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8/13/2019 Pediatric Nursing 1

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Pediatric Nursing

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ACKNOWLEDGMENTOur deepest gratitude to all members of the department

of Pediatric Nursing for their contributions.

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Content

*Perspective in Pediatric Nursing. 4

*Growth and Development in Children. 8

*Nursery School in the Lie o Preschool Child. !"

*#ssessment and $anagement o New%orn. 4&

*#ssess and $anagement o 'igh()is New%orn. "&

*Psychological #spect o 'ospitali+ation. ,8

*Congenital #nomalies. &-"

*eeding o /nant and Children. &!0

* Nursing $anagement o Children with &""

$alnutrition Distur%ances.

* Gastro(lntestinal Disorders. &8-

* Diseases o )espiratory System. &,"

* Diseases o 1rinary System. 00&

*2lood Disorders. 04"

* Nursing $anagement o Cardiovascular 03,Diseases.

* Diseases o the Central Nervous System. !&!

* Nursing Care o most Common Communica%le !4Diseases o Children .

* Nursing Care o 5ndocrine Diseases. !3-

* Nursing $anagement o Sin and Parasites !84Diseases.

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Perspective in PediatricNursing

General Objective:

2y the end o this lecture6 the student will %e a%le to discuss

perspectives in the nursing care of children.

Specific Objectives:

#t the end o this part6 the student will %e a%le to7

&.Deine what pediatric nursing means.

0. $ention the historical %acground o pediatric nursing and itsdevelopment.

!. 5numerate scopes o pediatric nurses practices.

4. List the 9ualities characteri+ing a good pediatric nurse.

. /dentiy the role o pediatric nurse.

". $ention the amily center care approach.

3. $ention the health education necessary to parents.

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Perspective in Pediatric Nursing

Introduction:

:here was a time6 not so long ago6 when the pediatric nursing didnt

e;ist6 or the special services or the protection o children. Previously6

hospitals or children or separate departments or their care in general

hospitals were rare. :hey were cared or with ill adults. :oday6 most large

general hospitals provide a special unit the art and science o giving nursing care to children rom %irth

through adolescent with emphasis on the physical growth6 mental6emotional and psycho(social development>.

Historical Background and Development of

Pediatric Nursing:

&. 5arly primitive people were nomads6 where they were moving

constantly to search or ood and saety rom wild animals. :hey used todestroy those who were sic or wea. Children had to receive a minimum

physical care to live6 and sic or malormed inants were either illed or let

%ehind to die.

0. /n 5gypt6 as early as &-- 2C6 children received treatment6 which

diered rom that given to adults. 5gyptian children were cared or %y

dressing inants in loose clothes and %reast(eeding was encouraged.

!. Due to the speed o modern transport and e;ploding world population5


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%rought people o the world closer. :hus6 health pro%lems that were the

concern o only a small segment o population %ecame threatening to the

whole world.

4. :he emphasis o pediatric nursing6 ity years ago6 was on the care o the

ill children in either the hospital or physicians oice. :oday6 dramatic

changes in the care o children occurred6 where the emphasis has

%roadened to include prevention o illness and accidents? the holistic health

care? and the nursing care o children within their amily constellation.

Scope of Pediatric Nursing Practices:Nurses have the responsi%ility in providing nursing interventions either in

am%ulatory or institutional settings. #m%ulatory setting7 such as home6 schools

and or physicians clinic where children and their parents have heath or

counseling needs. @hile6 institutional settings are mainly hospitals


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intellectual and emotional %eing within the conte;t o his amily and

communities


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Family Center Care Approac:amily and child centered care is amily oriented6> yet

individuali+ed and coordinated6 recogni+ing the worth o each person

as a mem%er o the amily constellation. 'ealth team should %e

le;i%le and creative in .coring or the child within his amily as theirintervention are %ased on the needs o. parent and child and on their

coping resources.

#lthough the amily is the ultimate coordinator o its own care6

the nurse can help esta%lish a positive environment or amily

mem%ers and help them accept and utili+e the care provided. She can

guide amily mem%ers through the unnown o new e;periences in

seeing holistic health.

Parent !ducation:Bne o the maor roles o the nurse is teaching %oth the child


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"eneral #$%ectives:

2y the end o this lecture6 the student will %e a%le to discuss

growth and development o children.

Specific #$%ectives:

2y the end o this lecture6 the student will %e a%le to7

/dentiy the importance o growth and development

Deine growth and development

$ention the principles o growth and development list actors aecting growth and development.

$ention types o growth and development.

/dentiy the stages o development.

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"ro&t and Development of Cildren

Introduction:

.Since conception6 the individual is constantly changing throughout hislie until his death. :he ways in which the whole child changes overtime are

%oth 9uantitative and 9ualitative in nature6 Growth and development are not

synonymous terms %ut they are parallet to each other and are interdependent

in unction

importance of gro&t and development for nurses:

Nurses must study growth and development or the ollowing reasons7

&. Enow what to e;pect o .a particular child at understanding the childs

growth and development help the nurse to o%serve and udge the child in

terms o norms or speciic level o development.

0.:he nowledge o growth and development is(important to the nurse

so that she may %etter understand the reason or particular condition and

illness6 ich occur in various age groups.

!. nowledge o growth and development would help the nurse in

ormulating the plan or total care6 which the physician and other health team

mem%ers outline or each child.

4. :he growth and development nowledge would help theF nurse inteaching mothers how to use such nowledge in order that might help :heir

own children to achieve optimal growth and development. :his could %e

achieved through understanding the changes in rates o growth and

development that can %e e;pected at each age or stage.

Definitions:

Growth:

Growth reers to an increase in physical si+e o the whole %ody or

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any o its parts. /t results %ecause o cell division and synthesis o proteins. /t causes

a 9uantitative change in the childs %ody. >

in ilograms6 pounds6 meters6 inches.... etc6

Development:

Development reers to a progressive increase in sill

and capacity o unction. /t causes a 9ualitative change in

the childs unctioning.


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4. not all %ody parts grow in the same rate at the. same time6

e.g.( during prenatal stage6 head grow aster than the other

organs6 %ut ater %irth6 the other organs are more rapid in growth

than the head.

. all types o growth and development dont occur at the

same rate6 their variationAamong them %ut within the normal

range.

". 5ach child grows in hisAher own uni9ue and >personal

way. :here are great individual variations in the age at which

developmental milestones are6

reached %ut within the normal range6 i.e.6 there are individual

dierences.

3. 5ach stage o growth and development is aects those

that ollow.

8. Growth and development proceed in regular6

relatedHdirections6 which relect the physical development and

maturation o neuromuscular unctions. :hese directions are7

a. cephalocaudalII II J where growth proceeds

rom head down to

toes. Infants achieve control of head before the

trunk and extremities; hold their %ac erect %eore they stand6

use control hands %eore eet.

%. Pro;imodistal II II J where growth proceeds rom

the center or midline6 o the %ody to the peripherally. /n the

inant6 shoulders control precedes mastery o hands?

whole hands %eore ingers.

Cephalocaudal

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Proximodistal

General to specific > where development proceeds

rom simple operations to more comple; activities and unctions6

i.e. rom very %road6 glo%al patterns o %ehavior to more speciicreined patterns emerge. or e;ample6 inant will respond to

people in generaK

%eore he recogni+e and preers his mother


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#ctors affecting gro$th and development:/. Heredity:

& 'eredity o a man and a woman determines that o their

children.

0 Se; o children determines their physical attri%utes andpatterns o growth.

!. )ace and nationality

//. Environmental factors: 1-Prenatal environment:a- Factors related to mothers during pregnancy,such as:

& Nutritional deiciencies6

0. Dia%etic mother

!. 5;posure to radiation.

4. /nection with German measles.

Smoing.

". 1se o drugs.

- Factors related to fetus, such as:

& $alposition in utero.

0. aulty placental implantation

!- Postnatal environment:

a. E"ternal environment, such as.&. Socio(economic status o the amily.

0. Childs nutrition.

!. Climate and season6 which might aect rates o

growth and development


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(ypes of "ro&t and Development:a) (ypes of gro&t:

&.physical growth such as weight height head

and chest circumerences.

0. Physiological growth such as6 vital signs.$) (ypes of development:

&. $otor development II e.g. sitting6

waling6 ...etc.

0. Cognitive development II


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childs %irth.


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!. $ormal $e%orn

InfantNew%orn stage is the irst 4 wees o lie. /t is transitional

period or an individual as he transers rom intrauterine lie to

e;tra ( uterine environment6 where new%orn inant has to adapt to

it. Physical growth:

a. %eight:$ost new%orn inants weight 0.3--Hto 4 gms

at %irth. :hey loose

to &- o weight %y ! to 4 days ater %irth as result

o7

&. @ithdrawal o hormones rom mother.

0. Loss o e;cessive e;tra cellular luid.

!. Passage o meconium


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acute at lips6 tongue6 ears6 and orehead.

( :he new%orn usually /s comort with touch.

b. (ision: & ( Pupils react to light.

