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Growth and Adjustment Problems of Newborn

BIRTH INJURIES Soft Tissue Injury - Primarily in the form of bruises and abrasions secondary to dystocia. - Common types of soft tissue injury: Erythema and abrasions Petechiae Ecchymoses Subcutaneous fat necrosis Subconjunctival (sclera) hemorrhages Retinal Hemorrhages - These traumatic lesions generally fade spontaneously and without treatment within a few days. However, petechiae may be a manifestation of an underlying bleeding disorder and are evaluated. Nsg. Management: - Directed primarily toward assessing the injury, maintaining asepsis of the area to prevent breakdown and infection, and providing an explanation and reassurance to the parents. Head Trauma - Occurs during the birth process is usually benign but occasionally results in more serious injury. - 3 most common types of extracranial hemorrhagic injury: Caput succedaneum Subgaleal hemorrhage Cephalhematoma Nsg. Management: - Assessment and observation of the common scalp injuries and vigilance in observing for possible associated complications such as skin breakdown, infection, or, rarely, acute blood loss and hypovolemia. Because these visible injuries resolve spontaneously, parents need reassurance of their benign nature. Fractures - Fracture of the clavicle , or collarbone, is the most common birth injury. Often associated with difficult vertex or breech deliveries of infants of greater-than-average size. - Crepitus (the coarse, crackling sensation produced by the rubbing together of fractured bone fragments) is often felt or heard on further examination, and radiographs usually reveal a complete fracture with overriding of the fragments. A palpable spongy mass, representing localized edema and hematoma, may also be a sign of a fractured clavicle.

Nsg. Management: - Often no intervention may be prescribed other than proper body alignment, careful dressing and undressing of the infant, and handling and carrying techniques that support the affected bone. - For immobilization and relief of pain, arm on the side of the fractured clavicle may be secured against the body by pinning the sleeve to the shirt or by applying a triangular sling or figure-8 bandage. Paralyses - Most common types of paralyses: Facial paralysis - pressure on the facial nerve ( the 7th cranial nerve) during delivery -Primary manifestations are Loss of movement on the affected side, such as an inability to completely close the eye, Drooping of the corner of the mouth, and absence of wrinkling of the forehead and nasolabial fold. Brachial paralysis - Brachial plexus injury results from forces that alter the normal position and relationship of the arm, shoulder, and neck. - referred to as Obstetric Brachial Plexus Injury - Erb- Duchenne paralysis (Erb paralysis) -caused by damage to the upper plexus - Usually results from stretching or pulling away of the shoulder from the head -Klumpke paralysis - results from severe stretching of the upper extremity while the trunk is relatively less mobile - Total Plexus - the 2nd most common type of plexus injury Phrenic nerve paralysis results in diaphragmatic paralysis as demonstrated by ultra sonography, which shows paradoxical chest movement and an elevated diaphragm. -sometimes occurs in conjunction with brachial palsy Nsg. Management: For Infant with facial nerve paralysis: -aiding the infant in sucking and helping the mother with feeding techniques. - Comprehensive evaluation of the infants oral motor skills by an infant feeding specialist is recommended to develop an effective multidisciplinary feeding regimen. - Breast-feeding is not contraindicated, but the mother will need additional assistance in helping the infant grasp and compress the areolar area. - For the eyelid on the affected side, artificial tears can be instilled as needed to prevent drying of the conjunctiva, sclera, and cornea. For Infant with brachial palsy: -affected arm should be gently immobilized on the upper abdomen -Passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated in the latter part of the first week. -Wrist flexion contractures may be prevented with the use of supportive splints. For Infant with phrenic nerve paralysis: -requires the same nursing care as any infant with respiratory failure.

-Familys emotional needs are also provided -Follow up care is also essential because of the extended length of recovery

DERMATOLOGIC PROBLEMS IN THE NEWBORN Candidiasis -known as moniliasis; Candida albicans, the organism usually responsible, may cause disease in any organ system -Yeast-like fungus that can be acquired from a maternal vaginal infection during delivery; person-to-person transmission (poor hand-washing technique); or from contaminated hands, bottles, nipples, or other articles. -usually a benign disorder in the neonate and is often confined to the oral and diaper regions. -Oral Candidiasis (thrush) is characterized by white adherent patches on the tongue, palate, and inner aspects of the cheeks, which is often difficult to distinguish from milk. -The infant may refuse to suck because of pain in the mouth. Nsg. Management: -Directed toward preventing spread of infection and correct application of the prescribed topical medication such as 1 ml of nystatin( Mycostatin) over the affected surfaces . -For Candidiasis in the diaper area, the caregiver is taught to keep the diaper are clean and to apply medication to affected areas as prescribed. Herpes -One of the most serious viral infections in the newborn -Classified according to the following types: Skin, eye, and mouth Localized central nervous system disease Disseminated infection involving multiple sites such as the lungs , liver, adrenal glands, CNS, skin, eyes, and mouth - Rash appears as vesicles or pustules on an erythematous base. Clusters of lesions are common. The lesions ulcerate and crust over rapidly. Fetal scalp monitoring sites are commonly the primary site of infection. Nsg. Management: -Neonates with HSV or suspected infection should be carefully evaluated for clinical manifestations. -Early recognition and treatment with antiviral therapy is key to the prevention of serious and often fatal complications. Bullous Impetigo -An infectious superficial skin condition most often caused by various strains of Staphylococcus aureus. -characterized by the eruption of bullous vesicular lesions on previously untraumatized or intact skin and may appear on any body surface and sometimes become widespread, but the usual distribution involves the buttocks, perineum, trunk, face, and extremities.

