Newborn Priorities in the First Days of Life PDF

NUR 145 MCN 2 SHITS SAS 17 Newborn Priorities in the First Days of Life All newborns have a number of needs in the first few days of life that take priority. They include: 1. Initiation and maintenance of respirations 2. Establishment of extrauterine circulation 3. Maintenance of fluid a...

NUR 145 MCN 2 SHITS SAS 17 Newborn Priorities in the First Days of Life All newborns have a number of needs in the first few days of life that take priority. They include: 1. Initiation and maintenance of respirations 2. Establishment of extrauterine circulation 3. Maintenance of fluid and electrolyte balance 4. Control of body temperature 5. Intake of adequate nourishment 6. Establishment of waste elimination 7. Prevention of infection 8. Establishment of an infant–parent/caregiver relationship 1. Initiation and Maintenance of Respirations: o Critical in the first 48 hours; inability to breathe can lead to respiratory acidosis and severe complications. o Predisposing factors: Low birth weight (LBW), maternal diabetes, premature rupture of membranes (PROM), maternal narcotic use, irregular fetal heart tones (FHT), meconium-stained amniotic fluid, low APGAR scores (55 years. Prenatal diagnosis: ultrasound. ASSESSMENT FINDINGS Physical Features: 1. Facial Features: o Broad, flat nose. o Extra fold of tissue at the inner canthus (epicanthal fold). o Laterally upward slanting palpebral fissures. o Specks in the iris (Brushfield’s spots). o Protruding tongue due to a smaller oral cavity. 2. Head and Neck: o Flat back of the head. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay  o Short neck with loose skin or an extra pad of fat (Puppy’s neck). 3. Ears and Extremities: o Low-set ears. o Poor muscle tone (rag-doll appearance). o Short, thick fingers with an inward-curved little finger. o Single palmar crease (simian crease). o Wide space between the 1st and 2nd toes and fingers. Cognitive and Health Concerns: Cognitive challenges. Increased susceptibility to: o Respiratory tract infections. o Acute lymphocytic leukemia. o Congenital heart diseases. o Gastrointestinal anomalies (e.g., duodenal atresia or stenosis). o Vision problems (e.g., strabismus, cataracts). MANAGEMENT General Principles: 1. Developmentally Appropriate Care: o Focus on developmental age rather than chronological age. 2. Goal Setting: o Set realistic and achievable goals. 3. Routine and Structure: o Adhere to consistent routines. 4. Task Simplification: o Provide simple and repetitive tasks to enhance understanding and participation. HYDROCEPHALUS Definition: Hydrocephalus is the accumulation of cerebrospinal fluid (CSF) in the ventricles or subarachnoid space, leading to increased intracranial pressure (ICP). CSF Formation: CSF is formed in the 1st and 2nd ventricles, passes through the aqueduct of Sylvius and the 4th ventricle, and empties into the subarachnoid space for absorption. Infants: In infants with open cranial sutures, excess fluid causes skull enlargement. TYPES OF HYDROCEPHALUS 1. Communicating (Extraventricular): CSF can reach the spinal cord. 2. Obstructive (Intraventricular): Blockage prevents CSF passage. 3. Congenital: Present at birth, often due to maternal infections (e.g., toxoplasmosis) or infant meningitis. 4. Acquired: Develops later in life due to trauma, infection, or tumors. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay Occurrence: 3–4 per 1,000 live births. SIGNS AND SYMPTOMS Key Symptoms in Infants: Rapid head enlargement (>1 inch/month). Sunset eyes (downward gaze of the eyes). Brow bossing (protrusion). Separation of cranial sutures. Head lag (developmental delay). High-pitched shrill cry. Feeding difficulties. Widened and bulging fontanels. Distended scalp veins and shiny scalp. Opisthotonos (arched back). Signs of Increased Intracranial Pressure (IICP): Decreased pulse rate and respiratory rate. Increased temperature and blood pressure. Hyperactive reflexes. Strabismus and optic atrophy. DIAGNOSIS 1. Head Circumference (HC): o Measure and plot HC on a growth chart for all children 32 degrees: Conservative treatment with bracing (Milwaukee brace). Electrical stimulation for mild to moderate curvatures. Post-operative care includes ROM exercises, log