Zandernursing.weebly.com



PEDIATRIC NURSING - NORMALSSUMMARY OF FUNCTIONAL CONCEPTSSET APrepared by: Lyzander A. sardonidoIMMEDIATE NEWBORN CARESuction first the baby before stimulating to crySuction time is 5 to 10 second onlyMaximum suction pressure is 100mmHg (130 cm H2O)Stimulate the newborn to cry by tangential footslap or gentle back rubProlonged suctioning causes laryngospasm, hypoxia, and bradycardiaCry is the way how newborn breath and communicateHigh-pitched shrill cry indicates increased ICP, meningitis, infected with HIVGrunting respiration indicates atelectasis/ RDSHoarse cry indicates laryngeal edemaWeak cry indicates hypoglycemia, prematuritySIGNS OF RESPIRATORY DISTRESS:“See-saw” pattern chest movementIntercostal retractionsNasal flaringExpiratory gruntingXiphoid retractionsFlaring of nostrils is the first sign of respiratory distress in a premature infant.Ductus venosus connects the fetal liver and the heart (inferior vena cava)Ductus arteriosus connects the aorta and pulmonary arteryForamen ovale is an opening between the atria.The blood of a fetus is mixed blood (mixture of unoxygenated and oxygenated blood)The right side of the fetal heart is stronger than the left side due to incraed pulmonary pressure.Sign of infection in newborn is behavioral changes (incessant crying, poor sucking)5 CRITERIA OF APGAR SCORING (introduced by Dr. Virginia Apgar)Pulse rate (heart rate)Respiration (cry)Activity (muscle tone)Grimace (reflex irritability)Appearance (color)APGAR SCORE INTERPRETATION:8 to 10 indicates no immediate distress4 to 7 indicates moderate distress0 to 3 indicates severe distress.Pulse rate is the most important criterion, whereae Appearance is the least important.Apgar score is taken twice. 1st Apgar score is taken on 1 minute and the 2nd Apgar score is taken on 5 minutes.The TRUE Apgar score is the 2nd Apgar sore because it assesses the adaptation of the newborn to extra uterine life.CHARACTERISTIC OF A FULL TERM BABY:Breast nodule Diameter = 7 mm and aboveEar lobe = Stiffened by thick cartilage; with recoilScalp hair = Coarse and silkyTestes and scrotum = Testes: pendulousScrotum: full; extensive rugaeFemale: covered labia minora and clitorisSole creases = Sole covered with creasesAGE OF GESTATION:Preterm = below 37 weeksTerm = 37 – 40 to 41 weeksPost term= 42 weeks and aboveBurning of brown fats is the major mechanism of preventing cold stressUtilization of brown fats causes production of ketones whick may lead to metabolic acidosis.Metabolic acidosis could lead to coma.Another way to produce body heat by the newborn is through increased muscular activity (kicking) which increases body metabolic rate and vital signs.COLD STRESS is acute and extreme hypothermiaBabies do NOT shiver due to immature hypothalamus (thermoregulator of the body)PROCESSES OF BODY HEAT LOSSEvaporation - wet surface turns to vaporConduction - in contact with cold surfaceConvection - transfer to cooler surrounding airRadiation - not in contact with cold surfacePOIKILOTHERMIA is a characteristic of the blood of the newborn that copies the external temperature, which contributes to cold stress.Kangaroo care is doen to promote body heat transfer from the mother to the baby and emotional bonding as well.5 THINGS TO WRITE DOWN IN A NAME TAGname of the motheradmission or hospital numberdate and time of deliverysex of babyname of physicianREGULAR NURSERY CARETo prevent hemorrhagic disease of the newborn, Vitamin K is administered because a newborn’s intestine is unable to synthesize vitamin K.The amount of vitamin K to be given is 0.1cc given IM, Vastus lateralisCrede’s prophylaxis is done to prevent opthalmia neonatorum. Opthalmia neonatorum is due to gonorrheal or chlamydial infection of the mother.Crede’s prophylaxis can be delayed for 1 to 2 hours to promote emotional bonding (eye to eye contact)Whether the mother has