Pediatric Nursing: High-Risk Newborn

• Pediatric nursing focuses on the care of newborns, infants, children, and adolescents.

High-Risk Newborn

• Focus is on newborns who face increased health challenges due to various factors.

Altered Gestational Age

• Pertains to newborns whose size doesn't align with their gestational age.

Small Birth Weight

• Describes neonates born smaller than expected for their gestational age.
• Weight falls below the 10th percentile for their gestational age.
• Lack of maternal nutrition, placental issues, PIH, multiple gestations, substance abuse, infections can cause this.
• Fetal distress, gestational/physical immaturity, temperature instability, hypoglycemia are manifestations.
• Signs of infection and physical abnormalities are also included.
• Interventions involve maintaining the airway, warmth, monitoring for respiratory distress and infection.
• Glucose levels should be monitored, feeding started early and provide touch/cuddle stimulation

Large Birthweight

• Neonates are larger than average, with weight above the 90th percentile.
• Contributing factor: Maternal diabetes
• Manifestations include gestational age variations, birth trauma, respiratory distress, and hypoglycemia.
• Close monitoring of vital signs and blood glucose levels is critical, feed early, watch for infection.

Problems in Maturity

Prematurity

• Neonates born before 37 weeks of gestation.
• The primary concern is the immaturity of body systems.
• Irregular respiration, low body temp, poor sucking reflex, diminished bowel sounds and unusual output.
• Extremities are thin, skin is jaundice, testicles may be undescended, labia narrow in girls.
• Monitor vitals, maintain cardiopulmonary functions, provide oxygen, monitor I/O and weight.
• Provide warmth, position changes every 1-2 hours, avoid infections, provide stimulation.

Postmaturity

• Neonates born after 42 weeks of gestation
• Manifestations of low glucose, parchment skin, long fingernails, profuse hair, long thin body
• Possible meconium staining.
• Interventions: Newborn care, monitor glucose, maintain temperature and watch for meconium aspiration.

Newborn Illness

Respiratory Distress Syndrome

• A serious lung disorder caused by immaturity and inability to produce surfactant.
• Results in hypoxia and acidosis
• Rapid heart rate, flaring nostrils, expiratory grunting, retractions
• Decreased breath sounds, apnea, cyanosis, hypothermia, poor muscle tone are included.
• Monitor breathing, support respirations as ordered.
• Monitor arterial blood gases and oxygen saturation levels.
• Check arterial blood gases and maintain oxygenation.
• Eye exam for premature newborn with O2 support before discharge.
• Suction, place in the correct position, give replacement therapy, respiratory therapy and provide nutrition.
• Give support and encourage breastfeeding
• Give as much parental participation in new born care as condition allows.

Meconium Aspiration Syndrome

• Occurs when infants inhale meconium during or before delivery.
• Post-mature infants, fetal distress are factors.
• It blocks airways, interferes with gas exchange, inflames airways.
• Green stained skin, umbilical cord or nailbeds
• Rapid or labored breathing, cyanosis, slow heartbeat, low Apgar score may be clinical signs.
• The interventions are suction and oxygen therapy.

Sudden Infant Death Syndrome

• Unexpected death of an infant under 1 year, autopsy reveals no clear cause
• May be related to brain stem abnormality in cardiorespiratory control, during winter months and sleep.
• More common between 2-4 months, in males
• Prone position may be risk factor
• Soft bedding, overheating, sleeping with an adult are all risk factors
• Found apneic, blue, lifeless.
• Found in disheveled bed, blankets over head, clutching bedding, wet diaper.
• Prevention: Supine position for sleep, firm mattress, avoid soft bedding and overheating.

Hyperbilirubinemia

• Jaundice appears during first day of life
• Serum levels over 12 mg/dL in term newborns indicate evaluation.
• Therapy prevents kernicterus (brain bilirubin deposition)
• Jaundice and elevated serum bilirubin levels are manifestations
• Intervention to monitor for jaundice, maintain hydration, examine skin color, and facilitate feedings.
• Phototherapy: Florescent lights reduce bilirubin levels
• Protect genitals and eyes during phototherapy
• Continue monitoring after therapy

Pediatric Disorder

Respiratory Disorders

• Focuses on conditions such as pharyngitis, choanal atresia, tonsillitis.