0( 2right lights appear to %e unpleasant

to new%orn inant.

!( ollow o%ects in tine o vision.

c. 'earing7

&( :he new%orn inant usually maessome response to sound rom%irth. 6

(. 0( Brdinary sounds are heard well%eore &- days o lie. :he new%orninant responds to sounds with eithercry .or eye movement6 cessation oactivity and A or startle reaction.

d. "aste)@ell developed as %itter and sour luids are resisted while sweet

D

luids are accepted.

e* Smell:Bnly evidence in new%orn inants search or the

nipple6 as he smell%reast rnil

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+evelopments#. ,otor +evelopment:&. 'is movements are random6 diuse6 and uncoordinated.0. Lac muscular strength to hold head steady and erect


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( 'e startle to aces as he shows vague and indirect regard o

aces.

/nancy period starts at the end o the irs&K month up to

the irst year o age. inants growth and development during thisperiod are characteri+ed %y %eing rapid.

P

h

sic

al

Gr

o$

th:

a.

%e

igh

t:

the

in

ant

gai

ns7( 2irth to 4 months !#

gAmonth.

to 8 months

gAmonth., to &0 months L

*gAmonth.:he inant will dou%le his %irth weight %y 4( months and triple it

%y &r&0 months

o age.#nother way o calculating the weight or inant age ! to &0

months

#ge in $onth

, @eight Q

IIIIII

IIIIII

I

0

.or e;ample6 the weight o 3 month old inantQ 8 g.

b.&eght:Length increases a%out ! cmHAHmonth during the irst

! months o age6 then it increases 0 cmA month at age o

Normal infant

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4(" months6 then at 3 to &0 months it increases & &4 cm A

month.

c.&ead 'ircumference:( /t increases a%out 0 cm A month during the irst !

months6 then R0cm A month during the second , monthso age.

( Posterior ontanel closes %y " to 8 wees o age.

( #nterior ontanel closes %y &0(&8 months o age

chest 'ircumference :2y the end o the irst year6 it will %e e9ual to head

circumerence.

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Phsiological Gro$th:

Pulse: && -( & - %eats A minute6

Respiration: !4 &-

cAminute.

2reath

though nose.

2lood Pressure7 8-A- 0-A&- mm'g.

Dentition75ruption o teeth starts %yHto " months o age. /t is called

>$ily teeth > or >Deciduous teeth >or >temporary teeth or primary

teeth.

#verage age or teeth 5ruption7erupt at "months6

erupt at 3. months.

erupt at ,

months6

erupt at &&

months6

erupt at &0

months6

erupt at &4

months6

erupt at &"months6

erupt at &8

months6

erupt at 0-

months

6 erupt at 04

months.

Lower central incisors&. Hlower central incisors0. 1pper central incisors

!. 1pper lateral incisors

4. Lower lateral incisors

. Lower irst molars

". 1pper irst molars

3. Lower cuspids

8. 1pper istn%lars

,. Lower second molars

&-. 1pper second molars

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Normal range for +entition:

Name o :eeth $andi%ular


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:55:'

#entral inci

Lateral incisor

#uspid$

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"irst %ola.r

Second %olar.

"irst permanent %olar &

"irst permanent %olar$

Second %olar.

"irst %olar.

#uspid.

Lateral incisor

#entral incisor

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S

e

n

s

e

s

i

s

u

a

l

7

0 months7 ( @hen on %ac6 ollow a moving o%ect %eyond the

midline o vision.

( 5yes ollow moving persons near%y.

! months7 ( @hen on %ac6 turn eyes to a moving light or dangling

o%ect.

( 2inocular coordination


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angle when in prone position and loos

around.

()olls over rom ront to %ac.

('olds head erect and steady while

in sitting position.

plays with ingers.(Grasps o%ect held near hand6 %utcannot pic it up when dropped.

(Grasps o%ects with %oth hands.(Carry o%ects to mouth

4th month

'olds %ac straight when pulled to a sittingposition.(2alances head well when sitting.(Sits with slight support.

(1ses thum% in picing up o%ects.(Grasps o%ects with whole hand


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support

51thmonth

Stands alone or varia%le length o time.

(Sits down rom standing position alone.

(@als in ew steps with help or alone

ah6&

2rdmonth: (Laugh loudly."thmonth: (ocali+es several well (deined sylla%les.3thmonth: (vocali+es da6 ma6 and %a.

,thmonth: ( #ssociates words with persons or o%ects6 says >ma ma. da da.>56thmonth: ( $ay spea one word >no> or >hi.>&0thmonth: ($ay spea two or more words %eside >ma ma>6 >da da>6 >%a

%a>.

In #rabic language:

/nant starts with throaty letters


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Social +evelopment:

2y 0 months7 (Distinguishes >mother> as primary care giver rom others.

(Learns that crying %rings attention.

2y ! to 4 months7 ( Smiles in response to smile o others.(Shows interest in otheramily mem%ers. 2y 3 to 8 months7 (Show earo stranger %ye(%ye> %y ,months and social games with adults e.g.> pee (a (%oo> %y &- months.

(/mitates acial e;pression at &- months.(5ye (to (eye contact6 smiling6 and vocali+ation are

the evidences o attachment %etween the inant and his parent6 especiallyhis mother.

(#ccording to 5rison6 through the inant

interaction with caregiver


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Normal "oddler

:oddler stage is %etween & to ! years o age. During this period6

growth slows

considera%ly.

Phsic

al

Gr

o$t

h:

%e

ight:

( #verage weight gain is &68 to 0.3 gAyear.

( ormula to calculate normal $eight of children over 5 ear ofago7

#ge in ears - 1 8 9 7........ ;gm.

&eight:

( /t increases a%out &- to &0. cmA year. &(0 years increases & cm A

month.

( ormula to calculate normal height of children over 5 ear ofage7

#ge in ears - 4 8 96 7........gm

&ead and 'hest 'ircumferences:

( & year to adult head increases &- cm only.

( During toddler years6 chest circumerence continues to increasein si %ecause o the

immature a%dominal musculature.

2owel and %ladder control7 Daytime control o %ladder and %owel control %y 04( !- months.

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Senses)

( 2inocular vision is well developed %y & months o age. isual

acuity o "A" is achieved during this period.

( Senses o smell6 hearing6 touch6 and taste %ecomes increasingly well

developed

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Physiological Growth:

' Pulse( )*'+,* beats - min averae ++* -min/.

' 0espiration( 1* ',* c /min.

%otor 2evelopment(

( @als alone.( Creeps upstairs.

(#ssumes standingposition withoutsupport.( Cant throw %allwithout alling.

(2uilds tower o 0( !%locs.(Bpen %o;es.('olds a cup withall ingers graspeda%out it.

($ae line with crayon.(Pats pictures in

%oos and %eings toturn pages.(Scri%%lesspontaneously.HHHHH

()un clumsily ? months

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( Develop >sense o autonomy> i.e. > / can do it my

sel.> :he development o autonomy during this period

is centered on toddlers increasing a%ilities to control

their %odies6 themselves6 and their environment. :heywant to do things or themselves6 using their newly

ac9uired motor sills6 e.g. waling clim%ing.... ect6 their

mental power o selection and decision(maing. / they

ell small and Aor when they are orced to %e dependent

on others6 eeling o dou%t and shame arise.

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Preschool Stage/t is the stage where child is ! to " years o age. :he

preschoolers grow relatively slow during this period.

Phsical Gro$th:%eight*:he preschooler

gains appro;imately &.8 gAyear.

&eight:'e dou%les %irth length %y 4( years o age.

Phsiologi

cal

Gro

$th:

Puls

e:8-(&0- %eatAmin


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Language Development7

2rdear:@

( oca%ulary o 8--( &--- words.

( 1ses 4 words sentences. .

( #s why.

3thear:

( oca%ulary o &-- words.

( 1ses ! to 3 words sentences.

( 1ses : in his speech.

4thear:

( oca%ulary o 0&-- words.

( #ss or the meaning o words6( )epeats sentence o &0 or more sylla%les.

Cognitive Development7Preschooler up to 4 years o age is in the pre(conceptual phase


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Social Development7

:he preschooler7

( 5gocentric in his thought and %ehavior6 una%le to see others

viewpoints.

( :olerates short separation rom parents %y ! years and separateseasily %y years o age.

( Less dependent on parents %ut needs their reassurance and help.

( $ay have dreams and nightmares.

( Demonstrates strong attachment or parent o opposite se;6

( $ore cooperative in play.

( :he preschooler is in the stage where he develops a sense o

initiative? where he wants to learn what to do or himsel6 learn

a%out the world and other people. / he ails to achieve this sense o

initiative6 he will develop a sense o guilt6 where he will appear

an;ious and rightened in his contact with others.

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Normal School* age

child

School( age child is %etween the ages o " to &0 years. 'e ischaracteri+ed %y gradual growth.

Phsical Gro$th:%eight:

School(age child gains a%out !.8 g A year. 2oys tend togain slightly more weight through &0 years.ormula or 3 to &0 years Q


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,otor +evelopment:School(age child continues to reine previously ac9uired sills.