or no infection, Crede’s prophylaxis is still given. The umbilical cord is cut twice. The first cut remains 8 to 9 inches from the baby and the second cut remains 1 to 2 inches form the baby.MILKING of the cord is NOT anymore recommended because it can cause hyperbilirubinemiaAlcohl is the best agent to use in cord care.Silver nitrate 1% causes chemical conjunctivitisOil bath is the first to be done to a newborn. The use of oil has 3 advantages:It serves as insulatorIt is a moisturizerIt remove the sticky vernix caseosaPHYSICAL ASSESSMENTThe normal weight of a Filipino newborn is 5.5 to 7.5 poundsBelow 5.5 pounds/ 10th percentile is SGA (small for gestational age)Above 7.5 pound/ 90th percentile is LGA (large for gestational age)The normal head circumference is 33-35cm measured on occipito-frontal circumferenceHead is the biggest part of the newborn’s body, covering 25% of the total body lengthThe normal chest and abdominal circumference is 31-33cmThe normal body temperature is 36.5 – 37.5OCRectal temperature is no longer recommended because it is a blind procedureThe best way to check for the anal patency is NOT by taking the rectal temperature but to check the meconium passage.Fever or hyperthermia in newborn usually indicates dehydration (not infection)75% of the newborn’s body is made up of waterThe normal blood pressure is 80/46.The 2 palpable peripheral pulses are BRACHIAL and FEMORAL pulsesThe best area of pulse assessment during regular assessment is APICAL PULSEThe best area of pulse assessment during resuscitation is BRACHIAL PULSEPhysiologic weight loss is only 5 to 10% (term babies)/ up to 15% (preterm babies)Physiologic apnea is less than 15 seconds. Pathologi c apnea is more than 20 seconds.Sudden Infant Death Syndrome (SIDS) is prone to babies who have low Apgar score, sleeping in prone postion and with pathologic apnea.If jaundice is suspected, examined the child by the window using natural light. Natural light is the BEST light to be used in assessment. If natural light is not available, make use of white light.Physiologic jaundice happens after 24 hours.Pathologic jaundice happen within 24 hours.Normally a newborn turns red/ pink upon crying due to polycythemiaACROCYANOSIS/ PHERIPHERAL CYANOSIS (blueness and coolness of the arms and legs) is normal in neonates because of their immature peripheral circulatory system; CENTRAL/ TRUNK CYANOSIS is a sign of congenital heart defects.Meconium stained amniotic fluid or baby is a sign of posterm baby or fetal distressAnterior fontanel (Bregma), diamond in shape, closes at 12-18 monthsPosterior fontanel (Lambda), triangle in shape, closes at 2-3 monthsCAPUT SUCCEDANEUM is scalp edemaCEPHALHEMATOMA is presence of blood between the periosteum and skullHead lag should disappear at 4-6 monthsThe proper way of checking for the head lag is pulling the arms of the baby towards sitting position and observing the shoulders and the head of the babyThe well developed human sense in a newborn is sense of TOUCH (tactile)The favorite picture of babies is HUMAN FACESThe first color to be seen by a newborn is BLACK AND WHITE. The favorite color of newborn is REDThe visual acuity of newborn is 20/150. 20/20 vision happens at 6 years oldThe Eustachian tube of a newborn is shorter and straighter, thus making them prone to OTITIS MEDIADuring ear inspection of a newborn, pull down and back the earsThe tip of the ear should be on or above the outer canthus of the eye.Low set ears are a sign of Down’s syndrome or kidney problems.A normal whitish discharge present from the nipples of a newborn is called WITCH MILKA normal reddish discharge present from a female newborn’s genitals is called PSEUDO-MENSTRUATIONWitch milk and pseudo menstruation are due to maternal ESTROGENThe first voiding (urine) is pinkish in color; consider this as NORMAL. This is due to urate formation (crystallize