Professional Documents
Culture Documents
&
FAMILY
ASSESSMENT
NURSING HISTORY
PHYSICAL ASSESSMENT
DIAGNOSTIC
ASSESSMENT
1. AIRWAY
2. BREATHING
3. CIRCULATION
4. WARMTH
Immediate Assessment of the
Newborn
The newborn infant should undergo a
complete P.E within 24 hours of birth.
NOTE :
It is easier to listen to the heart and lungs
first when the infant is quiet
Gestational age
Birthweight is plotted on a Growth Chart
Colorado intrauterine Growth Chart
( LUBCHENCO CHART)
Preterm – born before the 38th
week
Full
term – born at 38 to 42
weeks
BREAST NODULE 2 4 7
DIAMETER (MM)
SCALP HAIR FINE & FUZZY FINE & FUZZY COARSE &
SILKY
EAR LOBE PLIABLE, NO SOME STIFFENED BY
CARTILAGE CARTILAGE THICK
CARTILAGE
TESTES & TESTES IN LOWER SOME CARTILAGETESTES
CANAL, SCROTUM INTERMEDIATE PENDULOUS,
SCROTUM SMALL, RUGAE SCROTUM FALL,
EXTENSIVE RUGAE
posture
Square window
Popliteal angle
Scarf sign
Heel to ear
creases
Breast
Causes of Small –for-Gestational-Age
Infant ( SGA)
SGA infant experienced intrauterine growth restriction (IUGR)
Most common cause of IUGR is PLACENTAL ANOMALY
Mother’s nutrition during pregnancy play a major rule in fetal
growth.
severe DM mother
PIH
Mother who smokes heavily
Use of narcotics
Baby with Rubella & chromosomal abnormality
SGA
PRENATAL ASSESSMENT:
Fundic height
ultrasound
Biophysical profile
NST
Placental grading
Amniotic fluid amount
What do they look like???
SGA appearance
Infant suffer nutritional deprivation
EARLY in pregnancy
Increase in number of body cells
Below average
Weight, length & head circumference
Late in Pregnancy
Increase in cell size
Below average weight
Most SGA APPEAR LIKE??
Wasted appearance
Small liver
Poor skin turgor
Large head
Skull suture widely separated – lack of normal
bone growth
Dull hair
Sunken abdomen
Cord dry & stained yellow
Common problem of SGA
CBC
High hematocrit
Increase RBC ( polycythemia)
Blood glucose
Hypoglycemia <40mg/dl
Outcome Evaluation:
Obese mother
Multiparous women
LGA
Assessment:
Uterus unusually large for the date of
pregnancy
UTZ , NST
Prominentcaput succedaneum,
cephalhematoma or molding
LGA - DIAGNOSTICS
Increaseserum bilirubin
hypoglycemia
LGA – outcome evaluation
Infant
need careful watching
Encourage parents to nurture infant
PRETERM INFANT
Preterm infant
Mortality
: 80-90%
CAUSES:
Exact cause : rarely known
Low socioeconomic- inadequate nutrition
Lack of prenatal care
Age of mother – younger than age 20
PROM
PRETERM
POTENTIAL COMPLICATION:
Anemia of prematurity
Kernicterus
PDA
Intraventricular/Periventricular Hemorrhage
RDS – HMD
Apnea
Necrotizing enterocolitis
Retinopathy of prematurity
Management
Formula
Breast milk
ILLNESS IN THE NEWBORN
ILLNESS IN THE NEWBORN
1. RDS
2. TRANSIENT TACHYPNEA OF THE NB
3. MECONIUM ASPIRATION SYNDROME
4. APNEA
5. SUDDEN INFANT DEATH SYNDROME
6. HEMOLYTIC DISEASE OF THE NB
7. HEMORRHAGIC DISEASE OF THE NB
Respiratory distress syndrome
2 types
1. Hyaline membrane disease(HMD)
2. Transient tacypnea of the NB (TTN)
Respiratory distress
syndrome
>HMD( hyaline membrane
disease)
Common:1. preterm infant
2.infant of diabetic
mother
3.meconium aspiration
Pathologic feature
:
hyaline-like membrane formed fr an
exudate of infant blood
Causes:
Low level or absence of surfactant
Surfactant –
phospholipid lines the alveoli that
reduces surface tension on expiration
keep the alveoli from collapsing on
expiration
Form @ 34 wks AOG
Assessment
S/Sx:
initial 1.low body temperature
2.nasal flaring
3.sternal and subcostal
retraction
4.tachypnea
5. cyanotic mucus membrane
Assessment
S/Sx:
Clinical sign :
grunting, cyanosis in room air,
nasal flaring, retraction and
shock
Chest X-ray:
reveal diffuse pattern of radio
opaque areas
MANAGEMENT
1. surfactant replacement
2. oxygen administration
3.Ventilation
4. Additional therapy:
- Indomethacin or Ibuprofen – to close PDA
- muscle relaxant increase pulmonary
blood flow
PILLITTERI pp 778
Vol 1
Prevention:
Steroid
No marked cyanosis
1. Close observation
2.O2 administration
MECONIUM ASPIRATION
SYNDROME
MECONIUM ASPIRATION
SYNDROME
- Meconium present in fetal bowel
as early as 10 wks gestation
Meconium aspiration
- Infant may aspirate meconium either in utero or in
first breath after birth.
