Newborn PDF - Lifespan, Growth And Development

lifespan, Growth and Development SUP 3641 Intended Learning Outcomes (ILOs) Define full term neonate Explain initial assessment of full term neonate Discus the growth measurements of full term neonate Describe systems changes of full term neonate Explain modes of heat loss Enume...

lifespan, Growth and Development SUP 3641 Intended Learning Outcomes (ILOs) Define full term neonate Explain initial assessment of full term neonate Discus the growth measurements of full term neonate Describe systems changes of full term neonate Explain modes of heat loss Enumerate feeding and protective reflexes Discus nursing care for full term neonate lifespan, Growth and Development SUP 3641  Outline Definition of full term neonate Initial assessment of full term neonate Growth measurements of full term neonate Systems changes of full term neonate Modes of heat loss Feeding and protective reflexes Nursing care for full term neonate lifespan, Growth and Development SUP 3641  Definition The neonatal period is the period from birth to age of 28 days. lifespan, Growth and Development SUP 3641  Initial Assessment Apgar score It is done in 1st and 5th minute immediately after birth It includes 5 standardized observations: – Heart rate – Respiratory rate – Muscle tone – Reflex irritability – Color lifespan, Growth and Development SUP 3641  lifespan, Growth and Development SUP 3641 Apgar Score observation 0 1 2 Heart rate Absent Slow(below100) Over 100 Respiratory rate Absent Slow, Good ,sustained irregular, shallow cry, regular respiration Reflex irritability No response Grimace ,frown Sneeze, cough, cry Muscle tone Limp, Some flexion of Active motion, completely extremities, some good muscle flaccid resistance to tone,spontanous extension flexion color Cyanosis ,pale Body pink, Completely pink extremities pale An infant who has score of 8 to 1o is in a good condition and will only need suction and routine observation. An infant who has score of 4 to 7 indicates a moderately distressed infant who will need some of oxygen and close observation An infant who has score of 0-3 is considered severely distressed and will need resuscitation lifespan, Growth and Development SUP 3641  Assessment of Gestational Age Is measured within 72 hours after birth. It assesses both physical and neuromuscular maturity. lifespan, Growth and Development SUP 3641 Physical Maturity lifespan, Growth and Development SUP 3641 Neuromuscular Maturity lifespan, Growth and Development SUP 3641  weight Normal birth weight: 2700- 4000 gm. Loss 5 -10 % of birth weight in the first week due to:  Withdrawal of hormones from mother.  Loss of excessive extra cellular fluid.  Passage of meconium (feces) and urine.  Limited food intake. lifespan, Growth and Development SUP 3641  Regain or exceed birth weight by 2 week of age. Gain 30 gm daily during neonatal period lifespan, Growth and Development SUP 3641  Length Average: 50 cm Range: 48 - 53 cm. lifespan, Growth and Development SUP 3641  Head circumference Average :35 cm Range: 33 - 35 cm 2cm greater than chest circumference lifespan, Growth and Development SUP 3641  Chest circumference 2cm smaller than head circumference lifespan, Growth and Development SUP 3641  Vital signs Pulse HR: 120-160 b/min 80/minute relaxed, sleeping babies. Increased during activity lifespan, Growth and Development SUP 3641  Blood pressure The range is wide and varies with both weight and gestational age. 70/50 mm Hg (At birth) 80/55 mm Hg (by the fourth day ). lifespan, Growth and Development SUP 3641  Respiration Rate: 30- 60 breaths\ minute The breathing of newborns is almost entirely diaphragmatic The normal baby bas a characteristic variation and irregular in rate and rhythm of breathing. lifespan, Growth and Development SUP 3641  Temperature Normal range: 36.5- 37.5 c - Axillary : 36.4 37.2 c - skin: 36- 36.5 c - Rectal : 36.6- 37.2 c lifespan, Growth and Development SUP 3641 Modes of heat loss Convection Body surface to air (drafts) Radiation Body surface to cooler object not in contact (cold walls or window) Evaporation Conversion of a liquid to a vapor (wet infant) Conduction Body surface to cooler object in contact with baby lifespan, Growth and Development SUP 3641  Posture Flexion of head and extremities while resting on chest and abdomen lifespan, Growth and Development SUP 3641  Skin Bright red, puffy, smooth Dark pink by the second day Edema around eye face, legs and genital organs Acrocyanosis lifespan, Growth and Development SUP 3641  Vernix Caseosa Greasy whitish material over body. It is decreasing in amount as term approaches Protect the skin from infection and hypothermia Should not be vigorously removed during bathing lifespan, Growth and Development SUP 3641  Lanugo Hair It is a fine downy soft hair observed on the shoulders, back, extremities, forehead More in preterm babies lifespan, Growth and Development SUP 3641  Mongolian Spots Bluish coloration on the lower back, buttocks Disappear during first year of life lifespan, Growth and Development SUP 3641  Milia Small pinpoint white or yellow spots, Common on the nose, forehead, cheeks and chin, disappeared by few weeks lifespan, Growth and Development SUP 3641  Head - Round, symmetric, soft and moves easy from left to right and up to down. lifespan, Growth and Development SUP 3641  Head Birth Injuries Item Caput Cephalhematoma succedaneum Appearance (collection of fluids) ) Collection of blood) At birth Few hours after birth Consistency Soft and Firm, feeling of depressed Edematous, fracture on