Download - Growthand Dev
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Growth and Development
Growth- increase in physical size of a structure or whole.
-quantitative change.
Two parameters of Growth
1. weight- most sensitive measure of growth, especially low birth rate.
Wt doubles months!" 1yr
#" $-$ % yrs
$. &eight- increase by 1'(mo during 1 st months- average increase in ht - 1styear ) *+
stoppage of ht coincide with eruption of wisdom tooth.
Development- increase sills or capability to function- qualitative
&ow to measure development
1. bserve child doing specific tas.$. /ole description of child0s progress
!. 2T- enver development screening test.
332T 45hil6 3etro 3anila evelopmental 2creening Test.2T measures mental
# main rated categories of 2T
1. 7anguage communication$. personal social-interaction
!. fine motor adaptive- ability to use hand movement
#. gross motor sills- large body movement
maturation- same with development 8readiness'
Cognitive development9ability to learn and understand from e"perience to acquire and retain nowledge.
To respond to a new situation and to solve problems.
:; test- test to determine cognitive development
3ental age " 1++ ) :;
+-1++
Gifted child- ? 1!+ :;
@asic ivisions of 7ife
:. 5renatal stage from conception- birth
::. 5eriod of infancy
1. Aeonatal- 1st$B days or 1st# wees of life
$. Cormal infancy- $> day 9 1 year
:::. Darly childhood
1. Toddler 9 1-! yrs
$. 5re school #- years
:E. 3iddle childhood
1. 2chool age- F 9 1$ yrs
1
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E.7ate childhood1. 5re adolescent 11 9 1! yrs
$. =dolescent 1$ - 1B 9 $1
5rinciples of G 1. G is a continuous process
-begins form conception- ends in death
- womb to tomb principles2. not all parts of the body grow at the same time or at same rate.
- asynchronism
5atterns of G1. 6renal
digestive grows rapidly during childhood
circulatory
musculoseletal
$. 6Aeuromuscular tissue 4
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irectional trends- occur in a regular direction reflecting the development of neuromuscular function.These apply to physical, mental, social and emotional development and includes.
a. cephalo-caudal 8head to tail'
- occurs along bodies long a"is in which control over head, mouth and eye movements and
precedes control over upper body torso and legs.b. pro"imo- distal 8
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-answer
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'A P)AG'- 2wiss psychologists-develop reasoning power
SAG'S OF COG))' D''!OP3'=-Sensor# motor 0-2 #rs
-8practical intelligence'- words and symbols not yet available baby communicates through senses and
refle"es.
4sub div.6
2chema =ge @ehavior
1.6 neonate refle" 1 month =ll refle"es
$.6 primary circular 1-# months -=ctivity related to body-repetition of behavior
e". thumb sucing
!.6 secondary circular reaction #-B months -activity not related to body-discover obJ and person0s permanence
-memory traces present
-anticipate familiar events.
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*O4!5'(G- recognized the theory of moral dev0t as considered to closely appro"imate cognitive stages
of dev0t-sabay with cognitive devLt
Stages o/ 3oral dev6t:nfancy 9 premoral, prereligious, amoral stage
=GD 2T=GD D2
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% months- reaches out in anticipatory of being piced up-sits with support
-uses palmar grasp
-eruption o/ 1sttemp teeth %-8 months 2 lower in$isors
-say vowel sounds 8ah', 8oh'-handles bottle well
& months- transfer obJ. hand to hand-lies obJ that are good size
8 months- sits without support
-pea of stranger an"iety-planters refle" disappears B-> months in prep for waling
months- creeps or crawls
-neat finger grasp refle"- combine $ syllables 8mama' and 8papa'
- needs space for creeping
10 months9 pull self to stand
-understands 8no'-responds to own name
-pea a boo, pat a cae
-can clap
11 months- cruisse
- stands with assistance
12 months- stand alone tae 1ststep
-wal with assistance
-drin from cup, cooperate in dressing
-says $ words mama and dada-pots and pans, pull tay, nursery rhymes
oddler- parallel pla#- 2 toddlers pla#ing separatel#-provide with similar toys-squeay frog to squeeze
waddling duc to pull
trucs to push-push pull toy
building blocs, pounding pegtoys to ride on
fear- separation an"iety
begin > months
pea 1B months
! phases of separation an"iety 4in order6
1. 5- protect
$. d despair!. d- denial
-don0t prolong goodbye
-say goodbye firmly to develop trust- say when ul be bac
F
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17 months9plateau stage
wals alone lateness in waling- mild mental retardation
-puts small pellets into small bowl
-holds spoon well
- seats self on chair-creeps up stairs
- # - words
18 months- height of possessiveness
favorite word- 8mine'
bowel control achieved 4bowel 1stbefore bladder6
-no longer rotates spoon-can run and Jump in place
wals up and down stairs holding railing or persons hand
-1-$+ words
-name, body part-puts both feet on 1 step before advancing.