rolling, deep breathing, NPO, NGT, strict I&O, VS and NVS monitoring, BT, pain management, TEDS, gradual activity resumption. Milwaukee or Other Braces Worn 23 hours a day, off for showering, bathing, swimming. T-shirt worn underneath to protect the skin. Exercises several times a day while in brace. Slight muscle ache when first wearing the brace. Discharge Teaching Avoid slumping, bending or twisting torso, lifting over 10 lbs. Comply with activity restrictions for 6-8 months. Bone Tumors (Osteogenic Sarcoma) Description Tumor arising from a bone cell, probably the osteoblast. Most common bone cancer in children. Frequently affects the metaphysis of long bones. Etiology and Pathophysiology Common in adolescent boys, detected during rapid bone growth. Frequently affects distal femur, humerus, tibia, pelvis, jaw, phalanges. Malignant tumor frequently metastasizes to the lungs. High incidence in children with retinoblastoma. Assessment Pain and swelling are the initial symptoms. X-rays following traumatic injury may indicate disease. CT or MRI to detect metastasis. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay Planning and Implementation Treatment: Radical resection or amputation, prosthetic replacement, thoracotomy for lung metastasis, preop and postop chemotherapy. Emotional support and straightforward approach for amputation. Sterile stump care, special bandaging, maintain body alignment. Perform ROM exercises to joints above the amputation. Assist with early ambulation, temporary prosthesis use, early peer interaction. Sexually Transmitted Infections (STIs) Candida Albicans Symptoms: Vulvar reddening and pruritus, thick white cheese-like vaginal discharge. Treatment: Nystatin or miconazole (Monistat) suppositories, fluconazole orally, bathing with dilute NaHCO3 to relieve pruritus. Trichomoniasis Symptoms: Thin, irritating frothy gray-green discharge, strong putrid odor, itching. Treatment: Metronidazole (Flagyl) orally, douching with weak vinegar to reduce pruritus. Gardnerella Vaginalis Symptoms: Edema and reddening of vulva, milky-gray discharge, fishy odor. Treatment: Metronidazole (Flagyl) or clindamycin. Foreign Body Symptoms: Vaginal discharge, odor. Treatment: Removal of the foreign body. Herpesvirus Type II Symptoms: Painful, pinpoint vesicles on an erythematous base, watery vaginal discharge, painful urination. Treatment: Bathing with dilute NaHCO3, lubricating lotions on lesions, oral analgesics, topical acyclovir to heal lesions. Chlamydia Trachomatis Symptoms: Watery, gray-white vaginal discharge, vulvar itching. Treatment: Tetracycline or doxycycline, erythromycin during pregnancy. Neisseria Gonorrhoeae Symptoms: Possibly symptomless, profuse yellow-green vaginal discharge. Treatment: Ceftriaxone and doxycycline, oral amoxicillin. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay Enterobius Vermicularis (Pinworms) Symptoms: Rectal pruritus, especially in the morning. Treatment: Oral administration of antihelminthic such as mebendazole (Vermox). Treponema Pallidum (Syphilis) Symptoms: Painless ulcer on vulva or vagina. Treatment: Benzathine penicillin, administered IM. Group B Streptococcus Symptoms: Vaginitis, vulvar itching, edema, reddening of vulva. Treatment: Antibiotic (Amoxicillin). Hepatitis B and C Transmission: Spread by semen and blood. Syphilis Symptoms: o Incubation Period: 10-90 days. o Primary Stage: Painless lesion (chancre) on genitalia, lips, rectum lasting for 6 weeks then fades. o Secondary Stage: 2-4 weeks later, a generalized macular copper-colored rash on soles and palms (positive VDRL serologic test). o Latency Stage: Lasting years to decades (positive serologic test). o Tertiary Stage: Involves major organs causing blindness, paralysis, neurologic deformities, mental confusion, slurred speech, lack of coordination. HIV Human Immunodeficiency Virus, causing progressive immune system deterioration. Amenorrhea Description: Absence of menstrual flow. Causes: Pregnancy, tension, anxiety, fatigue, chronic illness, extreme dieting, strenuous exercise. Associated With: Low ratio of body fat to muscle, leading to excessive prolactin secretion, decreased GnRH secretion by the hypothalamus. Resolution: Menstrual cycle usually returns to normal within 3 months after stopping strenuous training. Dysmenorrhea Description: Painful menstruation caused by prostaglandin release during the ischemic phase. Prostaglandins: Cause smooth muscle contraction, leading to uterine pain. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay  Associated Illnesses: PID, myoma, endometriosis. Assessment: o Rare in the first 2 years of menstruation. o Categorized as mild, moderate, or severe. o Primary (no organic disease) or secondary (organic disease present). o Symptoms start with bloating and light cramping 24 hours before menstrual flow. o Pain: Colicky, sharp pain with dull, nagging pain in the lower abdomen, vulva, and inner thighs. o Possible diarrhea, mild breast tenderness, abdominal distention, N/V, headache, and facial flushing. Management: o Analgesics (aspirin, ibuprofen, naproxen sodium) - avoid on an empty stomach. o Low-dose oral contraceptives to prevent ovulation. o Alternative therapies: Imagery, TENS. Obesity Description: Common in adolescents with obese parents (environmental and genetic factors). Implications: Higher suicide rate in obese teens, low self-esteem, body image issues, depression. Diet: Adherence to a diet close to 1800 calories/day. Management: o Diet and Exercise: Main measures. o Psychological Counseling: For stress-related overeating. Measures to Help Decrease Overeating Log: Record amount, time, and circumstances of eating, and change those circumstances. Eating Habits: Eat in one place instead of while walking or watching TV. Slow Eating: Count mouthfuls, put fork down between bites, use small plates for larger-looking helpings. Anorexia Nervosa Description Refusal to maintain a minimally normal body weight due to a distorted perception of body size/appearance. Three Features: Self-induced starvation, relentless drive for thinness or morbid fear of fatness, medical symptoms from starvation. Prevalence: Most common in girls (90%) aged 13-20 years. Manifestation: Severe weight restriction through limiting food intake, excessive exercise, binge eating, or purging. Special Characteristics BMI < 17.5 or 100.4°F/39°C) for 5+ days. o Four or more of: changes in hands/feet (erythema, edema, peeling), polymorphous exanthema, bilateral conjunctivitis without exudates, changes in lips/mouth (erythema, strawberry tongue, dry, cracked lips), cervical lymphadenopathy (>1.5 cm, usually unilateral). o Laboratory changes: thrombocytosis, leukocytosis, elevated ESR and CRP, elevated liver enzymes, mild anemia. o Irritability and joint pain. Subacute Phase (Weeks 2-3): o Skin desquamation (palms and soles). o Increased platelet count, risk of clot formation. o Risk of coronary artery aneurysms leading to myocardial ischemia and infarction. Management: Immediate Treatment: o High-dose intravenous immunoglobulin (IVIG) within first 7-10 days of fever (2 g/kg, may repeat if fever persists). o High-dose aspirin (80-100 mg/kg/day divided four times daily) for 48-72 hours post-fever. Long-term Treatment: o Low-dose aspirin (3-5 mg/kg/day) for 6-8 weeks if no coronary abnormalities. o Continued aspirin indefinitely if coronary abnormalities are present. Inflammatory Processes Myocarditis Definition: Acute or chronic inflammation of the myocardium, commonly caused by viral agents (e.g., coxsackievirus, adenovirus, parvovirus). NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay  Assessment: Endomyocardial biopsy, cardiovascular MRI. Management: Symptomatic treatment, heart failure protocols, possible use of mechanical support (VAD, ECMO). Infective Endocarditis Definition: Inflammation/infection of endocardium or valves, caused by Streptococcus viridans and Staphylococcus aureus. Assessment: High fevers, toxic appearance, CHF symptoms, murmurs, persistent low-grade fever, malaise, weight loss, arthralgias, fatigue, rigors, diaphoresis. Management: Blood cultures, echocardiogram, 4-6 weeks of IV antibiotic therapy, prophylactic antibiotics for invasive procedures. Pericarditis Definition: Inflammation of the pericardial membrane, often viral/postviral. Assessment: Sharp, positional chest pain, fever, pericardial friction rub, diagnosed with ECG and CXR. Management: Anti-inflammatory agents (ibuprofen), corticosteroids, colchicine for refractory cases. SAS 29 Structural