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Lecture 2

NURS 3524 Lecture Notes - Lecture 2: Ibm 7090, Fontanelle, Silver Nitrate


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Lecture
2

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NURS 3524 York- Paediatrics Wk 2
NURS 3524: Paediatrics
September 18, 2014
Growth & Development of the Healthy Child Newborn, Infant and Toddler
Mavoy Bertram
A child’s health is based on...
Achievement of physiological & developmental milestones
Growth charts
Physical assessments
Report from parents
‘NORMAL development
Is highly variable
Is a cause of parental anxiety
Implications for nursing practice
Parent teaching
Power of the Internet
Power of family members (i.e. siblings, grandparents, aunts, uncles, etc.)
Impact of the culture
Power of the Internet
You are not the only source of information
Educate parents to be ‘smart’ consumers of internet data
Know your internet sources – what to recommend
Canadian Paediatrics Society (CPS)
American Academy of Pediatrics (AAP)
About Kids Health
Newborn= first 28 days of life
KNOW FLOW OF BLOOD INUTERO
https://www.youtube.com/watch?v=OV8wtPYGE-I
First breath
O2 is a vasodilator- lowered pH among others stimulates breathing. (Prostaglandin helps
to keep the ductus open.)
Ductus venosis closing- look up
Clamping the cord increases pressure on left side- closes flap of foramen ovale. Left side
does most of the work. Inutero, most pressure is on right side.
Coming thru birth canal –fluid in lungs is squeezed out.
Surfactant reduces surface tension of alveoli
Thermoregulation
Surface area to weight is very high.
A lot of metabolic stores can get used up because they cannot shiver
Being flexed conserves heat
Fluid & Electrolyte
50% of fluid is in ECC- extracellular compartment
Prone to dehydration & over hydration
Don’t correct sodium quickly
Causes shift in fluid-
Rapid fall in sodium= hypotonic. Fluid moves to interstitial tissues= swelling of brain
Rapid rise in sodium= intracranial hemorrhage
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NURS 3524 York- Paediatrics Wk 2
GI tract
Breast milk & formula
Easy to digest- stomach has few enzymes
Liver is immature- jaundice not conjugating bilirubin
Reflux – lower esophageal sphincter is weak
Delayed gastric emptying- less effective peristalsis
Renal System
Immature – cannot concentrate urine
Prone to dehydration
Specific gravity normal= 1.02 (should be within normal)
Integ & Musculoskeletal
Cartilaginous –not ossified
Sweat is limited- sweat glands are immature
Dermis & epidermis are thin- prone to skin tears
Thin- not fat deposited yet- more sensitive
Fontanels- Sutures of skull are open Posterior= 2 mo.
Anterior= 12-18 mo.
Endocrine
Low levels of ADH antidiuretic hormone
Prone to dehydration
Sensory
Moro reflex = startle reflex
Hands fan out
defenses
Skin is first line
Immune system is immature
Immunoglobulin's from mother- protection for up to 3 mo.
Immediate Adjustments
Respiratory System
Circulatory System
Thermoregulation
Hematopoietic System
Fluid & Electrolyte Balance
Gastrointestinal System
Renal System
Integumentary & MSK System
Endocrine System
Neurologic System
Sensory Functions
Defenses Against Infection
How far ‘outside of normal’ is abnormal?
Know the norms
Growth charts, growth charts, growth charts
Referrals to other professionals and agencies
Newborn Assessment
Key Considerations:
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NURS 3524 York- Paediatrics Wk 2
Initial Assessment (Apgar Score)
At 1 and 5 minutes after birth
Judges appearance, pulse, resp & activity- determines levels intervention
needed
Score 0-3 sever distress
4-6 moderate difficulty
0-3 resuscitate immediately
Periods of Reactivity
Shortly after birth –
2-5 hrs. after birth- periods of inactivity (Difficult to arouse)
Next 2-6 hours- awake & alert.
Newborn Assessment…
Newborn assessment…
Gestational age
Younger = higher morbidity
Head to toe assessment & all measurements
APGAR Scoring System
Measurements
Head Circumference :33-35 cm (13-14 inches)* molding** can skew number
Chest Circumference: 30.5-33cm (12-13 inches)
23 cm smaller than head
Crown-to-rump measure: 31-35 cm (12.5-14 inches) (~equal to head circumference)
Head-to-heel measure: 48-53cm (19-21) measure on bed with infant stretched
Weight and length
Abdominal circumference when necessary
KNOW types of extra cerebral fluid collections
Subgaleal hemorrhage
+ 2 others
Concept of Corrected Age
Ballard score
Determines gestational age in weeks through neuromuscular (6)& physical assessment
(6)
As the baby develops muscle tone distinct posture ensues and measurable angles of
resistance in key muscle groups are noted.
Used for newborns 20-44 weeks of gestation
Each parameter scores from -2 to 5 with a cumulative score correlating with gestational
age between 26 and 44 weeks
Ballard score…
Neuromuscular assessment – posture, square window, arm recoil, popliteal angle, scarf
sign and heel to ear
This is done with the infant in a supine position
The younger the gestational age – the less flexion the newborn demonstrates
Physical maturity – skin, lanugo, plantar surface, breast, eye/ear and genitals
Care of the Newborn
Protect from infection & injury
Eye care, umbilicus care, Vitamin K, immunizations & vaccines
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