tests: X-rays.

CHEILOPLASTY / PALATOPLASTY Treatment: Surgery (depends on the type of

defect).
● Surgical repair of cleft lip or palate.
● Creation of gastrostomy and cervical
Postoperative Care for Cleft Lip/Palate: esophagostomy.
● Division of fistula and esophageal
● Proper positioning: anastomosis.
○ Prone for cleft palate. ● Closure of gastrostomy.
○ Supine or side-lying for cleft lip.
● Apply elbow restraints and release every 2 Nursing Care for Esophageal Atresia:
hours.
● Use a rubber-tipped medicine dropper for 1. Proper positioning:
feeding after cleft lip surgery, and paper ○ Elevate the head to a 20-30 degree
cups or soup spoons after cleft palate angle.
surgery. 2. Regular suctioning.
● Cleanse the wound with hydrogen peroxide. 3. Administer oxygen if cyanotic.
● Administer postoperative medications 4. Administer total parenteral nutrition
(analgesics and antibiotics). (TPN) as the primary source of nutrition.
● Avoid sucking, suctioning, blowing, and
sharp objects (e.g., spoon, fork, straw). Total Parenteral Nutrition (TPN) or IV
● Ensure the baby does not suck the Logan’s Hyperalimentation:
bar or bow.
● Introduction of a hypertonic solution into the
_________________________________________ superior vena cava (SVC) through a central
line inserted in the neck, arm, or groin veins.
ESOPHAGEAL ATRESIA ● The solution contains sugar, fats, proteins,
minerals, and vitamins.
● Definition: Failure of the esophagus to form
a continuous passage between the mouth _________________________________________
and the stomach.
● A congenital defect, often associated with Oral Moniliasis/Candidiasis:
other defects. - white cheese like substance
● Assessment includes VACTERL:
○ V: Vertebral defects. ● Acquired by the baby during passage
○ A: Anorectal defects. through the birth canal.
○ C: Cardiac defects (PDA, most ● Cause: Candida albicans.
common). ● Management:
○ T: Trachea.
 ○ Antifungal (Nystatin) spread with a 1 week delaying of treatment will decrease the
gloved finger. IQ by 5 pts

_________________________________________ Congenital Torticollis (Wry Neck):

- Contraction of the sternocleidomastoid muscle.
Pyloric Stenosis:
● Cause: UNKNOWN
● Narrowing of the pylorus due to thickening ● Treatment:
of the pyloric muscle. ○ Exercise.
○ Application of warm packs or
Signs and Symptoms: compress.
○ Tenotomy: Surgical release of
1. Projectile vomiting (may be bloody). contracted muscle.
2. Visible peristalsis.
3. Palpable olive-shaped mass. _________________________________________
4. Irritability and restlessness.
ASSESSMENT OF THE ABDOMEN
Nursing Care:
● Normally dome-shaped and cylindrical.
1. Give thickened formula (e.g., rice cereal and ● If scaphoid: May indicate the presence of a
milk through gavage). diaphragmatic hernia.
2. Prevent and correct dehydration (administer
IV fluids). Palpable organs:
3. Measure intake and output (I&O).
4. Monitor for complications such as: 1. Liver: 2-3 cm below the right costal margin.
○ Metabolic alkalosis and acidosis. 2. Kidneys: 1-2 cm above the umbilicus.
○ Dehydration. 3. Spleen: Left quadrant.

Surgical Management: Other conditions:

● Fredet Ramstedt Procedure ● Gastric capacity: 90 ml with short

(Pyloromyotomy): Separation of the emptying time and rapid peristalsis.
hypertrophied muscle of the pylorus without ○ More secretory glands and larger
mucosal incision. surface area for absorption in the
● Laparoscopy. intestines.
● Reverse peristalsis is common.
_________________________________________
_________________________________________
ASSESSMENT OF THE NECK
Diaphragmatic Hernia:
● Short neck is typical. - protrusion of the abdominal organs in the chest
● Thyroid gland: Normally not palpable in cavity
the newborn.
● Test for cretinism (T3, T4, Thyroid scan). ● A birth defect where abdominal organs
Dwarfism naman tawag pag matanda na crowd into the chest cavity, leading to lung
collapse.
● Symptoms include mental retardation.
Two types:
Board Q.
When is the onset of mental retardation? Below 18 1. Left-sided: Bochdalek hernia.
2. Right-sided: Morgagni hernia.
● Treatment: Synthroid (thyroid hormone
replacement taken in the MORNING, before Signs and Symptoms:
breakfast, for LIFETIME). Also Vitamin D &
calcium for bone development 1. Difficulty breathing.
2. Fast breathing.
3. Fast heart rate.
 4. Cyanosis (blue skin color). ● Definition: Invagination or telescoping of
5. Abnormal chest development (one side the small bowel into the large bowel.
larger than the other).
6. Abdomen that appears caved in (concave). May occur as early as 3 weeks old, manifested
by:
Treatment:
1. Abdominal pain (earliest sign).
● Neonatal intensive care. 2. Projectile vomiting with bile or fecaloid.
● Mechanical ventilator. 3. Sausage-shaped mass.
● Extracorporeal membrane oxygenator. 4. Passage of currant jelly (bloody and mucoid
● Surgery. stool).

Diagnostic Test:

● Lower GI series or barium enema reveals a

coiled spring or staircase sign.
Omphalocele:
Treatment:
● Protrusion of abdominal organs through the
umbilicus. ● Barium enema.
● Usually contained in a sac and prone to ● Surgery (bowel resection with end-to-end
infection. anastomosis).
● Bowel milking.
Management:
_________________________________________
○ Cover the defect with a sterile saline
dressing, preferably changed every Hirschsprung's Disease (Aganlionic
two hours. Megacolon):

_________________________________________ ● Definition: Absence of ganglion nerve cells

resulting in the absence of peristalsis in the
Gastroschisis: affected segment, causing accumulation of
intestinal material and leading to
● Protrusion of abdominal organs through a megacolon.
defect or hole in the abdominal wall.
● Very prone to infection. Signs and Symptoms:
● No covering at all
● Mas prone to infection 1. Non-passage of meconium.
2. Vomiting and abdominal distention.
Management: 3. Chronic constipation.
4. Passage of ribbon-like or pellet stools.
1. Reduction process through a silastic silo. 5. Anorexia, shortness of breath.
2. Use of overhead warming unit.
3. Prophylactic antibiotics. Treatment: Surgery.
4. Surgery.
5. Keep it moist always ● Colostomy.
6. Cover it with saline dressing WITH NSS ● Swenson and Soave procedures.
(change q 2hrs) ● Closure of colostomy.
7. Provide warm environment
8. Minimize exposure to pathogens Nursing Care: Preoperative for Hirschsprung's
Disease:
_________________________________________
1. Daily enema (for retention: olive oil or
Intussusception: diluted antibiotic, for non-retention: isotonic
saline solution).
 2. Small but frequent meals of low-residue ■ Breastfed baby stool:
foods. Golden yellow, mushy, soft
3. Measure abdominal circumference daily. sweet odor; passed after
4. Position with head elevated to ease every breastfeeding session.
breathing.
5. Administer drugs as ordered (e.g., stool Board Q.
softeners). Bakit mushy, soft? Kasi it is easily digested
6. Provide oral hygiene. Bakit sweet odor? Because of the presence of
7. Offer psychosocial support. LACTIC ACID

_________________________________________ ■ Bottle-fed baby stool: Pale

yellow, hard and formed,
ANOGENITAL offensive/foul odor; passed
once per day.
● The newborn (NB) is expected to pass out
stool within the first 24 hours. Common problem in bottle fed/artificial milk is
1. Failure to do so indicates CONSTIPATION. Why? Because of the presence
obstruction, which can be caused of casein (protein of artificial milk) and is difficult to
by: digest.
■ Imperforate anus (walang
butas) Most reliable way to determine the patency of the
■ Hirschsprung's disease intestinal system is the PASSAGE OF MECONIUM
■ Cystic fibrosis (not common)
Problem ng nagttake ng breastmilk is prone sila sa
COLIC (paroxysmal abdominal pain)/kabag