2 months- terrible two
-can open doors by turning door nobs
-unscrew lids-can wal upstairs alone 9using both feet on same step at same time
-*+-$++ words 4 $ words sentences6
-daytime bladder control achieved 4 daytime 1st- ne"t nighttime bladder control6
"0 months or 2 9 #ears9 maes simple lines or stroe for crosses with a pencil
-can Jump down from chairs
-nows full name- copy a circle
- holds up finger to show age
- temp teeth complete
post molar- last temp teeth to appear
how many deciduous teeth -$+
beginning of toothbrush 9 $-$ % yrs
tooth brushing with little assistance ! yrstooth brushing alone 9 yrs
right time to bring to dentist- when temp teeth complete
"% months or " #rs- trusting !- unbutton buttons 4unbutton before learn to button6
-draw a K
- learns how to share
-nows full name and se" 4gender identity6- speas fluently
-nighttime bladder control
-!++->++ words
-ride a tricycle
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physiologic anore"ia- due to preoccupation with environment- food Jag that last
for short period of timeloves rough and tumbling play
loves toilet training-
failure of toilet training- unreadiness
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S$hool Age
5lay- competitive playD". Tug of war, trac and field, baset ball
Cear. 1.6 school phobia
-orient to new environment$.6 displacement from school
-teacher and peer of same se"
!. loss of privacy-wants bra
#.6 fear of death
-F->yrs death is personified
-death- permanent loss of life
2ignificant evelopment
a. boys- prone to bone fracture
b. mature vision $+($+
% #ears- temp teeth begin to fall
perm teeth appear- 1stmolar
1sttemp teeth- * months
1
st
perm teeth- yrs-yr of constant motion
clensy mou0t
recognize all shapes-1stgrade teacher becomes authority figure
-nail biting
-begin interest in God.
& #rs- assimilation age
-copy a diamond
-enJoys teasing and playing alone
-quieting down period
8 #rs- e:pansive age
-smoother mouth
-loves to collect obJects-count bacwards
#rs9coordination improves
-tells time correctly-hero worship
-stealing and lying are common
-taes care of body needs completely
-teacher finds this group difficult to handle
10 #rs- age o/ spe$ial talent
-writes legibly
-ready for competitive games-more considerate and cooperative
-Joins orgs.
-well mannered with adult
-critical of adults
11-12 #rs + pre adoles$ents
-full of energy and constantly active
-secret language are common-share with friends secrets
-sense of humor present
1+
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-social and cooperative
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:33D:=TD
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2&MAT2-shortcuts
uctus venosus- -shunts from liver to :ECCoramen ovale- shunts bet $ atrias
uctus arteriosus- from pulmonary artery to aorta
What will sustain 1stbreath- decreased artery pressureWhat will initiate lung circulation-lung e"pansion
What will complete circulation- cutting of cord
#.6 $ way to facilitate closure of foramen ovalea.6 Tangential Cootstep- slap foot of baby
-never stimulate baby to cry if secretions not fully drained to prevent aspiration
-chec characteristic of cry
normal cry- strong, vigorous and lusty cry
cri-du-chat syndrome-chromosomal obliteration cat lie cryb.6 proper position -right side lying pos.
-will increase pressure on left and foramen ovale will close
Coramen vale and uctus arteriosus will begin to close within $#h
ecrease 5$, increase 5
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bliteration-complete closure
2tructure =ppropriate time ofobliteration
2tructure remaining Cailure to close
C. vale 1yr Cossa valis =trial 2eptal efect
uctus
=rteriosus
1 month 7igamentum =rteriosum 5atent ductus
arteriosus
uctus Eenosus $ months 7igamentum venosumMmbilical
artery
$-! months 1.6 lateral umb. 7igament
$.6 interior iliac artery
Mmbilical vein $-! months -ligamentum teres 4 round ligament
of liver6
5osition of infant immediately after birthO
A2-trendelenberg( T position for drainage
contraindication of trendelenberg position - increase :
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1. dry and wrap baby
$. mechanical pressure 9 radiant warmeri. pre-heated first isolette 4or square acrylic sided incubator6
!. prevent an necessary e"posure 9 cover baby
#. cover baby with tin foil or plastic
*. embrace the baby- angaroo care
A. 'sta,lish Ade=uate utritional )nta>e
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!. 2timulate evaluate feeding refle"es
a.6 /ooting refle"- by touching the side of lips(chees then baby will turn to stimulus. isappearby wees- by wees baby can focus. /efle" will be gone
- 5urpose rooting- to loo for food.
