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Thursday, October 20, 2011

Pediatric Notes II

Physiologic Status of Newborn


CIRCULATORY STATUS


          UMBILICAL VEIN and DUCTUS VENOSUS  constrict  after cord is clamped.
          DUCTUS ARTERIOSUS  constricts w/ establishment of   respiratory function.
          FORAMEN OVALE closes functionally as respirations are   established, but anatomic or permanent closure may take   several months.
          HEART RATE averages 140 bmn
          BP  73/55 mmHg
          PERIPHERAL CIRCULATION acrocyanosis  w/n 24H




Renal System

         Urine present in the bladder at birth, but NB may not void for 1st  12-24 hours.
          Later pattern is 6-10 voidings/day  - indicative of sufficient fluid intake.
          Urine is pale and straw colored.
      - initial voidings may leave brick-red spots on diaperd/t passage of uric acid crystals in urine
          Infant unable to concentrate urine for the 1st 3 mos
  
DIGESTIVE SYSTEM

          Hard palate should be intact, small raised white areas on the  palate are normal.  EPSTEIN’S PEARLS
          Newborn can’t move food from lips to pharynx.
         capable of digesting simple CHO and simple CHON but fats
         Stomach capacity caries= 50-60 ml
          Feeding patterns

         FIRST STOOL is MECONIUM.
        - black, tarry residue from lower intestine.
        - usually passed within 12- 24 hours after birth.

   After 3 days MILK STOOLS  are usually passed.
     a. MILK STOOLS for BF-INFANT
                 - Loose and golden yellow
     b. MILK STOOLS for FORMULA-FED
                 - Formed and pale yellow

TEMPERATURE

          HEAT PRODUCTION - Metabolism of “BROWN FAT”
          Axillary temperature: 96. 8 to 99ºF
         NB’s  body temp drops quickly after birth. - cold stress occurs easily.
          Body stabilizes temp in 8-10 hours if unstressed.
          Cold stress increases O2 consumption. - may lead to metabolic acidosis and respi distress.         

WEIGHT
          normal= 2500 - 4300 g (5.5 to 9.5 lbs) at term.
          Initial loss of 5-10% of body weight
    - normal for the first few days
    - this should be regained in 1-2 weeks

 LENGTH
          Average 45.7-55.9 cm (18-22 in)

CHEST CIRCUMFERENCE
          30-33 cm (12-13 inches)
          should be equal to or 2-3 cm < head circumference      

HEAD

25% of the body length; circumference 33-37cm
          Bones of the skull are not fused
          Palpable sutures
          Fontanels
          Molding ,Caput Succedaneum,Cephalohematoma
          
 SKIN

         Pigmentation increases after birth
          Skin may be dry.
          ACROCYANOSIS
          Small amounts of lanugo and vernix caseosa still seen
          May develop “NEONATAL RASH
          HARLEQUIN SIGN

INITIAL CARE OF THE NEWBORN

         Observe and assist with initiation of respirations
          Assess Apgar score
          Note characteristics of cry
          Monitor for nasal flaring, grunting, retractions and               abnormal respirations
          Obtain vital signs
          Observe NB for signs of hypothermia or hyperthermia.

NURSING INTERVENTION

         Suction mouth, then nares with bulb syringe.
          Dry baby and stimulate crying by rubbing.
          Maintain temperature  stability.  
          Keep newborn with mother to facilitate bonding.
          Place newborn at mother’s breast if breastfeeding is planned or place on mother’s abdomen.
          Place newborn in a warmer.
          Position newborn on the side or abdomen or in modified Trendelenburg position to facilitate drainage of mucus.
          Ensure proper NB ID
          Footprint NB & fingerprint mother on ID sheet/ agency’s policies & procedures
          Place matching ID bracelets on mother & NB


APGAR SCORING SYSTEM

         Perform and record Apgar score at 1 min & at 5 mins.
         If the score is less than 7 at 5 mins., the Apgar score shld be            perform at 10 mins.
         A score of 7-10 indicates a healthy newborn.
         A score of 3-6 is considered moderately depressed.
         A score of 0-2 is severely depressed.


Pediatric Neuro Disorders

Hydrocephalus – accumulation of CSF more than normal volume
Types:
  1. Comunicating
  2. Non-comunicating

Dx Test: Myelogram
Dyes:
  1. Oil – FOB 6- 8 hrs.
  2. Water – head elevation 6 hrs.
  3. Air – trendelenburg

Mgt: Shunting

Spina Bifida – baby born without fusion of backbone
Cause: folic acid deficiency
Types:
  1. Oculta – dimple
  2. Cystica – sac protrusion
Meningocoele – sac contains CSF
Myeloeningocoele – sac contains CSF and Spinal cord

Mgt :
Surgery within 24 hrs after birth
Crede’s maneouver

Reye’s Syndrome – degeneration of aftes in the liver
Cause: aspirin toxicity
Mani : Decorticate and Decerebrate posture
Mgt: Oxygenation (No ore than 4L/min – Retrolental Fibroplasia)

Tumor – space occupying lesion
Medulloblastoma – fatal type -death within hours to days
Mgt: surgery


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