urine formed in the bladder during later of pegnancy)Umbilical cord is made up of 2 arteries and 1 vein (AVA)A missing blood vessel in an umbilical cord indicates congenital heart defects or kidney anomaliesUmbilical hernia is called OMPHALOCELEProlonged bleeding on the cord for more than 30cc is called OMPHALAGIAMILIA is white or yellow pin point papules over nose, chicks, chin and foreheadLANUGO is fine downy hairVERNIX CASEOSA is whitish, cheesy and odorless substance made from old cutaneous cellsLanugo and vernix is dominant is preterm babies.Grayish blue patch over the buttocks is called MONGOLIAN SPOTSERYTHEMA TOXICUM is commonly called as newborn’s rash; due to reaction of the body to environmental allergenDESQUAMATION is dry peeling of the skin; commonly seen in post term babies or malnourish baies.MORO REFLEX/ STARTLE REFLEX is the best reflex that test the brain functionTRUNK INCURVATION/ GALANT REFLEX is the best reflex that test the spinal cord functionPEDIATRIC NURSING - NORMALSSUMMARY OF FUNCTIONAL CONCEPTSSET BPrepared by: Prof. Brian YuNEWBORN SCREENINGNewborn screening act of 2004 is under Republic Act 9288The major disorder prevented by the newborn screening is MENTAL RETARDATION5 DISORDERS CHECKED IN NEWBORN SCREENING:PhenylketonuriaGalactosemiaCongenital hypothyroidismCongenital adrenal hyperplasiaG6PD deficiencyThe best time to subject a baby to newborn screening is after 48-72hrsThe requirement for newborn screening is breast milk intake of the babyHEEL PRICK (lateral of the heel) is the method of obtaining blood specimen for newborn screening.PHENYLKETONURIA is a protein metanbolic problem wherein the body cannot process phenylalanine. GALACTOSEMIA is a carbohydrate metaboilc problem wherein the body cannot process galactose.CONGENITAL HYPOTHYROIDISM is an endocrinologic prpblem wherein thebody has low thyroid hormones. Commonly cause by low iodine intake by the mother during preganacy.CONGENITAL ADRENAL HYPERPLASIA is an endocrinologic prpoblem where in adrenal hormones are too much specifically sex hormones.G6PD (Glucose-6- Phophate Dehydrogenase) deficiency is a blood disorder that causes hemolytic anemia and jaudice.BREAST FEEDINGTYPES OF MILK:Breastmilk = 0 to 6 monthsFormula milk = 6 to 12 monthsCow’s milk/ Whole milk = 12 months and aboveCOLOSTRUM is the first milk produced by the breast upon lactationFOREMILK is thin, watery milk secreted at the beginning of a feeding; HINDMILK is thick, high-fat breast milk secreted at the end of a feedingBreast milk is unique from other types of milk because it contains antibodies specifically IgAIgG is obtain from the placentaIgA and IgG are examples of NATURAL PASSIVE IMMUNITY from the mother given to the newbornIgA is use more on viral infection whereas IgG is use more on bacterial infectionCow’s milk should not be given to a child who is less than one year of age because of its low linoleic acid content (responsible for brain and skin development) and its protein casein, which is difficult for infants to digest.Breamilk and cow’s milk provide the same amount of calories per ounce: 20 caloriesBest way to evaluate milk intake is through WEIGHT GAINTo stop the newborn in sucking during breast-feeding, the nurse should teach the mother to insert a finger at the corner of the infant’s mouth.Breastfeeding should be exclusively given from 0-6 months but can be extened up to 2 years with supplementation of solid foods.The earliest time to give solid foods is at 4 months (the best time is at 6 months)The first solid food to be given is RICE CEREALS because it is hypoallergenic and wasy to digestEgg WHITE should be given at later months (starting at 12 months) because of its albumin which is highly allergenicFruits also contain latex allegy. FRUITS THAT CONTAINS LATEX ARE THE FOLLOWING:AvocadoBananaKiwiChest nut/ hazel nutsMangoStrawberrySoy