b.6 2ucing 9 when you touch middle of lips then baby will suc
- isappears by months- When not stimulated sucing will stop.
c.6 2wallowing- when food touches posterior of tongue then it will be automatically swallowed
d.6 D"trusion( 5rotrusion refle"
-when food touches anterior portion of tongue then food will be e"truded.
5urposeO to prevent from poisoningisappear by # months baby can already spit out by # months.
Criteria '//e$tive Su$>ing
a.6 @aby0s mouth is hied up to areolab.6 3om e"periences after pain.
c.6 ther nipple is also flowing with mil.
To prevent from crac nipples initiate proper production of o"ytocin.
-begin $-! min at Q breast4 * 9 F min other authors6to initiate production of o"ytocin
- increase 1 min( day 9 until reaching 1+ mins Q breast or $+ mins( feeding.
Cor proper emptying continuous mil production ( feeding
-feed baby on last breast that you feed her with, alternately 4 if not emptied - mastitis6
Pro,lems e:perien$ed in 5reast/eeding ?
!/day changes in breast post partum
a.6Dngorged- feeling of fullness tension in breast.
- sometimes accompanied by fever nown as 3:7R CDED/.
3gt? Warm compress- for breastfeeding mom
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Galactosemia
Tay 2achs disease
*. Dstablish of waste elimination
=. iff stools
1.3econium - physiologic stool- blac green, sticy, tar lie, odorless 42terile intestine6
will pass with in $# 9 ! hrs
failure to pass mecomium after $#h- G:T obstructione". &irschsprungs disease
imperforate anus
mecomium ileus 9 due to
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+ 1 $
&/ -absent 1++ ?1++
/esp effort -absent - slow, irreg, wea -good strong cry
3uscle tone - flaccid e"tremities - some fle"ion - well fle"ed
/efle" irritability
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Assessment o/ Gestational Age
-5allards Do,owitB
Cindings 7ess ! wees 45reterm6 !F - !B !> and up
2ole creases =nterior transverse crease
only
ccasional creases $(!
in
+ degree angle of wrist
- heal to ear sign-abundant lanugo-
Signs o/ Post term ,a,ies?
? #$ wees- classic sign 9 old man0s face
- desquamation 9 peeling of sin
- long brittle finger nails
- wide alert eyes
eonates in urser#
Asg responsibility upon receiving baby- proper identification
- foot printing, affi"ing mother thumb print- tae anthropometic measurement
normal length- 1>.* 9 $1 inch or #F.* 9 *!.F*cm, average *+ cm
head circumference !!- !* cm or 1! 9 1# 8&ydrocephalus - ?1#'
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:f $ vessel cord- suspect idney malformation- leave about 1' of cord
- if @T or :E infusion 9 leave B' of cord best access - no nerve
- chec cord every 1* min for 1st hrs 9 bleeding .? !+ cc of blood
bleeding of cord 9 mphalagia 9 suspect hemophilia
+
Ph#si$al ':am and Deviations /r ormal
1. if client is new born, cover areas not being e"amined$. if client is infant 9 the 1styr of life - get E29 tae // 1st
-begin fr least intrusive to the most intrusive area
!. if client is a toddler and preschool, let them handle an instrument lieO
- play syringe or stet, security blanet 9 favorite article. 7et baby hold it.#. D"plain procedure and respect their modesty - school age and adolescent
E(2O
TempO rectal- newborn 9 to rule out imperforate anus- tae it once only, 1 inch insertion
:mperforate anus
1. atretic 9 no anal opening$. agenetic 9 no anal opening
!. stenos 9 has opening
$+
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#. membranous 9 has opening
Darliest signO
1. no mecomium
$. abd destention
!. foul odor breath#. vomitous of fecal matter
*. can aspirate 9 resp problem
3gtO2urgery with temporary colostomy
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#.6 5= - failure of ductus arteriosus to close
- should close within $# h -complete close 9 1 month22"
1. continuous machinery lie murmurs
$. prominent radial pulse
!. D
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!.6 run$us Arteriousus- aorta pulmo artery is arising fr 1 single vessel or common trun with E22 2" 1. cyanosis
$. polycythemia 9 thrombus ) embolus ) stroe
3gtO &eart transplant
#.6 4#poplasti$ !e/t heart s#ndrome9 non f" 7eft ventricle
1. cynosis$. polycythemia 9 throm, emb, stroe
3gtO heart transplant
*.6 ri$uspid atresia9 failure of tricuspid valve to open
22UO open foramen ovale
4/ to 7 shunting 9 goes to 7t atrium6