● Three types of stools: _________________________________________

1. Meconium: Green-black, sticky,
odorless; passed about four times IMPERFORATE ANUS
per day.
● Signs and Symptoms:
Board Q. ○ Absence of anal opening
At what time do you expect the meconium to pass? ○ Misplaced anal opening
Within 24 hrs ○ Anal opening very near the vaginal
opening in females
2. Transitional: Yellow-green, slimy; ○ No passage of the first stool within
passed six or more times a day. 24 to 48 hours after birth
○ Stool passed through the vagina,
Physiologic weight loss - 5-10% of
base of the penis or scrotum, or
the birth rate, pero babalik between
urethra
2-3rd week. More than 10% is
○ Abdominal distention
abnormal and an indication of
● Treatment:
dehydration.
○ Surgery in stages:
■ Stage I: Colostomy
Causes of Physiologic weight
(newborn)
loss:
■ Stage II: Pull-through
1. Because of the frequent passage surgery
of transitional stool ■ Stage III: Closure of the
colostomy
2. r/t withdrawal of maternal ● Most reliable way to determine patency is
hormones the passage of meconium

3. sucking/swallowing reflex not UROGENITAL

coordinated w/each other
● Assessment:
3. Milk:
 ○ The NB is expected to void 6 to 8 ○ Usually resolves by 6 months to 1
times in the first 24 hours. year; if not, circumcision is
■ Failure may suggest recommended.
dehydration or absence of a ● If di nag disappear = true phimosis (need
urinary meatus. ma circumcise if meron nito)
○ After 24 hours, the NB should void - As early as 2 days old pwede na i
12 to 20 times per day.
circumcise
■ Failure to void may indicate
renal agenesis (congenital
absence of kidney)
● If does not void in 1st 24 hrs = could mean ● Female Babies:
○ Assess for pseudomenstruation
dehydration
(false menstruation) caused by
● If didnt pass out urine on 2nd day = renal maternal hormone withdrawal,
agenesis leading to the passage of a small
● Pag walang urine - possible walang kidney amount of blood.
● When do fetus produce urine? As early as 3 ● Uric Crystals:
mos after fertilization ○ Pink or brick-red crystals caused by
○ The bladder is stretched and urates.
emptied with about 15 ml of urine. ○ Cause of diaper rash “ammoniacal
● Direction of Urine Flow (Male): dermatitis”
○ A small projected arc suggests the
urinary meatus is in the middle _________________________________________
portion of the penis.
○ Abnormalities: HYPOSPADIAS
■ High arc may indicate
epispadias (urinary meatus ● Abnormal placement of the urinary meatus
located dorsally or above the on the ventral side of the penis. (under
penis). penis)
■ Absence of arc or downward ● Will not lead to infection
flow may indicate
hypospadias (urinary Pag epispadias - meatus is located above/dorsal
meatus located ventrally or surface the penis
below the penis).
● Palpation of the Scrotum: _________________________________________
○ Check for undescended testes
(cryptorchidism). CRYPTORCHIDISM
○ Palms of the examiner must be
warm (rationale: to avoid the ● Undescended testes
stimulation of cremasteric reflex) ○ Complications:
● Transillumination of the Scrotum: ■ Inguinal hernia
○ May reveal: ■ Testicular cancer (NCLEX
■ Transparent fluid known as ques) possible complication
hydrocele. ■ Sterility/infertility
■ Presence of intestinal loops ○ Management:
known as scrotal hernia. ■ Hormonal treatment (HCG &
testosterone)
■ Orchiopexy or orchidopexy
(surgical correction)
● Phimosis:
○ Most male babies have tight foreskin If the testes not descended, age is premature (b.e)
(phimosis). Testes will descend in 37th week of gestation
○ Foreskin should not be retracted ________________________________________
as it may cause laceration.
HYDROCELE
 ● Accumulation of intra-abdominal fluid in the ● Feet of the NB: Normally flat due to fat
scrotum deposits; usually point outward but will
straighten when walking begins.
Diagnostic Test: penlight ● Common Defects:
- iniilawan scrotum ○ Equinovarus -toes points downward
○ Varus (toes points inward)
○ Types: ○ Valgus - toes points outward
■ Non-communicating - ○ Calcaneus -toes points upward
normal
■ Communicating (requires Board Q.
elective repair to prevent Most common defect is Equinovarus (club foot)
hernia)
○ Transillumination may reveal fluid
or loop of intestines.