Abnormalities of the Urinary Tract Patent Urachus Definition: Urachus (tube connecting bladder and umbilicus) fails to close during development, more common in males. Assessment: Nitrazine paper test identifies urine at the umbilical cord, confirmed by ultrasound. Management: Usually requires surgical correction in the neonatal period to prevent infection. Hypospadias Definition: Urethral opening on the ventral aspect of the penis; may be familial. Assessment: Inspect all male newborns; may be minimal or severe with short chordee. Management: o Avoid circumcision. o Surgery to straighten penis (chordee repair) and extend urethra (meatotomy). o Delayed surgery for extensive cases (age 3-4). o Post-surgery: urinary drainage catheter, analgesics, anticholinergics. Exstrophy of the Bladder Definition: Midline closure defect exposing bladder at birth, detected by fetal ultrasound. Assessment: Pelvic bone defects, urethral defects, excoriated skin, risk of kidney infection, waddling gait. Management: o Surgical closure of bladder and abdominal wall. o Keep bladder mucosa moist and covered. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay  o Use protective topical applications for skin. o Post-surgery: suprapubic tube, positioning to prevent failure, possible bladder neck reconstruction. Infections of the Urinary System and Related Disorders Hydronephrosis Definition: Enlargement of kidney pelvis due to urine back-pressure from obstruction, often diagnosed by prenatal ultrasound. Assessment: Usually asymptomatic, repeated UTIs, irritability, abdominal mass, elevated blood pressure, flank/abdominal pain. Management: Surgical correction of the obstruction. SAS 30 Disorders Affecting Normal Urinary Elimination Enuresis Definition: Involuntary passage of urine past the age of expected bladder control; can be nocturnal, diurnal, or both. Types: Primary (never achieved bladder control) and Secondary (control established but lost). Assessment: o History taking to identify organic or functional causes. o Check for family stresses, patterns of wetting, and other symptoms (e.g., abdominal pain, burning, frequency). Diagnosis: Ultrasound, pre-post bladder scan, urodynamic testing, clean-catch urine specimen. Management: o Limit fluids 2 hours before bed. o Avoid bladder-stretching exercises. o Use desmopressin (DDAVP) for primary nocturnal enuresis. Polycystic Kidney Definition: Large, fluid-filled cysts replace normal kidney tissue; most common type inherited as autosomal recessive. Assessment: Detected by sonogram during pregnancy or at birth. Management: o Surgical removal of the diseased kidney if only one is cystic. o Renal transplantation if both kidneys are cystic. o Genetic counseling for parents and adolescents. Prune Belly Syndrome (PBS) Definition: Broad spectrum syndrome with cardiac, pulmonary, orthopedic, and urologic abnormalities, mainly in boys. Assessment: Severe dilation of ureters and bladder, bilateral undescended testes, wrinkled abdomen. Management: o Surgical remodeling. NOTES KAY NAKAKA WTF ANG SAS BBM_BaldicañoBeverlyMay  o Protect child's abdomen from trauma. o Possible kidney transplant as they reach school age. Acute Poststreptococcal Glomerulonephritis Definition: Inflammation of the glomeruli following a streptococcal infection, caused by immune complex disease. Assessment: o Common in children aged 5-10 years. o Boys affected more than girls. o History of recent respiratory infection or impetigo. o Hematuria (tea-colored urine), oliguria, elevated urine specific gravity, hypertension, hypoalbuminemia. Management: o Antibiotics to remove streptococci. o Diuretics (e.g., furosemide) may be tried. o Supportive care for heart failure: semi-Fowler’s position, digitalization, oxygen. o Antihypertensive therapy if diastolic BP > 90 mmHg. o Phosphate binders (aluminum hydroxide) and potassium-removing agents (sodium polystyrene sulfonate) if needed. o Daily weight monitoring, intake/output calculation. Chronic Glomerulonephritis Definition: Follows acute glomerulonephritis/nephrotic syndrome or occurs as primary disease; includes Alport syndrome (with hearing loss and ocular changes). Assessment: o Proteinuria, hypertension, red/white cell casts, occult blood in urine with low specific gravity (