cynosis, polycythemia3gtO fontan procedure 9 open tricuspid valve
.6 etralog# o/ Fallot
5 9 pulmonary stenosis
E 9 ventricular 2 9 overriding or de"troposition of aorta
/ 9 /t ventricular hypertrophy
2 2"O1. /t ventricular hypertrophy
$. high degree of cyanosis
!. polycythemia
#. severe dyspnea 9 squatting position 9 relief , inhibit venous return facilitate lung e"pansion.*. growth retardation 9 due no $
. tet spell or blue spells- short episodes of hypo"ia
F. syncope
B. clubbing of fingernails 9 due to chronic tissue hypo"ia>. mental retardation 9 due decreased $ in brain
1+. boot shaped heart 9 "-ray
3gtO
1. $$. no valsalva maneuver , fiber diet la"ative
!. morphine 9 hypo"ia
#. propranolol 9 decrease heart spasms
*. palliative repair 9@7T blaloc taussig procedure
@roc procedure 9 complete procedure
AC;)('D 4'A( DS'
1. (4D (heumati$ 4eart Disease- inflammation disease ff an infection acquired bygroup = @eta hemolytic strepto coccus
=ffected body 9 cardiac muscles and valves , musculoseletal ,
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ones Criteria
3aJor 3inor
1. polyarthritis 9 multi Joint pain 1. arthralgia 9 Joint pain
$.chorea9 sydenhamms chores orst. vetaus dance-purposeless involuntary hand and shoulder withgrimace
$. low grade fever
!. carditis9 tachycardiaerythema marginatum - macular rashes
2; nodules
!. all lab resultsincrease antibody
8 < reactive protein
8 erythrocyte sedimentation
rate 8 anti streptolysin
o titer 4=26
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=sthma-pathognomonic sign 9 e"piratory wheezing5et 9 fish. 2port 9 swimming
rugs 9 amynophylline 9 monitor bp, may lead to hypotension
7aryngo Tracheo @ronchitis7T@- inspiratory stridor9 pathognomonic sign
/2 respiratory dist synd or hyaline membrane dis
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* yo 9 unable to cough out, put on mist tent 4humidifier o$6 or croupe tie
Asg . &emangiomas 9 vascular tumors of the sin
" t#pes 4emangiomas
a.6 Aevus Clammeus 9 port wine stain 9 macular purple or dar red lesions seen on face or thigh. ADED/
disappear.
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D'P4
1stdegree 9 partial thicness 9 superficial epidermis - erythema, dryness, 5=:A
-sunburn, heals by regeneration from 1 9 1+ days
$nd degree 9 epidermis dermis- erythema, blisters, moist, e"tremely painful scalds
!rddegree 9 full thicness- epidermis, dermis, adipose tissue, fascia, muscle bone
lethargy, white or blac, not painful 9 nerve endings destroyed
e". lava burns
3gtO
1.6 1staid a.6 put out flames by rolling child on blanet
b.6 immerse burned part on cold &$oc.6 remove burned clothing of with sterile material
d.6 cover burn with sterile dressing
$.6 a(w
a.6 suction 5/A, o$ with increased humidityb.6 endotracheal intubation
c.6 tracheostomy
!.6 5reventiuon of shoc CD imbalance
a. colloids to e"pand bld volume
b. isotonic saline to replace electrolytesc. de"trose &$o to provide calories
#.6 Tetanus to"oid booster
*.6 /elief of pain 9 :E analgesic 3/5&:AD 2# 9 needed for $nddegree 9 very painful.61stdefense of body 9 intact sin
prevention of wound infection
a.6 cleaning debriding of wound
b.6 open or close method of wound carec.6 whirlpool therapy 9 drum with solution
F.6 sin grafting 9 !rddegree 9 thigh or buttocs 4autograft6, pigs( animals 9 "enograft
frozen cadaver 9 hallow graft
B,6 diet 9 increase
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A'3)A-pallor
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!. lumbar puncture 4756 9 determine
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4#drops 4h$+6Fetalis9 edematous on lethal state with pathologic Jaundice
Within $# h
3gtO
1. initiate breastfeeding to get colostrum
$. Temp suspension of breastfeeding- content breast mil pregnanedioles 9 that delays action of glucoronil transferees
liver enzymes converts in direct bilirubin to become direct bilirubin
!. Aeeds phototherapy#. needs e"change therapy
&yperbilirubinemia - ? 1$ mg(d7 of indirect bilirubin among full term
Aormal 9 +-! mg(d7- bilirubin encephalopathy
- Remicterus - ? $+ mg(d7 among full term
?1$ mg (dl of indirect 9 preterm
)can lead to cerebral palsy-
Ph#siologi$ aundi$e9 Jaundice within #B -F$ h 4$-! days6 e"pose morning sunlight
5athologic Saundice 9 within $#h. Saundice during delivery.