________________________________________
ERB'S PALSY
ASSESSMENT OF THE EXTREMITIES - r/t excessive traction exerted in the baby’s head,
neck, in the delivery of anterior shoulder
● Assessment:
● Signs and Symptoms:
Symmetrical movements of the arms ○ Absence of Moro reflex on the
affected side.
● Asymmetry suggests weakness or ○ Incomplete tonic neck reflex.
paralysis (Erb’s palsy or brachial ○ Decreased sensory and motor
plexus paralysis). function.
● Treatment:
Abnormalities: ○ Abduction with external rotation of
the affected arm and immobilization
■ Amelia: Absence of an entire with figure-eight or airplane splint.
limb.
■ Phocomelia: Absence of
arms or legs.
■ Hemimelia: Absence of
hands or feet.
● Ortolani Test: Performed to detect hip
dysplasia or dislocation. (positive if may HIP DISLOCATION/DYSPLASIA
click/clank, may resistance nung inabduct)
● Diagnostic Tests:
X-ray is the confirmatory test ○ Ortolani Test - test to determine
congenital hip dislocation
● Legs of the NB: Normally bow legged or ● Treatment:
varus until toddlerhood. ○ Pavlik harness, hip spica cast, or
Bryant’s traction.

_________________________________________

ASSESSMENT OF THE BACK

● Assessment:
○ Flat and straight back
○ The lumbar curve develops at
around 6 months.
○ Look for a tuft of hair, dimple, or
mass, which may indicate spina
bifida.
_________________________________________ Arnold-chiari malformation - downward
displacement of the medulla and the cerebellum
SPINA BIFIDA into foramen magnum which may cause obstruction
in the flow of CSF, thus resulting into
- incomplete closure of the vertebrae HYDROCEPHALUS
● Types: _________________________________________
○ Occulta: Hidden; no protrusion of
spinal contents, but signs include a
tuft of hair, dimple, or small mass.
ASSESSMENT OF THE SKIN
○ Cystica: With protrusion of spinal
● Assess the color and marks:
contents, which may be:
○ Note: PINK (ruddy) complexion may
■ Meningocele: Protrusion of
be due to high RBC count.
meninges and CSF.
■ Normal Values:
■ Myelomeningocele:
■ RBC: 4.4 to 7.5
Protrusion of CSF, nerve
million/mm³
roots, meninges, and spinal
■ HGB: 14.5 to 22.5
cord.
g/dL
■ Rachischisis: Protrusion of
■ HCT: 45 to 65%
spinal cord and meninges.
■ WBC: 5,000 to
35,000/mm³
Board Q.
● Abnormal Skin Colors:
Kelan nireremove ang shunt? Hindi na kasi pang
○ Blue: Indicates hypoxia (lack of
lifetime na. Shunt revision na lang gagawin.
oxygen).
Why shunt revision? Kasi the child outgrown the ○ Pallor: Indicates anemia; potential
shunt, nag ccause ng obstruction, nag develop ng causes include:
infection. ■ ABO and Rh incompatibility
(may be r/t g6pdd) BASIC
PROBLEM NITO AY
HEMOLYSIS
■ Bleeding, decreased
HYDROCEPHALUS synthesis of Vitamin K
(MOST COMMON VIT K
● Signs and Symptoms: given is AquaMEPHYTON
○ Sac at the back or phytonadione injection)
○ Increased intracranial pressure (ICP) ■ Deficiency of clotting factors
signs include: (hemophilia)
■ Macewen sign (cracked pot ■ Most common hemophilia is
sound) TYPE A or Classic
■ Bossing (protuberant ■ Lack of platelets (Wiskott-
forehead) Aldrich syndrome)
■ Sunset sign (iris lower than ■ MOST COMMON PROBLEM
sclera) ng wiskott aldrich &
■ Bulging and tense fontanel hemophilia is BLEEDING
■ High-pitched, shrill cry
■ Change in level of _________________________________________
consciousness (LOC)
■ Change in vital signs (VS)
● Surgery:
○ Excision of the sac.
○ Shunting to divert CSF and reduce
ICP.
■ Ventriculoperitoneal shunt
■ Ventriculoatrial shunt
● Prognosis: Depends on the location of the
defect and the availability of treatment.
 ■ Slate blue or gray patches
due to the accumulation of
melanocytes, commonly
seen on the buttocks and
back. Disappears in
preschool years.
3. Lanugo:
■ Fine downy hair seen on the
back, upper arms, and
shoulders. Common in
preterm infants and
disappears within two weeks.
4. Vernix Caseosa:
■ White, cheesy substance
seen all over the body.
2 types of Jaundice Disappears within 24 hours.
1. Physiologic/Normal Jaundice “icterus 5. Erythema Toxicum:
neonatorum” ■ Pink papules with
2. Pathologic/abnormal “icterus gravis” superimposed vesicles seen
on the face. Disappears
Purpose of phototherapy is to prevent: within two weeks; also known
- kernicterus/bilirubin encephalopathy as "newborn rash."