beansGrapesPineapplePassion fruitThe stomach of newborn is slightly alkaline. Citrus fruits should be avoided because it might cause gastric upset.The order of food introduction are the following: Rice cereals ? vegetables ? fruits ? egg yolk ? meat ? whole egg ? fish ? processed foods and sweetenersThe interval of changing from one type of food to another is 1 week.The initial feeding is consist of sterile water followed with breast milkLactation is affected by two pituitary hormones: PROLACTIN and OXYTOCINBreastmilk contains LACTOSE which may be contraindicated for newborns with lactose intoleranceThe characteristic of the stool of a newborn being BREASTFED is golden yellow in color, pasty in consistency and sour in odorThe lactose content of the breastmilk makes the stool sour in odorMECONIUM is the first tool of neewborn that is blackish-green incolor, sticky and odorless.The characteristic of the stool of a newborn being FORMULA FED is light yellow in color, formed, and foul smellingBurping or bubbling the baby is done in the middle and at the end of each feedingMake sure that the nipple of the baby bottle is always full of milk to prevent colicPropping the bottle should not be encourage because it causes 3 complications:Otitis mediaAspirationDental carries (baby bottle syndrome)To preven dental carries in newborn, change the milk with water when the baby is near to sleep.The UPPER TEETH is more prone to dental carries.Breastfeeding causes physiologic jaundice; commonly called at breastmilk jaundice. This is due to pregnanediol, a byproduct of progesterone that is release in the breastmilk after pregnancy. Pregnadiol interferes on the conjugation of the bilirubin.Calorie requirement/kg BW of a newborn = 110 – 120 calories/kg of BWFluid requirement/kg BW of a newborn= 80 – 100 ml/kg of BWNumber of voidings per day=10-15 timesBREASTMILK STORAGERoom temperature= 4 to 10 hoursRefrigerator= 24 to 48 hoursFreezer compartment inside refrigerator = 3 to 4 monthsDeep freezer (constant 0 degree) = 6 monthsTo promte swallowing reflex, makes sure that the nipple is pointed on the posterior part of the tongue.To initiate breatfeeding, just stroke the nipple on the cheeks of the baby (rooting reflex)4 CRITERIA to ensure proper LATCHINGChin touches the breastOpen mounth widelyLower lip turned outwardAreola is covered by the mouth/ areola is only visible aboveADVANTAGES OF BREASTMILKB – Best for babiesF – fresh alwaysR – Reduced allergyE – EconomicalE – Emotional bondingE – Easy once establishedA – Antibody presentD – Digested wellS – Stool is not offensiveI – Immediately availableT – Temperature is always rightN – NutritiousG – Gastroenteritis preventedPRINCIPLES OF GROWTH AND DEVELOPMENTGROWTH is generally used to denote an increase in physical size or quantitative change. DEVELOPMENT is used to indicate an increase in skill, the ability to function or qualitative change. There are 2 rates of growth:Growth gap – toddlers, preschool and school agersGrowth spurt – infants and adolescenceWEIGHT is the best parameter to measure growthRATE OF WEIGHT:2x at 6 months3x at 12 months4x at 30 monthsCEPHALOCAUDAL is a developmental pattern that decribes that the development precedes from head to toe. PROXIMODISTAL is a developmental pattern which describes that development proceeds from the center of the body to the distal parts. GROSS TO REFINED is a developmental pattern which describes that skill using large muscles is developed first before skills using small muscles. Growth and development are continues processes and start from CONCEPTION until DEATHGENETICS and ENVIRONMENT are the primary factors that influence growth and development.HIGH RISK NEONATESHyperbilirubinemia is increase bilirubin in blood. Normal bilirubin in blood is not more than 12 mg/dlBabies with yperbilirubinemia has GRAY colored stool and YELLOW sclera, skin and mucus