@reastfeeding Jaundice 9 caused by pregnanediole
=ssessment of Saudice O
1. @lanching neonates forehead, nose or sternum- yellow sin sclera
- color of stool 9 light stool
- color of urine 9 dar urine
3gtO 5hototheraphy 9 photo o"ygenation
Asg /espO
1. cover eyes 9 prevent retinal damage$. cover genitals 9 prevent priapism 9 painful continuous erection
!. change position regularly 9 even e"posed to light
#. increase fld intae 9 due prone to dehydration
*. monitor : 9 weigh baby. monitor E(2 9 avoid use of oil or lotion due- heat at phototherapy
) bronze baby syndrome-transient 2(D of phototherapy
weigh diaper 1gm ) 1cc
&ead 9 largest part of baby
of its length
Craniostenosis or $raniosinustosis9 premature closing of fontanel&ydrocephalus 9 ant fontanel open after 1B mos
3icrocephaly 9 small growing brain due- alcohol &:E mom
=nencepahly 9 absence of cerebral hemisphere
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Cephalhematoma- collection of blood due to rapture of pericostal capillaries
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$. :nfant children
- appearance- ability to follow obJect past midline
!. ! yrs 9 school age
- general appearance=llen cards 9 test for visual acuity. 2how picture $+ ft away
:shiharas plates 9 test for color blindness5rechool D chart - test for stereopsi of depth perception
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1.
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!. prevent colic
feed 9 upright seating or prone posburp frequently $" at middle and after feeding-lower to upper tap
#. orient parents to type of feeding
rubber tipped syringe 9 cheiloplasty
paper cup( soup spoon( plastic cup 9 urano plasty*. apply restraints 9 elbow restraints
so baby can adJust post op
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3gtO synthroid 9 sodium 7evothyrosine -synthetic thyroid given lifetime
- chec pulse rate before giving synthroid- tachycardia 9 2" of hyperthyroidism
C4'S
1. symmetry$. breast - transparent fluid coming out from newborn related to hormonal changes-
!. chest has retroactive 9 /2
#. sternum sunen 9 pectus e"cavation
A5DO3' 4in order6
1. inspection :
$. =uscultation =!. percussion 5
#. 5alpation 5 ) Will change bowel sounds, so do last
Aormal contour of abd 9 slightly protruding2unen abd- diaphramatic hernia 9 protrusion of stomach content through a defective diaphragm due
to failure of puroperitoneal canal to close.
2"O
1. sunen abd
$. 2" of /2!. / to 7 shunting
3gtO
Dmergency surgery within $#h
mphalocele 9 protrusion of stomach contents in between Junction of abd wall and
umbilicus.
