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