()ide a %icycle.

()uns6 umps6

clim%s6 and

hope.

(/n constantmotion6 whichis clumsy6 andawward.

(Enows let

hand rom right.

(/mproved eye(

hand

coordination.

(Prints words

and learns

cursive writing.

(Draws a person


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( :he " years old is still in pre(operational stage6where he is a%le to understand and thin


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0motional +evelopment:

( ears inury to %ody6 and ear o dar.

( ealous o si%lings


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"he Normal #dolescent

#dolescent is a period o transition rom childhood to adulthood. /tis %ased on childhood e;periences and accomplishments. /t %egins with theappearance o secondary se; characteristics and ends when somatic growthis completed and the individual is psychologically mature6 capa%le o

%ecoming a contri%uting member of society.

Phsical

Gro

$th:

%eig

ht:

( Growth spurt %egins earlier in girls


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'ognitive +evelopment:#dolescent can deal with a pro%lem that does not have a %asis in >here

and now> as he can thin %eyond the present. /n solving a pro%lem6 he can

mae use o assumptions? ormulating hypotheses while thining .he can

have in mind many ideas a%out a pro%lem simultaneously and can predicta variety o possi%le solutions.

0motional +evelopment:)apid physical changes occur in this period are accompanied %y

changes in emotional control. #dolescent e;hi%its alternating andrecurrent episodes o distur%ed %ehavior with period o 9uite one. :here isincrease in moods and sentiments. 'e may %ecome hostile or ready toight6 complain6 or resist everything. Little things can cause emotionalupheaval? as the tension is relieved6 emotion is %rought under(controland he retreats in an attempt to master his anger and to grow his a%ilityto control his emotions and gain rom the new e;perience.

Social +evelopment::hroughout childhood6 the child has %een going through the process

o identiication6


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Nurser School

in the life of the preschool 'hild

+efinition:

:he nursery school serves the needs o 0( or " years old children%y oering them e;periences adapted to what is now nown a%out the

growth needs o these age levels. /t shares with parents the responsi%ility

or promoting sound growth in a period when growth is rapid and

important. :he nurser school is a

place $here oung children learn as the pla $ith materials and

share e-periences $ith other children and $ith teacher.?

Objectives of nurser school e-perience

for nurses:&. Nursery school as a la% or nurses is considered a place to study

a%out human%ehavior and relationships with people and to applythis nowledge in various relationships with children andtheir amilies? considering that the childrens %ehaviors changesrapidly.

0. Gain nowledge and understanding o normal growth and

development o the preschool age children


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,eeting the preschool C age children>s

need in the nurser school:

"he unctions of the nurser school are to provide:

&. )ichness o inormal play U type learning0. 5;perience learning7

!. Bpportunities to e;periment with materials an

4. Bpportunities to communicate with others acting out> eelings6 which doesnt harm

and have much value. @e learn what aspects o the

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world he is concerned a%out. So o%serving play is an

important part o teaching. Children are delight in large in

ree %ody movements when there is plenty o space6 this

will help in developing motor sills. Plays also help the

children in discovering his world and satisy his curiosity.

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2.satisying activities especially rhythmic activities6 they willsing6 thereore encourage musical e;pression to satisy children

and help them or sel(e;pression also a%ility to sing improves

with practice.

$usic with setting pattern6 e.g.6 marching helps the child to

now with music6 how to eep time and to it response into

pattern o the music they hear. $usic also improves with

practice.

3. #rt:

#rt materials should always %e

#rt helps the child to %e. Creative why (are(we(interested in

creative e;pression

or children.

#rt helps in e;pression o eeling and develop personality6 art

provides the children the opportunity o sel(e;pression learning

and creativity through inger paint6 crayons6 clay6 sand6 andwater to mae shapes6

4. !iterature:5;perience with %oos as a part o the daily program provide the

children the learning e;perience as it increase their voca%ularyand their intellectual a%ility6 as well as story telling. )eadinggroups6 which should %e small in num%er6 should %eencouraged. 2oos should %e attractive and o interest to thechildren.

Nurser school as a sociali


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come until he eels secure without her.

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actors> affecting the child>s learning

e-perience:


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Observe and notice7&. @hat the child says and does.0. 'is a%ility in waling6 running6 or clim%ing.!. 'is response to other children and o%ects around him.

4. Compare child with others o his age e.g in what way he is lie

other children and in what way he is dierent6 what years old

children do that ! or 4 years old child .

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cant doV @hat are their interests6 a%ilitiesV( what a%out theirspeech6 physical appearance6 their dressV @hat games do. they play6their a%ility to eed themselvesV

Remember that:

No ive years old child is ive years old in all

phased o development. Observation

recording:&. /t is important to develop sills in recording what children .say.

Eeep record o what you see and hear. )ecord the e;act words

that a child used. Name and date every thing you record as well as

note the time o day. :his will help in nowing whether the child

is getting %etter or not.

0. Chart everything in a positive ashion and state suggestion or

direction in apositive orm. # positive suggestion is one6 which

tells a child what to do instead o pointing out what he is not to

do. e.g. :hrow your %all over here> instead o >don&K hart the

window>.

:he aim o all record eeping is to provide scientiic material %y

which you canunderstand children %etter.

"he social problems that might occur for the

child::he social pro%lems that might occur i the child is not adusted

to nursery school are7

( :hum% sucing.

(5nuresis.

(2ad language.

0. Destructiveness and aggressiveness.

!. School pho%ia.

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Assessment andNursing 'anagement

#f Normal ne&$orn.#ter the initial o%servation or neonatal condition re9uiring

immediate action6 the %a%y is sent to the normal new%orn nursery ormaternity loor. :he maor goal o the nurse in the care o the new%orninant is to esta%lish and .maintain homeostasis. :his care shared with the

parents in the maternity unit or in normal new%orn unit o a hospital orassumed %y parents in the home6

#dmission 'are:Bn admission o the nursery6 the nurse should carry out theollowing7

&. /dentiy good interpersonal communication


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may decrease slightly.

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Second stage:

/t lasts a%out 0(4 hours. 'eart and respiratory rates decrease6

temperature continues to all6 mucus production decreases6 and urine or

stool is usually not passed. :he new%orn is in state o sleep and relative

calm.

Second period of reactivit:

2egan when the new%orn awae rom the deep steep6 it lasts

a%out 0( hours. :he new%orn is alert and responsive6 heart and

respiratory rate are increased6 gag rele; is active6 gastric and respiratory

secretions are increased6 and passage o meconium commonly occurs.

ollowing this stage is a period o sta%ili+ation o physiologic

systems and a vacillating pattern o sleep and activity.

#ssessment of Festational age:


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#pical &-0(&4- %eatsA

min. )espiratory7

!-("-

%reathsAmin.

. .

2lood Pressure7

"A4& mm'g.

General #ppearance:Posture:

le;ion o head and e;tremities while rest on

chest and a%domen.

Sin7

#t %irth6 %right red6 puy smooth. Second to third day dar pin and dry.

/t is sot and has good elasticity or tissue turgor due to

hydrated su%cutaneous tissue. /t is evident when a sin old is

grasped and thenreleased6 it will promptly go %ac to normal smooth .state.5dema is seen around eye6 ace6 legs and scrotum or la%ia.Cyanosis o hands and eet.&. erni; Caseosa7

it is a sot yellowish cream6 which covers the neonates at %irth toprotect thesin rom inection. Kt is ormed o se%aceous gland mi;ed with oldepithelial cells. /tmay thicly cover the %a%y or it my %e ound only in the %ody crease and%etween thela%ia.

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parietal and rontal %ones. /t is 0(! cm in width and !(4 cm in

length. Kt closes

%etween &0(&8 month o age.

:he posterior ontanel? is triangular and located %etween the

occipital and parietal

%ones6 it closes %y the 0nd month o age.

ontanels should %e lat6 sot6 and irm. /t %ulge when the

%a%y cries or i there is increased intracranial pressure.

:wo conditions may appear in the head. :hese are caput

succidaneum and cephalhematoma.

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'aput Succidaneum) is edema o the scalp resulting rom

pressure during la%or.

'ephalhematoma: is a hemorrhage under the periostieum o one o

the cranial %ones


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. Startle rele; elicited %y a loud sudden noise.

pinna le;i%le6 cartilage present.

Nose? . . Nasal patency. Nasal discharge ( thin white mucous.

,outh and throat:.intact6high(arched

palate.1vul

a inmidline.Suc*ing rele;( strong and coordination.

)ootingrele;.

Gagrele;.

$inimal salivation.

NecH:

Short6 thic6 usually surrounded %y sin olds. :onic nec rele; present.

System #ssessment o the neonates7

&. Gastrointestinal Sstem: $outh should %e e;amined or a%normalitiessuch as clet lip and

clet palate. 5sptein pearls %rittle6 white6 shine spots near thecenter o the 'ard palate they mar the usion o the 0hollows o the palate. /t will

disappear in time. Gum7 $ay appear with a 9uite irregular edgesometimes %ac o gums may .%e whitish deciduous teethare semi(ormed %ut not

5rupted. 'heeHs: 'ave a chu%%y appearance due todevelopment o atty sucing pads that help to createnegative pressure inside mouth and acilitate sucing.