3gt- very small surgery
:f large 9 suspension surgery
Asg 3gtO protect sac- sterile wet dressing
Gastro$hisis9 absence of abd wall
Asg 3gtO sterile wet dressing
F: o/ G)
1. assists in maintaining CD acid base balance
$. 5rocesses absorbs nutrients to maintain metabolism support G
!. e"crete waste products from digestive process
/ecommended aily =llowance
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e.6 dilute fruit Juices 9 mos
f.6 never give half cooed eggs 9 usually causes of salmoneliosisg.6 don0t give honey 9 infant botulism
h.6 offered new food one at a time 9 interval of # 9 Fdays or 1 wee 9 determines food allergens
otal 5od# Fluids- comprises * - B* of body wt of infants childrenWhere fluids are greater in infants
D"tracellular fld 9 prone to develop dehydration
=cid @ase @alance dependent on the ffO
a. chemical buffers
b. renal resp system involvement
c. dilution of strong acids and bases in bld/esp =cidosis 9 carbonic acid e"cess
- hypoventilation
- /2
-
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'sophageal $an$er
=ssessment O
1. chronic vomiting$. faiture to thrive syndrome
!. organic 9 organ affected
#. melena or hematemesis 9 esophageal bleeding" procedure
1. barium esophogram 9 reveals reflu"
$. esophageal manometry 9 reveals lower esophageal sphincter pressure
!. intra esophageal p& content 9 reveals p& of distal esophagus.3eds o/ G'(D
=nti-cholinergic
a.6 @etanicol 4 urecholine6 9 increase esophageal tone peristaltic activity
b.6 3etachloporomide 4/eglam6 9 decrease esophageal pressure by rela"ing pyloric duodenalsegments
- increase peristalsis without stimulating secretions
c.6 &$ &istamine /eceptor =ntagonist 9 decrease gastric acidity pepsin secretion
- Vimetidine, /anitidine 4Vantac6 9 tae !+ min before meals
d.6 antacid 9 neutralizes gastric acid between feedings - 3aalo"
2urgeryO Aissen funduplication O
months 9 infant sit with infant supine? > months 9 prone with head of mattress slightly elevated !+ degree angle
O5S(;C)' D)SO(D'(S
=. 5H7/:< 2TDA2:2 9 hypertrophy of muscles of pylorus causing narrowing obstruction.
1.6 outstanding 2"- proJectile vomiting
- vomiting is an initial s" of upper G: obstruction
- vomitus of upper G: can be blood tinged not bile streaed. 4with blood6- vomitus of lower G: is bilous 4 with pupu6
- proJectile vomiting 9 increase :
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- palpate sausage shaped mass
3gtO
1.6 &ydrostatic reduction with barium enema
$.6 =nastomosis pull thru procedura
:nborn Drrors of 3etabolism- deficient liver enzymes
P4'!*'O;()A45RM6 9 deficiency of liver enzymes 45&T65henylalaninehydro"ylase Transferase 9 liver enzyme that converts amino acidsO
valine isolensine tryptophaselysine phenylalanine
Thyronine 9 decrease malanine production
1.6 fair comple"ion$.6 blond hair
!.6 blue eyes
Thyro"ine 9 decrease basal metabolism
- accumulation of 5henyl 5yruvic acid
#.6 =topic dermatitis*.6 musty ( mousy odor urine
.6 seizure 9 mental retardation
Test 9 GMT&/:D TD2T 9 specimen 9 blood
- preparation increase
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Darly 2"O
1. diarrhea 9 failure to gain wt ff diarrheal episodes$. constipation
!. vomiting
7ate 2"O
1. abd pain 9 protruberant abd even if with muscle wasting$. steatorrhea
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. antidote for acetaminophen poisoning 9 acetylsysterine 4 mucomyst6
F. caustic poisoning 4 muriatic acid 6 neutralize acid by giving vinegar . on0t vomit preparetracheostomy set
B. Gas- mineral oil will coat intestine
!ead poisoning
7ead ) estroy /@< functioning ) &ypochornic 3icrocytic =nemia ) estroy idney functioning
=ccumulation of anemia ) Dncepalopathy
2"O
1. beginning s" of lethargy
$. impulsiveness, learning difficulties
!. as lead increases, severe encepalopathy with seizure and permanent mental retardation
"O
1. @lood smear
$. abd " ray!. long bones
3gtO
1. remove child from source
$. if ? $+ ug(d7 9 need chelation therapy ) binds with led e"creted by idney
)nephroto"ic
Amogenital
CemaleO5seudomenstration slight bleeding on vagina related to hormonal changes
Tearing of fourchette with blood 9 rape( child abuse
/ape- /eport within #B h2hape pubic hair in inverted triangle 4 female6
3aleO
Mndescended testes 9 cyrptorchidism -common to pretermsurgery 9 orchidope"y
assess scrotum- warm room hands
baby 9 pee within $# h-chec for arch of urination'pispadias- urinary meatus located dorsal or above glans penis4ypospadias- urinary meauts loc ventral or ,elow glans penis
&ypospadias with chordee- fibrous band causing penis to curb downward
3gtO
2urgery
5himosis- tight foresin
@alanitis-infection of glands penis 9 due smegma
3gtO
-
8/11/2019 Growthand Dev
43/45
(enal Disorder Cause S: : SG CA('
AD5&/T: