NICOLE C.

MAPILI
2-6

CEREBRAL PALSY
CAUSE: Unknown
Assoc. with variety of contributing
factor:
Brain anoxia- brain cell
dysfunction
SGA
Short pregnancy interval delivery
Kernicterus (athetoid)
Infections
Head injury in utero or after birth
TYPES: Pyramidal or Spastic
SPASTIC
Hypertonic muscle
Abnormal clonus
Deep tendon reflexes
Neonatal reflexes present
No Parachute reflex
Scissors gait
Plantar flexion
DYSKINETIC/ ATHETHOID
Abnormal involuntary
movements
Limp and flaccid
Slow, writhing motions
Poor tongue and swallowing
movements
Stress= irregular and jerking
motions CHOROID
Disordered muscle tone
ATAXIC TYPE
Awkward, wide-based gait
Unable to perform finer-to-nose
test
Unable to do repetitive
movements
MIXED TYPE
Child shows symptoms of both
spasticity and athetoid
movements
Can be manifested at the same
tine

ASSESSMENT:
History
Physical Exam
Delayed motor development
Abnormal Head Circumference,
posture, reflexes
Neurologic Assessment
Cranial X-ray/Sonogram
Negative CT Scan
MANAGEMENT:
Instruct parents (Health
Teachings)
Promote functions not are not
affected by disease
Prevent further loss of function
Self-care (brushing teeth)
Communication
Ambulation (Safety devices)
Education
Safety
Nutrition (prevent aspiration)
Self-esteem (praise)

CONVULSIONS

Involuntary contraction of muscle

caused by abnormal electrical
brain discharges
50% unexplainable
Neonates: 75% known cause
Trauma and anoxia
Metabolic disorders
Neonatal infection
Kernicterus
Infants and toddlers: 50%
identifiable cause
-Infantile spasm
Burns itself out by age 2;
developmental lag remains
High doses of anticonvulsant
medication
Children above 3y/o: Idiopathic
Residual damage from

CLASSIFICATION OF SEIZURES:
Partial (Focal) Seizures

NICOLE C. MAPILI
2-6
Simple partial- with
motor/sensory signs
Complex partial (psychomotor)
Petit mal- Absence seizure (blank
stares)

FEBRILE CONVULSIONS
Seizure- No O2 in brain
Seizures assoc. w/ high fever (38.940)
Pre-school b/w 5mos. 5 yrs. (3
mos.-7 yrs.)
Tonic-Clonic
Familial
Subsides once temp. goes
down
Highly preventable- TSB,
fluids
Acetaminophen
Phenobarbital
MANAGEMENT:
Remain Calm
Keep environment safe
Prevent Aspiration
Ensure adequate supply of
medication
Status Epilepticus- an
exacerbation of a preexisting
seizure disorder, the initial
manifestation of a seizure
disorder, or an insult other
than a seizure disorder.
Status epilepticus- Oxygen
Remove sharp objects
Place paddings on side
Put pillow on headboard
Restraint
Keep airway patent/clear by
providing oral airway
AURA
S/SX of Seizure:
Twitching

Lip smacking
WHAT TO DO DURING
SEIZURE
Call-light button
Observe type,
classification, duration of
severe
Provide O2 therapy
DURING SEIZURE:
Do not interfere activity
Keep bed padded
AFTER SEIZURE:
Positioned px (Side-lying)
bec. Secretions in the
mouth

PROBLEMS IN
THE GENITOURINARY
SYSTEM
In healthy infants, kidneys at
functional level
6-12 mos. Nearly like adults
Only 20% of the nephrons have
long enough loops of Henle to
reach inner medulla
Newborn- bladder is in the
abdominal cavity
Shorter urethrasrisk of
developing UTI
Bladder control by 4-5 years
Children with acute renal failure
regain normal function
ASSESSMENT:
Chief concern: burning/cries on
urination, dark urine, frequent
urination, abdominal pain, flank pain,
enuresis, abdominal distention,
periorbital edema (swelling of the
eyes), weight gain, strong odor of
urine
Family hx: history of renal disease
Pregnancy hx: Nephrotoxic drugs
Oligohydraminos
Past illness: throat/ skin infection

NICOLE C. MAPILI
2-6
PHYSICAL ASSESSMENT:
General appearance: fatigue,
paleness, growth retardation, low
grade temp
Head: swelling around the eyes
(periorbital edema)
Mouth: pale mucus membrane
CV: HPN bec. Of Fluid Retention
RESPI: Rapid
Chest: Gynecomastia
Pain over kidney area
ABDOMEN: Tenderness over bladder
area, abdominal mass, protuberant
GENITALS: Reddened urethra, diaper
rash
Round urethra in males, constant
dripping of urine, a strong that usual
arch of urine in males, displaced
urethra of males
HYPOSPADIA- opening of penis
on upper surface
EPISPADIA: opening of penis on
dorsal surface
SKIN: poor skin turgor, white crystals
on skin, edema
EXTREMITIES: Bowed legs
NEUROLOGIC: Confusion, muscle
twitching (bec. Of hyperkalemia and
electrolyte imbalance)
LAB/DIAGNOSTIC TEST:
Urinalysis- examine urine color,
appearance, pH,ketones, RBC
and WBC
Glomerular Filtration Rate:
substances are filtered from the
blood in the kidneys; 100
mL/min
Urine Culture
Blood studies: BUN (5-20mg/dl)
Serum Creatinine (0.7-1.5
mg/dl)
Sonogram/MRI
X-ray

X-ray studies:
IVP- upper urinary tract where
radiopaque dye is injected into a
peripheral vein, circulates through
the bloodstream
Cystoscopy: direct examination
with cystoscope introduces through
the urethra
Renal biopsy: extent of disease,
beginning rejection of a
transplanted
THERAPEUTIC MEASURES:
Dialysis: separation and
removal of solutes from the
body through a semipermeable membrane
Peritoneal dialysis
Continuous Ambulatory PD
Hemodialysis

