Pediatric Nursing

Growth - increase in size of a structure. Human growth is orderly and predictable, but not even ; it follows a cyclical pattern
Development - maturation of physiologic and psychosocial systems to a more complex state
Cephalocaudal - head to toe progression of growth and development
Proximodistal - trunk to periphery (fingers and toes) progression of growth and development
Phylogeny - development or evolution of species or group; a pattern of development for species
Ontogeny - development of an individual within species

What pediatrician wants to tell parents of new born baby once the baby is home:
1. Encourage breastfeeding. Burp the baby after each meal.
2. Bathe the baby daily using lukewarm water and mild soap.
3. Avoid using of powder, cologne, strong perfume or harsh lotion.
4. Daily morning sunlight exposure is good for baby's skin.
5. Clean the umbilical stump with cotton and 70% alcohol twice daily. It will spontaneously slough off within 7-14 days.
6. Ocassional snezzing, snoring or sometimes noisy breathing can still be normal but when baby develops fever, vomiting or poor suck consult the pediatrician ASAP.
7. The first vaccination of baby is BCG and hepatitis B.
8. Avail New Born Screening Test in the hospital.

Rates of Development;
Fetal period and infancy - the head and neurologic tissue grows faster than other tissues
Infancy and adolescence - fast growth periods
Toddler through school-age - slow growth periods
Toddler and preschool periods - the trunk grows more rapidly than other tissue
School-age period - the limbs grow rapidly
Adolescence - the trunk grows faster than other tissue

Variations in Normal Signs by Age:

Age/ Temperature /Pulse /Respiration /Blood Pressure
New born/ 36.8C (98.2 F)/130 (80-180)/ 35 -40 /73/55
1 year old /36.8C (98.2 F)/ 120 (80-140)/ 30-50/90/55
5-8 y.o. /37C (98.6F)/ 100 (80-110)/ 20-30 /95/57
10 y.o. /37C (98.6F)/ 70 (60-90)/16-19/ 102/62
Teen/ 37C (98.6F)/ 80 (60-90) /16-19/ 120/80
Adult/ 37C (98.6F)/ 80 (60-100)/ 12-16/120/80
Over adult /37 C (98.6F)/ 70 (60-100) /12-16/ 120/80


C= (F - 32) x 5/9
F=(C x 9/5 ) +32
Axial = 6-15 minutes

Clinic -RHU
Pink- urgent, refer, hospital
Yellow- clinic BHS, RHU
Green - home

Hospital Trash:
Yellow- infectious, tartar
Black- dry, non-infectious
Green- wet, non-infectious

Immunization Schedule:
Age / Vaccine
Birth/ BCG, Hepa B1
6 weeks/ DPT1, Hepa B2, OPV1
10 weeks/ DPT2, OPV2
14 weeks/ DPT3, Hepa B3, OPV3
9 months/ Measles
15 months/ MMR

BCG- ID/RD- 0.05 ml@ birth; IM@ School entrance-0.10ml
DPT- IM/VL- 0.50 ml
Hepa B- IM/VL- 0.50 ml
Measles- SQ/DL - 0.50 ml
OPV- PO- 2gtts
TT - IM- 0.50 ml

Mental Retardation Scale (MR)
Range for IQ

Profound MR - IQ below 20
Severe MR - 20-34
Moderate MR- 35-79
Mild MR- 50-69
Borderline MR- 70-79

Intelligence Scale

Definite feeblemindedness- IQ below 70
Borderline deficiency- 70-89
Dullness- 80-89
Normal Average- 90-109
Superior- 110-119
Very Superior - 120-140
Genius- 140 and above

Death:
Toddlers-temporary
Preschoolers- reversible
School age- ghost; devil ; boogieman
Adolescent- universal belief

Developmental Milestone:
1 week- distinguish mother's voice
2 months- vowel sounds ah, eh, oh; stepping reflex is lost
2-3 months- posterior fontanel closes
3 months- pushes head; social smile; galant reflex is lost; chest up
3-6 months- Moro reflex is lost
3 months- 1 year- Landaus reflex is lost
4 months- cooing; bubling da, ba, ma, pa; rooting reflex; prone crawl reflex; doll's eye reflex; sucking reflex
6 months- roll-over from stomach to back; stranger anxiety; double weight; symmetrical tonic neck reflex is lost
6-8 months- assymetrical tonic neck reflex is lost
7 months - sits alone with assistance
8 months- 4 front teeth and 1 tooth each month; fear of stranger
9 months- sits alone without assistance; creeps on both hands and knees with belly off the floor; separation anxiety; plantar reflex; object permanence
9-18 months- Babinski reflex is lost
10 months- cruising
11 months- stands and walks with support; grasping reflex; plantar reflex; palmar reflex
12 months- one word sentence; stands alone and takes first step; body weight tripled; height increases by 50%; well developed immitative behavior
12-18 months- anterior fontanel closes
15 months- 4 words in vocabulary; milestone for walking
2 years- 300 words; 2-3 words sentences; full blown separation anxiety; needs security blanket
2-3 years- Mongolian spot disappears
3 years- 900 words; monster; magical thinking; complete 20 desidual teeth (milk teeth)
4 years- body mutilation; intact body ; band aid; masturbation
5 years- 2100 words
5-6 years- baby tooth starts falling off
6-12 years- fears bodily injury but cooperative; guts
12 years- complete adult teeth
13-18 years- adolescent; body image concern

Reflex that is never lost-blink; pupillary and knee-jerk reflex

Fetal heart beat- 12 weeks by doppler; 18-20 weeks by auscultation
Fetal movement- @ 2o weeks
Fetal skeleton- by sonography or x-ray

Neonate @ birth:
Weight- 5-9 lbs. (2-4 kg)
Length- 18-22 inches
Head circumference- 13 1/2 to 14 inches
Chest circumference- 1 inch < head circumference
Temperature- 36.7 to 37.2 degrees centigrade
Pulse Rate (apical)- 120-160 bpm
Respiratory Rate- 40-60 bpm

Harlequin Sign- lying side is red and pale on upper side

Tips:
Tetanus- lockjaw
Meningitis- nucchal rigidity
Polio- flaccid paralysis
Rabies- hydrophobia
Dengue- Homan's sign
Malaria- fever and chill
Filariasis- elephantiasis
Mumps- swollen carotid gland
Kawasaki- strawberry tongue ; systemic vasculitis
Scarlet- raspberry tongue
Measles- Koplik's spot
German Measles- Forscheiner's
Chicken Pox- vesiculopapular lesions
Herpes Zooster- lesion follows peripheral nerve pathway
Scabies- wheeping itch
Leptospirosis- orange eyes
Pertusis- paroxysmal cough ending in whoop
TB- initially asymptomatic
Pneumonia- fast breathing; chest drawing
Enterobiasis- nocturnal itchiness
Thyphoid - 3 C's; ladderlike fever; rosespots; spleenomegaly
Diptheria - pseudo membrane
Cholera- rice watery stool
Candidiasis- cheeselike discharge
Gonorrhea- thick purulent discharge
Syphillis- painless chancre
Intussuception-paroxysmal abdominal pain; telescoping of bowel
Ciliac's -glutein free diet
Patent ductus arteriosus- machinery like murmur
Duchenne- Gower's sign
Pyloric stenosis- projectile vomiting
Acute glomerulonephritis-Coca-cola urine
PKU- low phenylalanine diet
Cystic Fibrosis- panclog
Croup- mist; seal bark
Cerebral palsy- brain damage related to anoxia