membranes.Kernicterus is a condition wherein hyperbilirubinemia affects the brain cells which causes permanent neurologic damage/ cognitively challenge.Phototherapy is need in babies with hyperbilirubinemia.In phototheapy, cover the eyes (to prevent blindness) and genital (to prevent sterility). If photoblanket is used, no need to cover the eyes.Fetal Alcohol Syndrome (FAS) is a condition that happens to a newborn due to maternal alcohol abuse during pregnancy.Babies with FAS are born with Facial deformities (Upturned nose, Smooth philtrum, Micrognathia, Long thin upper lip, Short palpebral fissure, Epicanthal fold)Neonatal Abstinence Syndrome is a condition that happens to a newborn due to maternal narcotic drug abuse during pregnancy.Babies with FAS or NAS are prone to seizures after birth due to withdrawal.Infant of diabetic mother experiences hypoglycemia at birth.Hypoglycemia happens due to hyperinsulinism and decrease glucose supply upon cutting of the cord.Erythroblastosis Fetalis/ Blood Incompatibility/ Hemolytic Disease Of The Newborn is a condition wherein there is RBC destruction due to antigen-antibody reactionCOMPLICATION of blood incompatibility are: Hemolytic anemia or hyperbilirubinemiaRHincompatibility happens when:Mother’s Rh is NEGATIVE (-)FETUS’s Rh is POSITIVE (+)ABO incompatibility happens when:MOTHER is TYPE A and the FETUS is TYPE BMOTHER is TYPE B and the FETUS is TYPE AMOTHER is TYPE O and the FETUS is TYPE A or BRh immune globulin, RhoGAM must be administered to the mother within 72 hours to prevent the formation of MON CAUSES OF SMALL FOR GESTATIONAL AGE (SGA) ARE Smokingmaternal hypertensionInfectionPlacental insufficiencyPoor nutritionMaternal alcoholismCOMMON CAUSES OF LARGE FOR GESTATIONAL AGE (LGA) ARE:Diabetic motherCongenial hypothyroidismPHIMOSIS is unretractable foreskin of the penis; treated by circumcisionPenile opening on the dorsal or upper segment is called EPISPADIAS. Penile opening on the ventral or lower segment is called HYPOSPADIASUndescended testes is called CRYPTORCHIDISMExtra digits or toes is called POLYDACTYL while Missing digits or toes is called OLIGODACTYLAbsent digits or toes is called ADACTYLWebbed digits or toes is called SYNDACTYLExcessive mucuc/ drooling is a danger sign of congenital deect esophageal atresia or tracehoesophageal atresia. Assess for maternal polyhydramnios.Sac or dimpling at the lower back over the lumbar region is a sign of spina bifidaRespiratory Distress Syndrome (RDS)/ Hyaline Membrane Disease is manifested by difficulty in respiration due to deficient surfactant which could lead to lung collapse (atelectasis)Lung surfactants are measured by Lecithin and Sphingomyelin ratio. Normal L/S ratio is 2:1Development of lung surfactants is depressed if thhe mother has diabetes mellitus.RDS is the elading cause of deaths in premature newborns. If RDS is suspected, steroids is adminsitered to promote lung surfactant productionGROWTH AND DEVELOPMENTGrowth is changes in size and weight (physical change) and it is quantitative in nature.Weight is the best parameter in quantifying growth.Development is changes in skills, functions and behaviors and it is qualitative in nature.Maturation is changes due to genetic inheritance.Denver Developmental Screening Test (DDST)/ Metro Manila Developmental Screening Test (MMDST) is the best parameter to qualify development.DDST/ MMDST is composed of 4 categories: (1) gross motor skills, (2) fine motor skills, (3) socialization, (4) language.DEVELOPMENT OF DENTITION:6 months = 1st temporary teeth (2 lower central incisors)30 months = complete temporary teeth (20 teeth)6 years = 1st permanent teeth12 to 18 up to 21 years old = complete permanent teeth (32 teeth)Thomas Hobbes – doctrine of ORIGINAL SIN: suggest children are inherently evil and selfish egotists who must be controlled by societyJacques Rousseau – doctrine of INNATE PURITY: suggest children are inherently good and born without an intuitive sense of what is right and wrongJohn Locke – doctrine of TABULA RASA: suggest children are neither good or evil, but rather enter the world as a blank slate without inborn tendencies, and are molded through life experiencesGROWTH AND DEVELOPMENT: INFANCY (0 – 12months)Eric Erickson (Psychosocial theory), the developmental task of infants is ‘’Trust vs Mistrust.’’Sigmund Freud (Psychosexual theory), the developmental task of infants is ‘’Oral stage.’’Solitary play is the common play for infants; the best is interaction with the caregivers.The primary care giver, usually the mother, is the most important person in the life of an infant.Fear of stranger is common during infancy. It starts at 6 months and peaks at 8 months.The safest type of balloon in infants is mylar balloonPosition of car seat is rear facing center back seat (less than 20 lbs), forward facing center back seat (20 to 40 lbs)LANGUAGE2 months – cooing4 months – babbling6 months – 1st syllable9 months – 1st word12 months – 2 words + mama and dadaMOTOR SKILLS5 months – rolls over6 months – sits with support, hold a cup using both hands8 months – sits without support9 months – crawling10 months – stands with support, pincer grasping12 months – stands without supportSOCIALIZATION2 months – social smile5 months – mirror image6 months – start of fear of the stranger8 months – peak of fear of the stranger10 months – peek-a-bookGROWTH AND DEVELOPMENT: TODDLER (1 – 3 years)Erickson (Psychosocial theory): AUTONOMY (Independence) versus SHAME AND DOUBT (Dependence)Freud (Psychosexual theory): Anal stageThe 3 psychosocial needs of toddlers are: (1) gaining control, (2) autonomy, and (3) independencePlay: Parallel (must be in the same age group regardless of sex)Fear: Separation anxiety; 3 stages: Protest, Despair, and DisplacementThe activities/ toys must promotes leg and arm muscles development such as push and pull toys and stacking blocksManagement for pessimistic/ negativism: provide choicesManagement for temper tantrums: ignore but provide safetyManagement for breath holding episodes: ignoreManagement for physiologic anorexia/ food jags: small frequent feedingGROWTH AND DEVELOPMENT: PRESCHOOLER (4 – 6 years)Erickson (Psychosocial theory): INITIATIVE versus GUILTFreud (Psychosexual theory): PhallicPlay: Associative and Cooperative PlayOedipal complex is attraction of the son to mother; Electra complex is attraction of daughter to father.At the start of preschool age, there should be attachment of the child to opposite sex parent.At the end of preschool age, there should be attachment of the child to same sex parent.ANIMISM is putting life to non-living things, e.g. The child says, “Rocks have human qualities.”EGOCENTRISM presents all things has reference to self.Provide bandage to injection site due to fear of mutilationDo not subject child to circumcision due to fear of castration.GROWTH AND DEVELOPMENT: SCHOOLAGE (7 – 12 years)Erickson (Psychosocial theory): INDUSTRY versus INFERIORITYPlaymates of school age should be same sex (normal homosexual).To promote INDUSTRY, give short and simple assignments.Fear: school displacementPlaymates should be SAME SEX.GROWTH AND DEVELOPMENT:: ADOLESCENCE (12 – 18 years)Erickson (Psychosocial theory): IDENTITY versus ROLE CONFUSIONPUBERTY is the maturational, hormonal and growth process that occurs when the reproductive organ begins to function and secondary sex characteristic develops; Male: 12 – 16 and Female: 10 – 14ADOLESCENCE is the physiologic period between the beginning of puberty and the cessation of bodily growthMenarche is the onset of menstruation; Thelarche is the onset of breast developmentBody Image Disturbance is the common nursing diagnosis for adolescence. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download