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Stomach and intestine: :he capacity oinants stomach varies ater %irth rom !-("- cc and increaserapidly. $any inants swallow air during eeding soeructation is necessary.

#bdomen: Cylindrical in shape. Liver7 Palpa%le 0(!cm %elow costalmargin.

Spleen7 :ip palpa%le at end o irst wee oage.

1m%ilical cord7 2luish white at %irth with twoarteries and one vein. /t is ormed o gelatinousconnective tissue called @hartons elly. :he

cord shrins6 dries and drops o its place o

attachment heals ina%out 3(&- days.

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ou

s

S

ste

m:

Re

fle

-e

s:

Certain rele;es are a%solutely essential to the inantlie( as protective rele;es7 2lining rele;( it is aroused when the inant issu%ected to light. Coughing and snee+ing( to clear the respiratory tract.

Gagging((to prevent choing.

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eeding rele;es7( :he rooting rele;(cause the inant to turn his head

towards anything6 which touched his chec6 and inhis way to reach or ood.

( Sucing rele; provide such movements when

anything touches the lips.

Swallowing rele;7( it ollows sucing rele;.

:he gagging rele;7

( Comes into play when he has taen more into his mouth

than he can successully swallow6 can also cough i a little

o the luid is swallowed the wrong way and enters the

trachea.

Bther refle-es:

&. :he grasp rele;7 an inant will grasp any o%ect

put into his hands6 holds on %riely and then drop

it.

0. $oro rele;


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Suckin reflex 0ootin reflex

Babinski reflex

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Some Neonatal Refle-es:

)ele; 5liciting )esponseDevelopmental Duration

2a%insi Gentle stroe along sole o

oot rom heel to toe.

:oes an out6 %ig toe le;es. Disappears %y end o &st years.

2a%in Pressure applied to%othpalms while %a%ys lying on

its %ac.

5yes closed and mouth opens?head recurrent to centerposition.

.Disappear in !(4months.

2lin lash o light or pu o air

delivered to eye.2oth eyelids close. Permanent.

Divingrele;

Sudden splash o cold water

in the aceF

'eart rate decelerate6 %lood

shunted to %rain and heart.

2ecomes progressively wea

with age.

Enee

rete;:ap on patellar tendon Enee ics Permanent

$oro rele; Sudden loss o support

#rms e;tended6 then

%rought toward each

other? lower e;tremities are

e;tended

Disappears in a%out "

months

Palmar

rele;

2e" Fo inger pressed

against inants paim.:he o%ect is grasped Disappears in !(4

months

)age rele;

Place %oth hands on side

o aiert inants head and

restrain movements?%loc mouth with cheeseclothor covering or &-seconds

Crying and strugglingDisappears in 0(4months

)ootingrele;

B%ects lightly %rushinginants chee

( FF

2a%y turns towardso%ect and attempts to suc

Disappears !(4 months

Sucingrele;

inger or nipple

interested 0 inches into

)hythmic sucing Disappears !(4 monthsmouth

@aling

rele; .

2a%y is held upright and

soles o eet are placed on

hard surace? %a%y is dippedslightly orward

/nant steps orward as i

waling

Disappears !(4 months

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Immediate 'are of the

Ne$born

"he main nursing managements

are:&. Clear airway.0. 5sta%lished respiration.!. $aintain o %ody temperature.

4. Protection rom hemorrhage.

. identiication.

'lear air$a:/t is indicated %ecause airway is illed with amniotic luid6

meconium particles6

%lood6 etc. inhalation o these particles may plug6 irritate or

contaminate respiratory

tract.

,ethods of clear air$a:&. @iping o the neonates ace.

0. Gentle suctioning with a sot

catheter. In suctioning the nurse must

consider the follo$ing:

Suction must %e done rom mouth irst then the nose.$ae sure that there is nothing or the neonate to aspiratei he should

grasp when the nose is suctioned.

2e careul how vigorously is the suction and how deepthe suction catheter or %ul% syringe is inserted.

Stimulation o the posterior pharyn; during the irst ewminutes ater %irth can produce a vagal response causing

severe %radycardia and A or apnea.

@hen using a mechanical suction apparatus6 the suction

pressure should

%e set so that when the suction tu%ing is occluded6 the

negative pressure

doesnt e;ceed &-- mm 'g or 4 inches 'g. Following

suction hold the neonates head down to drain secretions

immediately while gently compressing the throat toward

the mouth to mil

out secretions.

1. 0stablishment of respiration:/ respiration doesnt occur spontaneously ater clearance o

airway the neonate should %e stimulated to %reath

Slappin9 the heel


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/ %reathing is still not initiated6 the new%orn will needresuscitation #pgarscore> evaluation. . #pgar score is done within the &stminutes ater neonates.

%ody has %een %ornthen is repeated when he is minutes old. #pgar score is assessed6%y using signsthat indicate the state o cardiopulmonary unction #pgar score> is4 or %elow at oneminute i.e. there is cyanosis6 heart rate %elow &-- %eatsAminute andinade9uate ordiicult respiration6 he will need o;ygen6 i he has a score o (&-he usually needsno treatment.

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incu%ator.

Place the new%orn against the mothers %ody.

/n warning the new%orn the nurse must

consider the ollowing7)e(warm the neonate gradually i he %ecomes child.)e(evaluate the neonates %ody temperature to stop or

modiy the warming devices.)ecording and reporting the neonates %ody temperatureto physician.

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&eat loss and heat production:

:he %ody temperature o the new%orn inant ismaintained as a result o %alance %etween theamount o heat produced and the amount oheat loss. .

/ heat production e;ceeds heat loss6 the %odytemperature rises6 lie wise i heat toss e;ceedsheat production6 then the %ody temperature alls.

'eat is lost in several ways6 which are75vaporation6 conduction6

radiation and convection.0vaporation:

'eat loss rom luid on the neonate inants sin ormucous mem%ranes to the room air. @hen moistureevaporates rom a surace6 the surace is cooled. :hus6 aninant can %e cooled %y evaporative heat loss whenmoisture such as %ath water or amniotic luid evaporates

rom the sin. Prepping> the sin or a

procedure wilt cool an inant. 'onduction:Bccurs when the new%orn inant is placed on a cool6 solid

o%ect. :his type o heat loss or gain occurs when an o%ect is

placed in direct contact with a warm or cold surace


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0-amples:

Rou already now that7

Placing an ice pac to you orehead will cool the sin. :he

same ind o

thing happens with an inant. >Placing an inant on acold mattress or ta%le may lower his %ody

temperature.

Placing an inant on a cold scale or ;(ray plate can alsolower his %ody temperature.

Placing a warm water %ottle ne;t to the inant will cause anincrease in temperature.

/n a nursery situation conduction is a common way in whichinants lose %odyheat6 as the items they come in contact with are usually cooler thanthey are. Roucan minimi+e this type o heat loss %y preheating all o%ects that

come in contact withthe inant. :his is especially important when placing the inant on themattress o radiant warmer or incu%ator.

)adiation7@hen heat is transerred rom the neonate to another solid

o%ect not in direct contact


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windows at night and out o the sunlight during the day6and maing sure radiant warmers are set at the appropriatetemperature.

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%leeding6 when this occurs6 an additionalclamp or orceps must %e placed.

ollow aseptic techni9ue


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General Nursing

,anagement of

the

Normal Ne$born#* (ital Signs:

ital signs should %e taen twice a day6 )eer to

immediate care protocol.

/* "emperature ,aintenance:

)eer to immediate care o new%orn inant

protocol.

'* Gro$th ,easurement:#ccurate %irth weight is important %ecause it

provides a %aseline or assessment o ris status

and uture growth.

/t must %e remem%ered that normal ull(term

inants will lose up to &- o their %ody weigh

in the irst ew days. :he weight loss is due to7

( Loss o e;cessive e;tracellular luid.

( Limited ood intae6 especially in %reast

ed inants.

( @ithdrawal o mothers hormone.

( Passage o meconium and urine.

:he neonate %eings to gain weight %y one

wee and %irth weight is regained %y &-(& days.

@eight the neonate daily at the same time and

same circumstances6 e.g. %eore eeding.

+* Infection 'ontrol:

Protect the neonate rom inection. )eer to lecture

o inection control.

0* Observation:

:he nurse should o%serve7

&( $econium and urine passage7

* :he neonate should pass urine within 04 hours

and meconium

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within 48 hours.

:he neonate may have a stool with every

eeding. Particularly6 when

%reast(ed.

:he nurse (should assess or deviation in stool

pattern or consistency and or either too

ew or too many saturated diaper with urine.

0( 1m%ilical cord o%servation or hemorrhage and

inection.

!( Neonates %ehavior.

4( #ny a%normalities7 Such as6 hemorrhage o

cord6 hypothermia6 hyperthermia6%radycardia and any

changes in neonates %ehavior.

* /.'.G. (accination.

G* Promote Parent*infant /onding:

2onding is a comple; process that develops

gradually and is its determined %y the type o

initial contact %etween the neonate and parent6 #s

the mother responds to the inant6 the inant must

respond to the mother %y sonic signal6 such as6

coging6 ye contact or6 grasp.

:he steps o %onding are7

&. /nitiation6 in which interaction

%etween neonate inant and parent

%egin.

0. Brientation6 which esta%lishes the

partners e;pectation o each other

during the interaction.

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!. #cceleration o the attention cycle to a pea o

e;citement. :he inant reaches out and co%s6 eyes

dilate and ace is %rightens.

4. #ter a short time deceleration o the e;citement and

turning away occurin which the inants eyes shitaway rom the mother.

. :he nurse must e;plain to parents and encourage

them to esta%lish promote neonate(parents %onding

through7

( 2reast(eeding within the irst hal an hour

ater %irth to acilitate inant( mother interaction.

( )ooming in o mother and inant.

( Li%eral visiting or ather6 si%ling and

grandparents help interaction %etween the neonate

and amily.

Parents must now that smiling6 stroing6 or

rocing demonstrate positive attachment6 sin to

sin contact %etween mother and inant.

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Nursing 'are Plan for Normal

Ne$born and amil:Nursing +iagnosis:

/neective airway clearance related to e;cess

mucous6 improper position.

Nursing Goal7 5sta%lish and maintain a patentairway.

Patient Goal7 @ill maintain a patent airway.

Intervention: Suction o the mouth and nasopharyn; with pulp

syringe as needed.

Lavage stomach rom amniotic luid and chec

or tracheoesophogeal anomalies.

Position inant on side acilitate drainage o secretions.

:ae vital signs according to institution policy more

re9uently i necessary. Position inant on right side ater eeding to prevent

aspiration.

Eeep diapers6 clothing and %lanets loose enough to

allow ma;imum lung


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'igh ris or inection related to deicient

immunologic deenses6 environmental actors.

Nursing Goal:

Protect inant rom

inection.

Patient Goal: @ill

e;hi%it on evidence

o inection.

Intervention: @ash hands %eore and ater caring or each inant. @ear gloves when in contact with %ody secretions. $ae certain appropriate eye prophyla;is has %eencarried out.

#pply alcohol to cord as order.

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Eeep um%ilical stump clean and dry6 place diaper %elowum%ilical stump.Eeep inant rom potential sources o inection i.e.persons with reps6 inections.

Nursing +iagnosis:

#ltered nutritional? less than %ody re9uirementstal out> their la%or and deliverye;perience.

'elp parents to demonstrate attachment %ehaviors such

as touch6 eye contact naming and calling inant %y

name6 taling to inant6 participating in are giving

activities.

Nursing Goal: 1. Prepared

inants discharge.

Patient Goal: @ill %e prepared or

discharge and home care.

Intervention:'elp should %e given to mother to get ready ordischarge.

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/nant should %e dressed with an e;tra diaper and%lanet.

/dentiication o %a%y should %e esta%lished./nstruction mother in other aspects o new%orn care such

as um%ilical care and%athing.

5ncourage use o support persons such as lactationspecialist as well as mem%ers o the amily.

5ncourage mother or ollow up care as well asparticipation in parenting classes.

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References:&. @ong6 DL6 Nursing Care o /nants and Children6 th

ed.6 St6 Louis7 $os%y co. &,,.

0. Eoops 2L6 $organ L6 2attaglia C6 Neonatal

$ortality )is in relation to 2irth weight andGestational #ge7 1pdate6 ournal o Pediatrics? &-&


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Assessment and

'anageme

nt of Hig

0iskNeonates

Out line:Deinition.

Predisposing actors.

$ethods used in determination o gestational age.

Classiication o new%orns.

Pro%lems associated with Preterm6 SG#6 and Posterm

inants.

#ssessment

&. :he initial assessment using the #pgar

scoring system.


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+efinition::he high ris neonate can %e deined as

anew%orn6 regardless o gestationalage or %irth weight6 who has a greater than average

chance o mor%idity or mortality

%ecause o threats to lie and health that occur during

prenatal6 perinatal and

postnatal period.

/t can also %e deined as a neonate e;posed to any

condition that maes his lie

in danger.

actors Predisposing to

&igh*RisH Neonate:,aternal actors:

'igh(ris pregnancies as in lac o

antenatal care6 poor socioeconomic

condition6 previous history o o%stetric

complications as a%ortion to;emias6 placentaK

insuiciency6 still%irth. $edical illness o mother

as dia%etes mellitus6 heart and

idney diseases arid severe inection.

Complications o la%or and delivery as

prolonged rupture o mem%ranes6 cesarean sectionand still%irth.

Neonatal actors:

#s neonatal asphy;ia6 neonatal inection6

congenital anomalies6 prematurity6 post(

maturity low apgar score6 hypoglycemia and

others(

#t %irth6 all inants should have a complete

gestational age assessment. :he purpose o this

assessment is to compare a given inant against

standardi+e norms o ne natal growth %ased on

gestational age. /t also includes evaluation o

physical characteristics o the inant or the degree

o maturity. :his assessment helps to identiy

inants that are Preterm6 post(term6 small or large

or gestational age. :hen o%serve6 report6 help in

medical treatment and intervene in nursing

management.

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+efinition of Gestational #ge:

:he course o time rom day one o

menstrual cycle in which conception occurred till

%irth.

,ethods used in +etermination of

Gestational #ge:

&. Physical and neurological e;aminations.

0. L.$.P.

!. B%stetric history.

4. La% tests.

. etal ultrasonic scanning.

'lassification of Ne$born:

Classiication o new%orn at %irth %y %oth

gestational age and weight provides a more

satisactory method or predicting mortality ris

and providing guidelines or management o

neonates./n using gestational age neonates can %e classiied

as7

Preterm: :he neonate is %orn %eore term i.e. is

less than !8 wees o gestation.

"erm: :he neonate is %orn %etween !8(40 wees

o gestation.

Post term: :he neonate is %orn is %orn ater 40

wees o gestation.


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@hen using gestational .age and birth

$eight ne$born can be

classiied as7

Small for gestations age DSG#E: when plotted onintrauterine growth chart6

they lie %elow &-thpercentile6

#ppropriate for gestational age D#G#E: @hen

plotted on intrauterine growth

chart6 they lie %etween &-thand ,-thpercentile.

L!arge for gestational age D!G#E: @hen plotted on

intrauterine growth chart:hey lie a%ove ,-th percentile .


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93


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'lassification of &igh*risH Infants:#ccording to si


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a(

/ntrauteri

ne

#sphy;ia

6

%(

$econium

#spiratio

n.

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Sstemic #ssessment of &igh*RisH Neonates:a. General assessment:

@eigh daily6 measure length and head circumerence.

Descri%e generaK %ody shape and si+e6 posture at rest6 presence

and

location o edema.

>Descri%e any apparent deormities.Descri%e any signs o distress7 Poor color6 mouth open6

grimace(urrowed %row.

b. Respirator assessment)

Descri%e shape o chest


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Determine level o response. Determine changes in head circumerence7 si+e andtension o ontanels6 suture ines.g. "emperature:Determine sin and a;illary temperature.>Determine relationship to environmentaltemperature.h. SHin assessment:

Descri%e any discoloration6 reddened area6 signs oirritation6 a%rasions. B%serve or monitoring e9uipment6inusions6 or other apparatus coming in contact with sin.Determine te;ture and turgor o sin? dry6 smooth6Descri%e any rash6 sin lesion or %irthmars.

Determine whether intravenous inusion device is in place ando%serve or sign o iniltration.i. ,onitoring phsiological data:

ital signs7( :emp7 !".(!3.!OC.

( Pulse7 &0-(&- %eatAmin.( )espiration7 4-("- cycleA $in.2lood e;amination is a necessary part o the ongoingassessment and monitoring o ris new%orns progress.:he tests most oten perormed are %lood glucose62iliru%in6 calcium6 and hematocrit and %lood gases.2lood glucose


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Planning::he ollowing are %asic goals or care o all high(ris inants7

&. 5;hi%it ade9uate o;ygenation.

0. $aintain sta%le %ody temperature.!. Protect the inant rom nosocomial inection.

4. )eceive ade9uate hydration and nutrition.

.$aintain sinintegrity. G.5;perience nopain.3. )eceive appropriate development care.8. )eceive appropriate amily support6 including6 preparation or homecare.

Implementation:5. Respirator Support:

#ssess or deviations o respiratory unction6 o%serve or signs odistress6 grunting6 cyanosis6 nasal laring and apnea6 many inantsre9uire supplemental o;ygen and assisted ventilation.

Nursing Intervention:Position or optimum air e;change


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$onitor or signs o hypothermia( cold e;tremities6cyanosis


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2. Protection from infection:'igh(ris neonates are particularly suscepti%le to inection. :he sourceo inection rise in direct relationship to the num%er o person andpieces o e9uipment coming in contact with the inant.Nursing Intervention:

5nsure that all care givers wash hands %eore and ater

handling the inant5nsure that all e9uipments in contact with inant are clean orsterile. (. 5nsure strict asepsis or sterility with invasive procedures.

