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• 10 rights

  1. Right med

  2. Right dose

  3. Right time

  4. Right route

  5. Right client

  6. Right client education

  7. Right documentation

  8. Right to refuse

  9. Right assessment

  10. Right evaluation
• Phototherapy


  1. Physiologic jaundice - after 24hrs

  2. Pathologic jaundice - w/in 24hrs
• Blood Transfusion


  • Restore blood volume
  • Restore oxygen carrying capacity of blood
  • Administer required blood component by patient
• Universal Donor and Recipient

  • Donor: O-
  • Recipient: AB+
• Blood typing


  • ABO and Rh antigens
• Blood Products


  • Whole blood
  • Packed RBC
  • Autologous RBC
  • Platelets
  • Albumin/Plasma protein
  • Cryoprecipitate
  • Plasma protein factor
• Nursing Responsibilities

  • Administer for 4 hrs (whole blood, packed RBC)
  • Administer for 20 mins (plasma, platelets, cryoprecipitate)
  • Dextrose cause hemolysis
• Enteral Feedings


  • Intermittent Fasting
  • Continuous Feeding
  • Cyclic Feeding
• Purpose of NGT

  • Provide feeding
  • Administer meds
  • Decompression
  • Irrigation
  • supplemental fluids
  • Obtain specimen for lab analysis
• NGT size


  • 6fr (neonates)
  • 8fr (infants to 5yrs)
  • 8-10fr (above 5yrs)
  • 10-14fr (adults)
• NGT position

  • Adult: high fowler
  • Infants: supine with head slightly hyperflexed
• NGT measurement

  • Adult: tip of nose - earlobe - sternum
  • Infants: tip of nose - earlobe - midxiphoid umbilicus
• NGT placement

  • X-ray
  • pH
  • Stethoscope
• NGT complications

  • Aspiration
  • Hyperglycemia
  • Abdominal distention
  • Diarrhea
  • Fecal impaction
• Magnesium Sulfate indications

  • Pregnancy: pre-eclampsia and eclampsia
  • Children: acute nephritis, hypomagnesemia, tetany, uterine
• Magnesium Sulfate side effects

  • Flushing
  • Sweating
  • Low BP
  • Hypothermia
  • Stupor
  • Respiratory depression
• Magnesium Sulfate signs


  • RR - 12cpm
  • UO - 100mL
• Magnesium Sulfate antidote


  Calcium gluconate
• Magnesium Sulfate administration


  • IM - dorsogluteal: alternate buttocks q4
  • IV - 3-5 mins
• Phototherapy indications

  • Helps liver process bilirubin
  • treatment for hyperbilirubinemia
  • Prevents kernicterus helps the liver process bilirubin
• Newborn Screening (NBS)


  • Detects if infant has heritable congenital metabolic disorder
  • NBS Act of 2004 (RA 9288) protects right of children to survival and full and healthy development as normal individual
• Ideal time for NBS

  • 48-72hrs after birth
• Standard 6 tests in NBS

  • Congenital hyperthyroidism
  • Cretinism
  • Congenital adrenal hyperplasia
  • Phenylketonuria
  • G6PD
  • Galactosemia
• Congenital adrenal hyperplasia


  • High levels of male sex hormone
  • Salt-wasting CAH
  • Simple virilizing CAH
• Maple syrup urine disease


  Cannot break down branched amino acids
• Spina Bifida


  • Split/open spine
  • Occurs in vertebral column
  • Common in lumbar/sacral portion of spine
• Risk factors for Spina Bifida

  • Chemicals
  • Meds
  • Genetic
  • Maternal health conditions
• Types of Spina Bifida

  • Spina Bifida Occulta
  • Spina Bifida Cystica
• Spina Bifida Occulta


  Not visible external
• Spina Bifida Cystica

  • Visible with external saclike protrusion
  • Rare neurologic
• Forms of Spina Bifida Cystica

  • Meningocele
  • Myelomeningocele
• Meningocele


  • Meninges and spinal fluid
  • Not associated with neurologic deficit
• Myelomeningocele


  • Both meninges and spinal fluid
  • Exposes nerves
  • Few or no symptoms to paralysis
  • Partial or complete paralysis
• Clinical Manifestations of Spina Bifida based on location of defect

  • Thoracic level: Paralysis of legs, weakness and sensory loss
  • Lumbar 1-2 level: Hip flexion and adduction, can't extend knees
  • Lumbar 3 level: Flex hips and extend knees, paralyzed ankles and toes
  • Lumbar 4-5 level: Flex hips, extend knees: Weak or absent ankle extension, toe and hip extension
  • Sacral level: Mid weakness in ankles
• Hydrocephalus


  • Congenital / Acquired
  • CSF volume: 60-100mL
  • Imbalance production of CSF in ventricular system
• Types of Hydrocephalus

  • Communicating
  • Noncommunicating
• Communicating Hydrocephalus


  Problem with absorption
• Noncommunicating Hydrocephalus


  Obstruction of CSF flow within ventricular system
• Treatments for Hydrocephalus


  • Ventriculoperitoneal shunt (VP shunt) - ventricles
  • Ventriculoatrial shunt (VA shunt) - right atrium
  • Ventriculopleural shunt - pleural cavity
  • Ventriculostomy (non-shunting procedure)
• Medication for Hydrocephalus


  Acetazolamide (anti-convulsant and diuretic which reduce CSF)