palpation Extent Cross the suture line Not cross the suture line Resolution Few days 2 weeks – 3 months Associated with Skin patches Anemia and jaundice if large Management nothing Management of Anemia and jaundice Head Birth Injuries caput succedaneum cephalhematoma lifespan, Growth and Development SUP 3641  Fontanels Anterior Fontanel: 2-3 cm wide and 3- 4cm long ( diamond shape ) and closed at 12-18 month. Posterior Fontanel: 1-2 cm at birth ( triangle shape) and closed 8- 12 weeks. lifespan, Growth and Development SUP 3641  Eyes Edematous eye lid Eye color is not determined until the age of 3-6 months Pupils: react to light Absence of tears Blinking reflex is present lifespan, Growth and Development SUP 3641  Ears Top of the pinna on horizontal line with canthus of eye Startle reflex Pinna flexible, cartilage present lifespan, Growth and Development SUP 3641  Abdomen Cylindrical in shape Stomach capacity 30 – 60 cc Liver palpable 2-3cm below costal margin Umbilical cord drops off 7 – 10 days Soft bowel sound heard shortly after birth lifespan, Growth and Development SUP 3641  Circulatory system Ductus Arteriosus Foramen ovale The Ductus venous lifespan, Growth and Development SUP 3641  Major Areas of Cardiovascular Changes Increased aortic pressure and decreased venous pressure Increased systemic pressure and decreased pulmonary artery pressure Closure of foramen ovale Closure of the ductus arteriosus Closure of the ductus venosus lifespan, Growth and Development SUP 3641 Fetal and Neonatal Circulation lifespan, Growth and Development SUP 3641  Blood volume Full term Neonate - 80 to 90 ml/kg * N.B. Depend on the amount of blood from placenta. lifespan, Growth and Development SUP 3641  Respiratory System Slight sternal retraction Respiration is chiefly abdominal Cough reflex 1-2 days after birth Nose breathers lifespan, Growth and Development SUP 3641  Urinary System Voids at birth or some hours later Pass urine within 24 hours after birth Glomerular and tubular functions increase with age The maximal concentration ability is less than in adults Newborns have less ability to handle a water load lifespan, Growth and Development SUP 3641  Male Genitalia Urethral opening at tip of glans penis Testes are palpable in each scrotum Scrotum is edematous, covered with rugae lifespan, Growth and Development SUP 3641  Female Genitalia Labia and clitoris are usually edematous Urethral meatus behind clitoris lifespan, Growth and Development SUP 3641  Endocrine System Swollen breasts: Witch’s milk: Infantile menstruation lifespan, Growth and Development SUP 3641  Nervous System Protective Reflexes Blinking Coughing and sneezing Gagging lifespan, Growth and Development SUP 3641  Feeding Reflexes Rooting Reflex: lifespan, Growth and Development SUP 3641 Sucking & swallowing Reflex lifespan, Growth and Development SUP 3641 Stepping & Walking Reflex lifespan, Growth and Development SUP 3641 Other Reflexes Grasping reflex lifespan, Growth and Development SUP 3641  Moro & Startle Reflex We can do it by Dropping the head, Making a loud noise near the baby’s ear, Withdrawal of blankets underneath the infant THE RESPONSE: Abduction of the arms at the shoulders and extension of the forearm at the elbow. the hands and fingers are held wide open. A vigorous cry follows these movements. lifespan, Growth and Development SUP 3641  lifespan, Growth and Development SUP 3641  Tonic neck reflex Placing the infant in a supine position. Lateral rotation of the head to one side extension of the arm and leg towards which the head is turned flexion of the limbs on the opposite side lifespan, Growth and Development SUP 3641  lifespan, Growth and Development SUP 3641 Babinski reflex lifespan, Growth and Development SUP 3641  Duration Response Stimulation Reflex Disappears at three Turns toward source, Cheek stroked or side Rooting to four months up to opens mouth and of mouth touched seven months sucks Disappears at three Sucks on object Mouth touched by Sucking to four months object Weakens at three Grasps tightly Palms touched Grasping months; disappears at a year Permanent Closes eyes Flash of light or puff Blinking of air Disappears at two -Extension of the arm Placing the infant in a Tonic neck months and leg towards supine position. which the head is Lateral rotation of turned the head to one side -Flexion of the limbs on the opposite side Disappears at nine Fans out toes and Sole of foot stroked Babinski months to a year twists foot in lifespan, Growth and Disappears at three Moves feet Development as if to SUP 3641held Infant upright Stepping &  General Nursing Care of Newborn Vital signs Temperature maintenance Growth measurements Protection from infection Observation of abnormalities BCG vaccination T3 &T4 testing lifespan, Growth and Development SUP 3641  Promotion of parent/infant bonding Feeding Body hygiene Play (sensory motor stimulation) Basic needs gratification lifespan, Growth and Development SUP 3641  Developmental Care Interventions – Place photographs of parents and siblings in visual range of the newborn – Initiate eye contact; repeat as tolerated. – Reduce light levels. – Stroke skin slowly and gently in head-to-toe direction – Provide boundaries, foot bracing, blankets, “nesting.” – Encourage skin-to-skin (kangaroo) holding by parents and siblings as tolerated. – Play tape of parents and siblings voices. – Softly play simple, soothing music, recording of womb sounds – Provide nonnutritive suckling at mother's breast. lifespan, Growth and Development SUP 3641  lifespan, Growth and Development SUP 3641