Prevent persons with upper respiratory tract orcommunica%le inections rom coming into direct contact withinant./solate inants who have inections.

5mphasi+e health care worers and parents to administeranti%iotics as ordered.

>5nsure that the incu%ator must %e clean and sterili+ed to

com%at inections


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3$onitor urinary output and la%oratory values orevidence o dehydration or over hydration


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M. 'are to Promote Gro$th and +evelopment:$uch attention had %een ocused on the eects o early intervention

or its lac on %oth normal H and preterm inants. indings indicate

that inants are a%le to respond to a greater variety o stimuli. :he

atmosphere and activities o the N/C1 are over stimulating.

Nursing Intervention:Provide optimum nutrition to ensure steady weight gainand %rain growth Provide regular periods o undistur%ed rest todecrease unnecessary B0use. and caloric e;penditure.Provide age I appropriate .development interventionsimulate all the sense o inant and o%serve their responsee.g. visual tactile6 auditory6 olactory and taste.

Promote parent(inant interaction since it is essential or normal growthand development.

56.amil Support and Involvement:

:he %irth o a preterm inant is an une;pected and stressul event orwhich amilies are emotionally unprepared.

Nursing Intervention:

Give inormation to help parents understand most importantaspects o care.

5ncourage parents to as 9uestions a%out childs status.2e honest? respond to 9uestions with correct answer toesta%lish trust.5ncourage mother and ather to visit the inant so thatattachment process in initiated.'elp parents %y demonstrating inant care and oer

support.5ncourage si%lings to visit inant

>5;plain to amily mem%ers the inant condition and why he cannot comehome soon.

+ischarge Planning and &ome 'are:#ssess readiness o amily to care or inant in homesetting to acilities parents transition to home with inant.

:each necessary inant care techni9ues and o%servation.

)einorce medical ollow up.

)eer to appropriate agencies or services so thatneeded assistances are provided.

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0valuation:

:he eectiveness o nursing intervention is determined %y

continuous reassessment and evaluation o care %ased on the

oliowing o%servational guidelines and e;pected outcomes7

:ae vitaK sings and perorm respiratory assessments at time

intervals %ased on inants condition and needs. B%serve inants

respiratory eorts and response to therapy.

$easure a%dominal sin and a;illary temperature at speciied

intervals.

B%serve inants %ehavior and appearance or evidence o sepsis.

#ssess or hydration7 assess and measure luid intae6 o%serve

inant during eeding6 measure amount o ormula or parental

intae6 weight daily.

B%serve inants response to pain and pain relie interventions.

B%serve inants response to developmental care.

B%serve parental interaction with inant6 interview amily

regarding their eelings and readiness or home care.

#dmission 'riteria for &igh RisH Jnit:

Preterm.

Post term.

'yper%iliru%inemia. .

)espiratory disorders.

'emolytic disorders.

Neonatal sei+ures.

Sepsis.

'ypoglycemia.

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I. Premature Ne$borns

+efinition::he premature new%orn is a %a%y %orn %eore completion o !3 wees o

gestation. :he cause o prematurity is unnown.

Predisposing actors of PrematureNe$born:( $others age less than &3 years or over ! years.

( :o;aemia o pregnancy.

( $ultiple %irths.

( #ntepartum hemorrhage.

( Premature rupture o mem%rane.

( Chronic maternal malnutrition.

( Cardiac disease and hypertension o the mother.

( $aternal dia%etes meliitus.

( #cute or chronic inection. 6

( /nade9uate antenatal care6

( #%normality o the pelvis.

( 5;posure to radiation during pregnancy.

( etal a%normality.

'haracteristics of Premature Ne$born:/dentiication o these characteristics provides valua%le clues to the

gestational age and hence to the physiologic capa%ilities o new%orns.

( Premature new%orn is small in si+e with large head in proportion to the

whole %ody.

( 'air is ine and u++y on thehead.

( Su%cutaneous tissue is deicient.

( Sin is thin6 wrinled6 red6 and smooth and clearly visi%le %lood

vessels.

( 5;cessive lanugo and no orA littie verni;caseosa.

( 5yes are pronnineri and the ear cartilage is sot and easily olded.

( :hora; is less irm.

( 2reast tissue is minimal Small genitalia6 as male new%orn have ew scrotal rugae and

testes are undesecnded. emale new%orn has separated li%iamaora and li%ia minora areprotruding.

( Soles and palms have minimal creases.

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( Shortand sot inger nails and toenails.

( Premature new%orn is inactive and has a wea cry with

e;tremities e;tended.

Phsiological Reasons for Premature

Ne$born ,aladaptation:Prematurity accounts or the largest num%er o admission to an

N&C1. :he premature new%orn is at ris %ecause o immaturity oorgan system and lac o reserves

5. Respirator function::here is a numerous deicits in the respiratory system7

(Decreased num%er o alveoli6

( Deicient suractant levels.

( Smaller lumen in the respiratory system.

( Greater collapsi%ility o respiratory passages. (/mmature and ria%le capillaries in the lungs.

1. 'ardiovascular function::he nurse must %e prepared to intervene i symptoms o

hypovolemia6 or shoc6 are present as indicated %y decreased %loodpressure6 slow capillary reill and continued respiratory distress.

2. 'entral nervous sstem function:

:he premature new%orn CNS is suscepti%le to inury rom

various sources7

( 2irth trauma with damage to immature structures.

( 2leeding rom ragile capillaries.

( /mpaired coagulation process6 including prolonged

prothrom%in time.

( )ecurrent ano;ic episodes.

( Predisposition to hypoglycemia.

3. Renal function:

:he premature new%orn immature renal unction is una%le7( #de9uately e;crete meta%olites.

( :o concentrate the urine.

( :o maintain the %alance in acid(%ase6 luids6 or

electrolytes.

4. &ematologic status::he premature hematologic pro%lems raised as a result o the

ollowing actors7

( increased capillary ria%ility.

( /ncreased tendency to %leed.

( Slowed production o. red %lood cells


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( Loss o %lood rom re9uent la%oratory tests.

( Decreased red %lood cell survival related to

relatively larger si+e o the )2C and increased

permea%ility to sodium and potassium.

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"herapeutic ,anagementNew%orns who do re9uire resuscitation are transerred

immediately to the N&C1 in a heated incu%ator where they areweighed6 intravenous lines6 Y0therapy6 and other therapeuticinterventions are initiated as needed. Su%se9uent care is

determined %y the status o new%orn.

Nursing 'onsideration::he nursing care6 lie the therapeutic management is

individuali+ed or each new%orn


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ollowing7

( $inimal insulating su%cutaneous at.

( Decreased stores o %rown at.

( Limited stores o %rown at.

( /mmature temperature regulation center in the %rain.

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,ethods of &eat !oss and Gain:

&. Convection7 @here heat loss is aided %y surrounding aircurrents


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preventing heat loss.

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( Compare the new%orns temperature with the temperature inthe incu%ator


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III) Hyper$ilirn$inemia

45perbilirubinemia is a condition in 6hich the bilirubin level in theblood is increased.it is characteri7ed b5 a 5ello6 discoloration of theskin$ mucous membrane$ sclera$ and various PISB8IS' 9f h:5ello6discoloration is caused primaril5 b5 accumuiation in the skin uncon;uated

blirubin$ a breakdo6n product of hemolobin formin after its releasefrom hemol5e7ed 0B#s.

Biliru$in 'eta$olism:

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"pes of &perbilirubinemia:

Physiological aundice Pathological

aundice

( Not appears %eore the 0nd

or !rd day in term %a%y. /n

premature %a%y6 it appears

ater !rdor 4thday.

( /N term new%orn6 it

disappears %y the end o 3

days while in premature

lasts or , to &- days.

( :he level o total serum

%iliru%in never e;ceeds &0 mgAdlin ullterm new%orn and & mgAdl

in preterm new%orn and the direct

%iliru%in doesnt e;ceed & mgAdl

o the total%iliru%in.

( Daily raise o S.

%iliru%in never e;ceed

rngAdl.

( No erntcterus.

( )e9uires no treatment

( :he new%orn is good

sucer6 no anemia6 not sic6

normal stool6 and urine

color.

( #ppears within the &st

day


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ological

aundice.(aundice o prematurity.(Congenital reduction o Glucoronyltranserase en+yme. Drugs inhi%it the

Glucoronyl transerase en+yme action.('ypoglycernia.(2reast mil aundice.

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/.'onjuFated &perbirirubinemia:& /mpaired transport o conugated %iliru%in out o liver ceils as in >Yuoin(

ohnsons syndrome.>0 'epatitis.