Complications of kernicterus
- brain damage, mental retardation, cerebral palsy
6. Milia:
■ White spots caused by
clogged sebaceous glands,
commonly seen on the nose,
also called whiteheads of the
newborn.
7. Desquamation:
■ Dry, peeling off the skin.

_________________________________________

NEUROLOGICAL ASSESSMENT
(REFLEXES)
● Reflexes are involuntary movements or
actions that help identify normal brain
function and nerve activity.
1. Moro Reflex (Embrace Reflex):
_________________________________________ ■ Elicited by jarring the crib,
dropping an object, or
SKIN MARKS allowing the head to drop at
a 30-degree angle.
● Common Skin Marks: ■ The response includes
1. Hemangioma: extending the arms with open
■ Strawberry marks (Nevus hands and the middle and
vasculosus) thumb in a "C" position.
■ Telangiectasis nevi (flat, red ■ Disappears by 4 to 5 months.
areas of capillary dilation on ■ Absence indicates a
glabella, upper eyelid, upper neurological problem.
lip) 2. Tonic Neck Reflex (Fencing
2. Mongolian Spot: Reflex):
 ■ Elicited by turning the head ○ Disappears by 3 to 4 months.
to one side; the newborn will 2. Extrusion/Protrusion Reflex:
extend the arm on the side to ○ Elicited by placing an object on the
which the head is turned, anterior surface of the tongue; the
while the opposite arm baby pushes the object away.
flexes. ○ Disappears by 4 to 5 months when
■ Disappears by 5 to 7 months. the baby is ready for solid foods.
3. Stepping Reflex (Dance Reflex): 3. Sucking Reflex:
■ Elicited by holding the baby ○ Elicited by placing an object
upright; the baby will take between the lips; the baby opens
steps when touching a solid their mouth and grabs the object.
surface. ○ Disappears by 6 months.
■ Disappears by 2 months. 4. Swallowing Reflex:
4. Grasp (Palmar) Reflex: ○ Assists in the baby's ability to
■ Elicited by touching the swallow liquids.
anterior surface of the hand;
the baby responds by closing _________________________________________
their hand around the object.
■ Disappears by 5 to 6 months. PROTECTIVE REFLEXES
5. Crawl Reflex:
■ Elicited by placing the baby 1. Glabellar’s (Blink) Reflex
in a prone position; the baby 2. Gag Reflex
will bend their knees and 3. Sneezing
move forward. 4. Coughing
■ Disappears when the baby
starts to stand and cruise,
PEDIATRIC DISEASES
around 10 months.
Cardiovascular Diseases