Pharyngitis

• Inflammation of the pharynx, including palate, tonsils and posterior wall.
• Commonly caused by acute infection.
• Group A beta – hemolytic streptococcus (acute bacterial pharyngitis) agent
• Peak age-group: 5 – 18 y/o but may occur in all age groups
• Abrupt sore throat and fever, and can be managed with antibiotics.
• Encourage compliance with antibiotics, saline gargles, antipyretics, bed rest, and fluids

Choanal Atresia

• Narrowing or blockage of the nasal airway
• Closure one or both posterior nasal cavities.
• Manifestation may include breathing difficulty, cyanosis, chest retractions.
• Treatment involves resuscitation, artificial airway and surgical removal of growth.

Tonsillitis and Adenoiditis

T- Inflammation of tonsils and adenoids.

• Is an infection that causes airway obstruction, appetite loss, and pain.
• Tonsils, adenoids are first line against defense.
• Group: A beta hemolytic Streptococcus is a known cause.

Acute and chronic manifestations

• Sudden vs gradual sore throat, fever, drooling, ear pain, bad breath, red tonsils. - Mouth breathing, frequent sorethroat, anorexia, stunted growth, difficult breathing, muffled voice.

Medical and Nursing measures

• Antibiotics may be used
• Surgical intervention for removal.
• Preop: Assess bleeding, prepare for postop sore throat.
• Postop: Side lying, have suction, monitor hemorrhage, no coughing, give no citrus juices, or red liquids.

Sinusitis

• It is the inflammation of the mucous membrane of sinuses.
• Viral infections, and allergies are two causes for it.
• A "cold" lasting more than 10 to 14 days is a manifestation
• Thick yellow-green nasal drainage, post-nasal drip are two others.
• Headache/facial pain, irritability/fatigue, swelling around eyes.
• Reduce exposure to allergies/pollutants
• Use nasal decongestants to relieve stuffiness.

Common Cold/Viral Rhinitis

• Upper tract infection.
• CORYZA: - inflammation of the mucus membrane of the nose
• Symptoms last week.
• Symptoms - acetaminophen and ibuprofen Avoid antibiotics.

Cardiovascular Disorders

Congenital Heart Disease

• Predisposing factors include rubella, alcoholism and diabetes.

Acyanotic (Left to right shunting)

• Patent ductus arteriosus (PDA): Shunts oxygenated blood (typically surgical)
• Ventricular septal defect (VSD): Abnormal Right & left ventricles (surgery may indicated)
• Atrial septal defect (ASD): Abnormal atrial opening.

Cyanotic (Right to left shunting)

• Poorly oxygenated blood enters systemic circulation.
• Tetralogy of Fallot Four defects; Cyanosis Clubbing
• Transposition of the Great Vessels Pulmonary artery/left and aorta/right ventricle (severe cyanotic)

Nursing management

• Prevent congenital heart disease, optimal nutrition (small frequent feeding), prenatal care.
• Recognize early symptoms - cyanosis, poor weight gain, poor feeding habits.
• Administer medications (digoxin & indomethacin to close ductus)
• Help Adjustments - Monitor vital signs and heart rhythm.

Rheumatic Fever

• Affects connective tissue, 2-6 weeks following untreated strep, complication: heart disease.
• Involuntary Extremities/ Face / with Sore Throat.
• Heart inflammation/red skin lesions Joints tender.
• Assess vital signs & clinical, Control pain via hot/cold compresses, bed rest.

Kawasaki disease

• Lymph node; Systematic Inflammatory illness/acute systemic inflammatory illness.
• Acute: Fever/ conjunctival hyperemia, Strawberry tongue
• Subacute: Cracked lips, finger desquamation, Joint pain, Cardiac, Thrombocytosis.
• Temp for hear sounds, fluids, Prevent Aneurysms.

Hemotologic Disorder

• Severe Anemia- Sickle Cell
• RBC Aggregates cause elongation
• Most crisis common Vaso-occlusive (occlusion/pain).
• Monitor blood hydration and flow, oxygen.
• Help support extremity position/diet.
• Administer antibiotics as prescribed - prevent infection.

Thalassemia

• Autosomal Recessive, Reduced production of one for globulin chains.
• Mediterranean Descent.

Clinical Manifestations

• Features yes, frontal, nose, and liver, and also anemia severe.
• Monitor the blood and iron flow/transfusion to prevent damage.
• Genetic counselling/treat.

Hemophilias

• Sex linked, Deficient Factor 8 & 9/ Abnormal bleeding is trauma/Joint pain and swell.
• Plan blood transfer with factors to help with any pain.