;ernicterus:/t is also called the %iliru%in encephalopathy and is caused %y the

deposition o the unconugated %iliru%in in the %rain* esp6 within the %asalganglia6 cere%ellum6 and hippocampus. :his deposition can occur %ecause ouncougated %iliru%in is highly lipid solu%le maing it capa%le o crossing the%lood (%rain %arrier i not %ounded to al%umin. /t results in the yellowish stainingo the %rain tissue and the necrosis o neurons and occurs i the concentration othe uncougated %iliru%in reaches to;ic level.

Stages of Hemicterus:&. Stage &7 Poor $oro rele;6 poor eeding6 vomiting6 high(pitched cry6

decreased tone and lethargy.0. Stage 07 Bpisthoionus6 sei+ures6 ever6 occulogyric crises6 and paralysis

o upward ga+e. $any new%orns die in this phase.!. Stage !7 Spasicity is decreased at a%out one wee o age.


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. 5rythema and sin rashs..

;". 2ron+e %a%y syndrome.-(

3. CeiK damage and mutations.

8. 1pset o maternal new%orn interaction.

,. Dar yellow urine.

Nurse>s responsibilit in phototherap:

&. :he lamp should %e (8 cm over the incu%ator.0. Continue the eeding.!. Shield the new%orns eyes.4. Eeep new%orn naed e;cept or the diaper area and change position

re9uently.. Cleanse sin re9uently to prevent irritation6". $aintain ade9uate luid intae to prevent dehydration and calculate intaeand output.

3. Chec new%orns %ody temperature every our hours.8. @eight new%orn daily.,. B%serve sin6 mucous mem%ranes6 and stool.&-(2iiiru%in levels should %e ollowed or at least 04 hours ater

discontinuing phototherapy.

0-change "ransfusion:it is an /deal dilution o s. %iliru%in and any%odies. # catheter is introduced

into the um%ilical vein ater cutting the cord. :hrough a special valve6 the um%ilicalcatheter is connected with the donor %lood. 5;change is carried out over 4("- min

period %y alternating aspiration o 0- ml o new%orns %lood and inusions o 0- mlo the donor %lood.


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I(. &poglcemia

Glucose is primary meta%olic o the new%orn. During intrauterine lie6 theetus relies on the placenta or a constant supply. #t %irth6 the new%orn is a%ruptlyremoved rom that environment6 and hormonal and meta%olic changes occur thatacilities adaptation to intrauterine lie and regular glucose homeostasis.

#ter %irth new%orn must supply nutrients to meet energy re9uirements ormaintaining %ody temperature6 respiration6 muscle activity6 and regulations o%lood Fglucose. Glucose is derived primarily rom glycogen stores deposited inthe liver6 heart6 and seletal muscles during last trimester o pregnancy. 1ndernormal circumstances6 ull term new%orn usually has suicient source or the irst0(! days. 'owever6 any condition that increases energy re9uirement can rapidlydeplete this store.

+efinition of &poglcemia:'ypoglycemia is deined as a %lood glucose level o less than 4- mgAdl in the

term new%orn or less than !- mgAdK in the preterm new%orn.

'auses of &poglcemia:#. Increased glucose utili


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2ecause the %rain depends on giucose or energy6 cere%ral signs such as?itteriness6 sei+ures6 tremors6 lethargy6 apnea6 or high(pitched cry are present.Bther signs are cyanosis6 poor eeding6 high(pitched cry6 apnea6 and respiratorydistress.

+iagnosis:Diagnosis is conirmed %y directed analysis o %lood glucose concentration.

"reatment:a. Ne$born at risH:

/nants at ris are inants o dia%etic mother6 premature6 inant o to;emicmothers6 inant with respiratory distress and postmature.

Sta%le near(term or term new%oms at ris or hypoglycemia should %e edearly6 soon ater %irth. 2reast mil or de;trose should %e used i the %a%y isa%le to tolerate nipple or nasogastric tu%e eedings. :hese new%oms should haveglucose values monitored until they are taing ull eeding and have three normal

preeeding readings a%ove 4-(4 mgAdl.

/ the new%orn at ris or 'ypoglycemia is una%le to tolerate nipple or tu%eeedings6 maintenance / therapy with &- glucose should %e initiated andglucose levels monitored.

b. "reatment of the ne$born $ith &poglcemia:New%orns who develop hypoglycemia should immediately %e gives 0--

mgAg glucose or 0 ccAg o &- de;trose6 over minutes6 repeated as needed.1ntreated hypoglycemia in new%orns can result in death or permanent neurologicaldamage. #lthough low %lood sugar must %e %rought up 9uicly6 concentratedglucose solutions such as - glucose are not indicated6 they can result in osmotic

stress and re%ound hypoglycemia.# continues inusing o &- giucose at rate o 8(&- mgAgA min should %e

started. /ncreased the rate and Aor glucose concentration to eep glucose valuesnormal Dnote) &- mgAgAmin o de;trose &- Q&44 ccAgA day6 or ," ccAgAday ide;trose 0=re9uent %esides glucose monitoring is necessary to ensure hat thenew%orn is receiving ade9uate glucose.

@hen eeding is tolerated and re9uent %edside glucose monitoring valuesare normal6 the inusion can %e decreased gradually. :his may tae 04( 48 hours or

longer to avoid re%ound hypoglycemia.

Nursing ,anagement:5#ssessment:

&. 'istory.0. Determine gestational age.

!. #ssess eeding and luid.

4. #ssess glucose level.

. #ssess or

signs o

hypoglycemia.

1.Nursing

+iagnosis:

#ltered nutrition6 less than %ody re9uirement6 related to inade9uate supply o

glucose o increased glucose use in the neonate.

2*lrriplementation

( 2lood glucose level should %e o%tained regularly with a screeningstrip.

( Provide eeding.

( Provide l.. luids.

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Provide the new%orn with a neutral environment %ecause hypoglycemiaincrease glucose re9uirements decrease the ris o hypoglycemia.

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(. Idiopathic Respirator +istress Sndrome

DIR+SE

:he terms respiratory distress syndrome


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Respirator Signs and Smptoms::achypnea Dyspnea6

Pronounced su%stemaK retractions.

ind inspiratory grunt #udi%le e;piratory gruntlaring o the e;ternal nares.

Cyanosis.

#s the disease progresses:

( laccidity.

( /nertness.

( 1nresponsiveness.

( re9uent apneas episodes.

( Diminished %reath sounds.

Severe disease associated $ith:

( Shoc(lie state. #s maniested %y diminished cardiacinlow and lo$ arterial%lood pressure.

( Diminished cardiac return.

+iagnostic assessment:

( 2ased on clinical maniestation and radiographic studies.

( Chest ;( ray shows congested lung ield with a ground*glass appearance that represents alveolar atelectasis and darstreas.

( )espiratory and meta%olic acidosis is determined %y gas

analysis.

( Criteria or visually evaluating the degree o respiratory

distress are illustrated.

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"herapeutic ,anagement:Largely supportive6 including genral measures re9uired or any premature

new%orn. 'owever6 the administration o artiicial suractant has dramatically

changed treatment and prognosis. /t is given prophylacticaily at %irth or on diagnosis

o /)DS. :reatment prevents atelectasis and contri%utes to luid clearance rom the

alveoli. /mprovement may tae place with one single endotracheal dose6 %ut most

new%orns re9uire multiple doses.

:he most crucial supportive measure to avora%le outcome include7

&. $aintain a neutral thermal environment to conserve utili+ation o o;ygen.

0. Provide additional raction o inspired o;ygen


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( :he goal o o;ygen therapy is to provide ade9uate o;ygen to thetissue6 prevent lactic acid accumulation resulting rom hypo;ia inaddition6 at the same time avoid to;ic eects o o;ygen. #ll methodsused to improve o;ygenation re9uired that the gas %e warmed andhumidiied %eore entering the respiratory tract. / the new%orndoesnt re9uire mechanical ventilation6 o;ygen can %e supplied to a

plastic hood placed over the 6new%orns head to supply varia%leconcentrations o humidiied o;ygen. K o;ygen saturation o the

%lood cant %e maintained at a satisactory level and the car%ondio;ide level


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( /neective airway clearance.

( /neective %reathing pattern.

( /mpaired gas e;change.

(. 'igh ris or trauma


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Planning:#s the same or any premature new%orn with special emphasis on

respiratory needs7

( acilitate respiratory eort.

(

Preventcomplica

tions.

implem

entatio

n:&. :hic6 tenacious mucus may arm in the respiratory tract.

Pulmonary de%ris intereres with gas low and predisposes too%struction o the passages6 including the endotracheal tu%e.

0. Suctioning is perormed only as necessary %ased on individualnew%orn assessment6 which includes auscultation o the chest?

evidence o decreased o;ygenation e;cess moisture in the 5:tu%e6 or increased new%orn irrita%ility.!. )emoval o secretions can %e done %y vi%ration to thoracic wall6

%ut cupped hand is much too large to %e used on very smallnew%orns. Commercial devices are availa%le or this purpose.i%ration is diicult to accomplish i respiratory rate is "-(8-

%reaths A min.4( Percussion and vi%ration are perormed6 as needed6 %ased onnew%orns tolerance.. :he most advantageous positions or acilitating an new%orns

open airway are on the side with the head supported in alignment%y a small olded towel or when on the %ac positioned to eepthe nec slightly e;tended. 'ypere;tenston reduces thetracheal diameter in neonates. /t improves o;ygenation as well aslung mechanics and volumes6 and decreases energy use ris ogastric relu;.