APNEA
Apnea :
Mgt:
1.phototherapy
2.if with severe jaundice can do
exchange transfusion
3.initiation of early feeding
RH incompatibility:
Monitor temp
Management:-
S/sx
Early onset
First day of life – Pneumonia
Tachypnea
Apnea
Shock – dec urine output, extreme paleness or
hypotonia
Can die within 24 hours of life
Beta-hemolytic, Group B
Streptococcal Infection
S/sx
late
onset
Occurs at 2-4 weeks of age- meningitis
Lethargy, fever , loss of appetite
Bulging fontanelles – increased ICP
Mortality 15%
Beta-hemolytic, Group B
Streptococcal Infection
Diagnostics
mother’s vaginal culture
Blood culture of NB
Therapeutic management
Ampicillin IV @ 28 wks AOG & during labor
( reduce NB exposure)
Bld test positive : gentamicin, ampicillin &
penicillin
Hepatitis B Virus Infection
Vaccinate the NB
HepatitisB vaccine + immune serum globulin (HBIG)-
within 12H – decrease possibility of infection.
Bathed infant as soon as possible after birth –
removed blood
Gentle suctioning- avoid trauma
Breastfed infant – if HBIG is given
Herpes Virus Infection
HSV-2
Common Multiple sexual partner
MOT:
Contracted through the placenta – if mother
has primary infection during pregnancy .
Vaginal secretion of mother.
Herpes Virus Infection
S/sx:
Herpes vesicles clustered with reddened base
– covering the skin
Severe neurologic damage
If acquired at birth: ( D4 & D7 of life)
Loss of appetite
Low grade fever & lethargy
Diagnosis:
Culturefrom vesicles
Blood serum analyzed for IgM antibodies
Therapeutic Mgt:
Acyclovir ( zovirax)
Advised CS- minimize newborn exposure
Isolate infant
Infant Of Diabetic Mother
Macrosomia- LGA
Chance to have Congenital anomaly –
cardiac
Limp / lethargic first day of life –
hypoglycemia
Greater chance of birth injury
hyperbilirubinemia
Pp 791
pillitteri
Infant Of Diabetic Mother
Diagnostics
Serum glucose <40 mg/dl NB
Therapeutic Mgt
Fedearly with formula or administered a
continuous infusion of glucose
Pp 791
pillitteri
Infant Of Drug Dependent Mother
SGA infant
Infant show withdrawal
syndrome
Irritability , disturbed
sleep pattern
Constant movement
Tremors
Frequent sneezing
Shrill high pitched cry ,
hyperreflexia
Convulsion
Tachypnea , vomiting ,
diarrhea
Infant Of Drug Dependent Mother
withdrawal period
Opiate – signs usually begin 24- 48 HOL max: 10 days , last
2 weeks
Heroin – begin first 2 wks of life
ave.onset 72 HOL
last 8-16 wks or longer
Methadone –begin 24-28 HOL
reappear : 2-4 wks of age
no sign : 2-3 wks old
Cocaine : no predictable sequence
Infant Of Drug Dependent Mother
CARE
Swaddled infant
Small isolation nursery – avoid excessive
stimulation
Darkened room
Infant Heroin addicted mother – quiet if
given pacifier
Maintain fluid & electrolyte
IV infusion if with diarrhea & vomiting
Infant Of Drug Dependent Mother