Growthand Dev

8/11/2019 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


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(enal Disorder Cause S: : SG CA('

AD5&/T:

Growthand Dev

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Transcript of Growthand Dev