". Sin inspection6 changing position [ mouth care also important6as the new%orn is not receiving any thing per mouth.

N.2.7

( Suctioning is not a harmul procedure


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optimum %lood gas measurements without ventiatoryassistance.

0. New%orn remains ree o complications.

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(II. Neonatal Sepsis

+efinition:/t is a type o inection6 which occurs when %acteria or their

poisonous products nown as endoto;ins6 gain access to the %lood

stream. Sepsis or septicemia reers to a generali+ed %acterial inectionin the %lood (stream.

,ode of "ransmission:Prenatal ac9uisition o inection occurs %y organism placentaliy

transerred directly into the etal circulatory system and rom inectedamniotic luids. During %irth6 contact with an inected %irth canal canresult in generali+ed or local inection. Postnatal inections may %eac9uired during resuscitation or through the introduction o oreign o%ects.

2acteria can reach the etus or new%orn and cause inection inone o the ollowing ways7

&. 2acteria can pass through the maternal %lood stream through theplacenta as ru%ella6 to;oplasma6 and syphilis.

0. 2acteria rom the vagina or cervi; can enter the uterus6 as groups 2streptococci6!. :he new%orn may come in contact with %acteria as it passes

through the %irth canal as gram( negative organisms.4. :he new%orn may come in contact with %acteria in its environment

ater %irth


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,. Diicult or traumatic la%our or delivery.&-. immature immune system.

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&&. #ntimicro%ial therapies.

&0. Galactosemia.

0nvironmental factors:

&. 5;posure to %acteria rom caregivers.0. 5;posure to %acteria rom contaminated e9uipment.!. /nvasive procedures


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Gastrointestinal sstem:

( Poor eeding.

( omiting6

( Diarrhea or decreased stooling

( #%dominal distention.

(

'epa

tome

gely.

&em

atop

oieti

c

sste

m:

( aundice.

( Pallor.

( Petechiae6 ecchymosis.

( Splenomegaly.

+iagnosis ,easurement:it

involves7&

(2loodcult

ure.0. 1rine culture.

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!. :racheaK culture.4. Cere%o(spinai luid culture.. C2C with dierent and platelate count.

Nursing 'onsideration:Prevention7

( Demonstrate the eect o hand washing upon the preventiono the noscomial inections.

( Standard precautions should %e applied in the nursery or inection

prevention

( /nstillation o anti%iotics into new%orns eye &(0 hours ater %irth isdone to prevent the inection.

( Sin care should %e done using worm water and may use mildsoup or removal o %lood or meconium and avoid the removal overni; caseosa.

( Cord care should %e cared out regularly using alcohol or anantimicro%ial agent.

Curative7

( 5ncourage %reasteeding rom the mother.

( #de9uate luid and caloric intae should %e administered %ygavage eeding or intravenous luids as ordered.

( 5;tra( measure or hypothermia or hyperthermia that may tae place

to the new%orn.

( #dministering medications as doctor order.

( ollow the isolation precautions.

( $onitoring the intravenous inusion rate and anti%iotics are the nurse

responsi%ility.

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References:

&. @ong6 %.L6 Nursing Care o /nants and Children6 thed.6 St. touts7 $os%y

co.

&,,.

0. Eoops 2L6 $organL6 2attaglia C6 Neonatal $ortality )is in relation

to 2irth weight and Gestational #ge7 1pdate6 ournal o Pediatrics? &-&


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Pschological #spect of

&ospitali


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Introduction:'ospitali+ation o children is so common today that individuals

tend to orget its importance as a %rea in the unity o amily./nants and children are not the only one who e;perience distresswith hospitali+ation6 mothers also e;perience it when they leavetheir children in the hospital6 %ecause mothers need a continuous

relationship with their young children. $others suer rom greatan;iety when they are orced to leave their children in the hands odoctors and nurses whom they have had a little e;perience to eelconident in their a%ilities to care or their children.

Children also want continuous relationship with their mothersand when they are sic6 their need is intensiied. :hereore6 thenurse has the main role in helping the children and their parentsadust to the hospital situation. :he nurses attitude is pro%a%ly themost important actor in the emotional atmosphere during thechildrens admission to the hospital6 as well as6 during theirhospitali+ation period.

0motional Reactions to &ospitali


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overcome this stressul situation.

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'hild>s Reaction to &ospitali


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actors #ffecting Separation #n-iet and'hildren>s #djustment:

&. Developmental levels o the children6 i.e. age.0. Previous e;periences with separation and hospitali+ation.!. 5;tent to previous social contacts outside the amily.

4. Preparation or the hospitali+ation6 which will depend onchildrens? #ge

/llness /Y level Past history o coping.

. Yuality and duration o the illness or hospitali+atione;perience6 which is either temporally6 or permanent.

". amilys attitudes toward the separation and hospitali+ation.

our ,ajor RisHs for &ospitalis Role in Separation #n-iet:&. Provide continuous care with limited num%er o personnel

who must spend suicient time with the children.0. 'elp children e;press their eelings6... Support their coping

with eelings and e;pressing these eelings. Play must %eprovided as non(ver%al means o communication ande;pression o eelings.

!. Provide positive reinorcement or positive coping sills andwhat they do independently.

4. Provide amiliar clothing6 toys6 ood and rituals that help(indeveloping sense o amiliarity.

. / children will %e admitted or surgery6 they must %e oriented withunamiliar settings %y visiting operating room and recovery room

%eore the operation.". Provide sounds and sights proect


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Pschological Preparation for &ospitali


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'haracteristics of ,odern Pediatric

Jnits

"he pediatric Jnit: :he pediatric unit must %uild and urnished to meet the needs to meet o

children

and their parents.

it should provide ade9uate care6 protection rom physical danger e.g.

inection.

#ge7 rom inancy to &! years old.

5*"he Pediatric %ard:Small !( 4 %eds never e;ceeds

" %eds A room. 'riteria for

&ealth %ard:

@ell ventilated.

Sunshine should %e provided. Saety measures should %e availa%le.

2uilding utensils and urniture should %e suita%le to childrens si+e and

height.

2eds and %esides ta%les must %e availa%le6 curtain must %e attractive


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Nursing 'hild in the &ospital

"he 'hild in the &ospital

5* Nursing +iagnosis:#n-iet ear related to separation rom accustomed routine

and support system? unamiliar surroundings.

Patient Goal::he patient wilt e;perience minimi+ed separation.

$ursing #nterventions:&. #ssign same nursing personnel as much as possi%le and primary

nurse to provide the consistency that %uilds trust.0. 5ncourage parents to room( in whenever possi%le to preventseparation.

!. 5;plain to child when parents leave and when they will return.4. isits or short %ut re9uent times rather than one long time6

encourage parents and relatives to tae turn visiting. Leave avorite articles rom home6 such as %lanet6 toy6 %ottle6

eeding utensil6 or article o clothing6 with the child6 since thishelps to tolerate separation.

". #rrange worload and schedule to allow personal contact withchild.3. Provide an atmosphere o warmth and acceptance or %oth

child and parents6 encourage e;pression o eelings. Providephotographs o amily mem%ers and recordings o theparents voices %eore %edtime to amiliari+e the unamiliarenvironment.

E"pected &utcomes: Child has consistent caregivers. Parents visit as much as possi%le. Child accepts and responds positively to comortingmeasures.

!- $ursing 'iagnosis:#n-ietfear related to distressing procedures6 events6

Patient Goals:@ill receive support during tests and procedures.

$ursing #ntervention:&. Prepare child or procedure according to age and level ounderstanding.0. )emain with child to provide support %y physical presence.!. #nswer 9uestions and e;plain purpose o activities64. Eeep child and amily inormed o progress.

0-pected Outcome: Child remains calm and cooperative

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during the procedures. Child eels supported %y others during

procedures.

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2* Nursing +iagnosis:Diversional activity deicit related to impaired

mo%ility6 musculoseletal impairment6 and coninement tohospital6 eect o illness.

Patient Goal:@ill have opportunity to participate in activities.

Nursing Intervention:&. Schedule therapies and periods o rest to allow or activities.0. /nvolve child in planning care to the e;tent o capa%ilities to

reduce eeling o passivity.!. #rrange or and encourage interaction with others as

easi%le to promote sociali+ation.4. 5ncourage visits rom amily and riends.. Provide opportunity to sociali+e with non( inectiouschildren.

0-pected Outcome: Child helps in plan care and schedule. Child interacts with amily and other children.

3* Nursing +iagnosis:)is or inury Atrauma related to unamiliar environment6

therapies and ha+ardous e9uipment.

Patient Goal:

:he patient will e;perience no inury.

Nursing Intervention:&. 5mploy environment saety measu

pediatric nursing 1الجزء الأول

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