● Acyanotic Defects:
6. Plantar Reflex:
○ Includes the following:
■ Elicited when the ball of the
■ Ventricular Septal Defect
foot is pressed; the baby
(VSD)
flexes their toes towards the
■ Patent Ductus Arteriosus
object.
(PDA)
■ Disappears when the baby is
■ Coarctation of the Aorta
ready to walk, around 9 to 10
months. CYANOTIC DEFECTS
7. Babinski Reflex:
■ Elicited by stroking the foot ● Types:
from the heel towards the big 1. Tetralogy of Fallot (TOF)
toe in an inverted "J" curve. 2. Transposition of the Great
■ The baby responds by Arteries (TOGA)
fanning the toes with the big
toe curved inward. DIFFERENCES
■ Disappears by 12 to 18
months. ● Acyanotic:
○ Left to right shunting
_________________________________________ ○ Effects:
1. Decreased cardiac output
FEEDING REFLEXES 2. Congestive heart failure
(CHF)
1. Rooting Reflex: 3. Left ventricular hypertrophy
○ Elicited by stroking the cheek or (LVH)
corner of the mouth; the baby moves ● Cyanotic:
their head to locate the object. ○ Right to left shunting
 ○ Effects: ○ Decrease edema.
1. Cyanosis ○ Improve tissue perfusion.
2. Decreased cerebral and
peripheral perfusion _________________________________________
3. Polycythemia
4. Multi-organ malfunction OTHER PEDIATRIC DISEASES:
RESPIRATORY INFECTIONS
SIGNS AND SYMPTOMS
1. Bronchiolitis
● Common symptoms:
○ Viral infection caused by
○ Tiring quickly
Respiratory Syncytial Virus (RSV)
○ Dyspnea
○ Symptom: Expiratory wheezing
○ Edema
2. Croup or Acute
○ Diaphoresis
Laryngotracheobronchitis
○ Oliguria
○ Can be viral or bacterial
○ Growth retardation
○ Symptom: Inspiratory stridor
○ Cyanosis becomes severe with
exertion
○ Syncope CROUP
○ Hypercyanotic (Tet) spells
● Types:
DIAGNOSTIC TESTS 1. Acute Infectious Laryngitis
2. Acute Spasmodic Laryngitis
● Common tests include: 3. Acute Laryngotracheobronchitis
○ Chest X-ray 4. Acute Epiglottitis
○ 2D Echo (echocardiogram) ■ Important Note: Never
○ ABG (arterial blood gas) depress the tongue as this
○ Cardiac catheterization may cause complete airway
obstruction.
MANAGEMENT
_________________________________________
● Palliative Procedures for Tetralogy of
Fallot (TOF): ACYANOTIC DEFECTS
○ Blalock-Taussig Shunt:
Anastomosis between the ● Ventricular Septal Defect (VSD):
subclavian artery and pulmonary ○ A hole between the ventricles
artery. leading to left-to-right shunt of blood.
○ Potts Procedure: Anastomosis
between the aorta and pulmonary _________________________________________
artery.
○ Brock Procedure: Correction of PATENT DUCTUS ARTERIOSUS (PDA)
pulmonary stenosis (PS) but not
VSD. ● Failure of the ductus arteriosus to close
● For Transposition of the Great Arteries after birth, leading to a left-to-right shunt of
(TOGA): blood.
○ Blalock-Hanlon Procedure:
Enlargement of the foramen ovale. _________________________________________
○ Rashkind Procedure: Interatrial
balloon septostomy.
○ Prostaglandin infusion: To
COARCTATION OF THE AORTA
maintain ductus arteriosus patency.
● Narrowing of a part of the aorta, which
● Principles in the Care of a Patient with
causes increased blood pressure in the
Cardiac Defects:
upper body and decreased blood flow to the
○ Improve the efficiency of cardiac
lower body.
function, thereby increasing cardiac
output.
_________________________________________
○ Decrease the cardiac workload.
CYANOTIC DEFECTS (Continued)
● Tetralogy of Fallot (TOF):
○ A congenital heart defect that
involves four anatomical
abnormalities:
1. Ventricular septal defect
(VSD)
2. Pulmonary stenosis
3. Right ventricular hypertrophy
4. Overriding aorta