CONGENITAL
DEFECTS
BLADDER EXTROPHY
Midline closure defect occurring
during the embryonic period,
usually on the 1st 8 weeks, where
bladder lies open and exposed
on the abdomen.
SX:
No anterior bladder wall
No skin covering on the lower
anterior abdomen
Bright red bladder
TX:
Surgical closure of the bladder
and the anterior abdominal wall
Creation of urethra
Surgical removal of the bladder,
then construction of continent

NICOLE C. MAPILI
2-6
urinary reservoir or an artificial
bladder
Ileoconoduits
PRE-OP:
Prevent infection
Prevent excoriation of the skin
Reduce pressure
POST-OP:
2stages
Prevent infection
Suprapubic catheter
Analgesic and antispasmodics
Prevent non-fused pubic bone
from separating
Prevent stress on suture line
SX:
Urethral opening at lower or
upper aspect
Hypospadias with chordee- a
fibrous band that causes the
penis to curve downward
Cryptorchidism
TX:
Circumcision not done
Meatotomy (12-18 months/
3-4 yrs)
HYDRONEPHROSIS
Enlargement of the pelvis of
the kidney with urine as a
result of back pressure in the
ureter
Caused by obstruction

SX:
Asymptomatic
Recurrent UTI
BP
Flank/ abdominal pain
Abdominal mass
IVP/ Sonogram; Enlarged pelvis
at point of obstruction

TX: Surgical correction of

obstruction

POLYCYSTIC KIDNEYS
Large fluid-filled cyst have
formed in pace of normal
kidney tissue
Autosomal recessive trait
Oligohydramnios during
pregnancy
SX:
Kidneys large, soft and
spongy
If unilateral-oliguria
If bilateral-will not pass oit urine
Potter facies appearance
Hypertelorism
Epicanthal folds
Flattened nose
Micrognathia
Transillumination/ Sonography: Fluid
filled cyst
Liver filled w/ identical
cyst
Mild Abdominal mass
Systemic HPN
TX:
Surgical removal- unilateral
Renal transplantation
Genetic counseling

INFECTIOUS
DISEASE
UTI
Involves urethra, bladder,
ureters, renal, pelvis and
renal parenchyma
2-6 yrs

NICOLE C. MAPILI
2-6
Common in Females
Caused by E. coli
S/SX:
Pain in urination
Frequency
Burning
Hematuria
Low/high grade fever
Abdominal pain
Enuresis
Vomiting
TX:
1st UTI: Oral AB specific to
agent x 10 days
Large quantity of fluids
Acidify urine- (Cranberry
juice, buko juice)
Mild analgesic
Repeat urinalysis

GLOMERULONEPHRI
TIS
Inflammation of the
glomeruli of the kidney
Immune complex disease
after an infection with
nephrotogenic period
Latent period 10-21 days
Nephrotogenic GABS
Edema infiltration of
leukocytes Occludes
capillary lume Plasma
filtrationWater and Na
retention Plasma and
interstitial volumes
Circulatory congestion and
edema
5-10 yrs. ; common in
boys
SX:
Tea colored/ cola colored
urine (red- brown urine)
Sudden hematuria and
proteinuria

Oliguria (K levels inc.)

urine sugar
HPN
Abdominal pain, anorexia,
vomiting
Edema, headache.
Puffy eyes
Cardiac involvement
Mild Anemia
Inc. ESR
Impaired filtration- Inc.
BUN Creatinine
Elevated ASO- Circulating
Se antibiotics
TX:
AB/ Diuretics not effective
Palliative therapy
DIET: Inc. CHON, Dec. salt
diet
COMPLICATIONS:
Pulmonary congestion
Cardiac enlargement
Pleural effusion during
edematous phase
Altered fluid and
electrolyte imbalance
(Hyperkalemia,
hypocalcaemia,
acidosis)
May need PD or HD
May follow AGN or
nephrotic syndrome
Weigh daily, accurate I&O
SX:

Proteinuria
Edema, hypertension
RBC/WBC in urine
SpGr, BUN creatinine
Renal biopsy:
permanent destruction
of glomeruli membrane
TX:
Antihypertensive

NICOLE C. MAPILI
2-6

Diuretics
Corticosteroids
Dialysis
Kidney transplantation

-If correctly managed, normal

renal function will be retained

Nephrotic Syndrome
Altered glomeruli
permeability due to
fusion of the glomeruli
membrane surfaces,
which cases OF
abnormal loss of protein
in urine
Leads to massive
proteinuria
CAUSES:
1. Congenital
2. Secondary
3. Idiopathic
Glomerular damage
hyperalbuminuria/hypocollo
idal osmotic
pressurehydrostatic
pressureaccumulation of
fluids in interstitial spaces
vascular volume
(HYPOVOLEMIA)renin
release
SX:
Proteinuria
Edema (periorbital and
scrotal)
Ascites

Low serum
Hyperlipidemia
Periorbital edema
Pallor, anorexia, diarrhea
Dyspnea
TX:
Steroid therapy
Diuretics not commonly
used
IV albumin
Cyclophosphamide
CHON, sodium, potassium
diet
Weigh daily, Measure I&O
Prevent infection
Positioning
Kidney transplantation

RENAL FAILURE
Inability of the kidneys to
excrete waste materials
Unable to regulate the
volume and composition
of urine
Food and fluid intake
SX: Oliguria, N&V,
drowsiness, HPN, Edema,
TX: Treat underlying cause,
mange complication,
supportive therapy

CHRONIC RENAL
FAILURE
Disease can no longer
maintain normal chemical