-Bullae rupture in 1 to 2 days, leaving a superficial red, moist, denuded area with little crusting. Nsg. Management: -Once the diagnosis is suspected, the infant is isolated until therapy is instituted to prevent spread of infection to other infants. People who have come in contact with the infant are investigated to determine the possible source of the infecting organism. - parents and other visitors are instructed regarding precautions for the prevention of infection , especially through hand washing and standard precautions. COMMON BIRTH DEFECTS CLEFT LIP - Failure of the maxillary processes to fuse with the nasal passage - Etiology unknown but strong genetic and environmental factors - more common in males - prone to ear, nose and throat infection o Nursing management: - Preoperatively: be aware of sucking problems and infants swallow a great deal of air during feeding, burp frequently and use adaptive feeding devices: large soft nipples, syringe with rubber tubing - Postoperatively: use medicine dropper - Elbow restraints, do not position on abdomen - Advise parent not to use pacifier - Apply LOGAN BAR to reduce tension on the suture line Cleft Palate - failure of the palatine processes to fuse - more common among females - repair usually completed by 12-18 mos to prevent speech problem o Nursing management: Postoperatively - Child is fed through a cup, cannot use spoon - Use of elbow restraints - May position on the abdomen HYDROCEPHALUS - Imbalance in either absorption or production of CSF within the intracranial cavity - Etiology: often associated with neural tube defect - Clinical manifestations: o Categorized by age: o Infants: increased head circumference Bulging anterior fontanel Distended scalp vein High pitch cry Feeding problems Discomfort when held

o Older children: Headache Vomiting Diplopia Blurred vision o Nursing management: - Preoperative measurement of head circumference - Postoperatively: o Perform frequent neurologic assessment with daily head circumference Position on non-operative site Institute seizure precautions - Monitor for s/s of shunt infections - Give frequent small feedings, planned rest period after feeding. Daily weights HERNIAS - Protrusion of the bowel through an abdominal opening in the abdominal wall, in children this occurs most commonly at the umbilicus and through the inguinal canal Clinical Manifestations: Umbilical hernia - swelling or protrusion around the umbilicus Inguinal hernia - usually a painless swelling in the inguinal area Nursing Management: Assess for signs of strangulation and incarceration Perform postoperative care




PATENT DUCTUS ARTERIOSU S (spontaneous closure at 3 wks)

Failure of the ductus arteriosus to close, often a complication of respiratory distress

- recurrent apnea - wide pulse pressure - machinelike - murmur


A communication between the left and right atria

-systolic murmur - acyanotic asymptomatic -thin and

Medical: administration of indomethacin (Indocin) Surgical: - Ligation of patent ductus (in infancy) Open heart with direct closure or suturing with plastic

From pulmonary artery to aorta

Left to right

VENTRICU- A LAR SEPTAL communication DEFECT Between the right and left ventricles

asthenic frequent episodes of -pulmonary - inflammator y - diseases - poor exercise - tolerance - failure to thrive - frequent respiratory infections - loud, harsh murmur - systolic thrill

prosthesis (usually done at preschool age)


- Preductal constriction of the aorta bet. Subclavian artery and ductus arteriosus - Postductal constriction of aorta directly beyond the ductus

Some small - Left to defects may right close spontaneously. (during first year of life) Open heart with direct closure/suturin g with plastic prosthesis - (usually at preschool age, for large defects mybe done in earlier infancy - hypertensio - Surgical - Obstruction of n in upper resection of blood flow extremities coarctate area through th e with with direct constricted decreased anastomosis or segments BP in lower with use of a extremities graft - weak or - (correction absent usually done by pulsations 2 yrs of age to in lower prevent extremities permanent hypertension)

REVIEW OF CYANOTIC CONGENITAL ANOMALIES ANOMALY DESCRIPTION SYMPTOMS TREATMEN T TETRALO- Pulmonary - acute - Surgical: GY OF cyanosis at Blalock Taussig - stenosis FALLOT - birth - Repair: open - Right-sided

B L OOD SHUNTING Right to left

heart closure of - clubbing of VSD and fingers resection of - and toes stenosis - systolic - (usually done murmur during the first - tet two years of life) spell(acute - episodes of - cyanosis and - hypoxia) - squatting - - growth retardation TRANSPOSI- - The aorta - early - Administr T IO N O F originates from clubbing of ation of IV THE GREAT the right toes and prostaglan VESSELS ventricle and the fingers din and (TGV) pulmonary surgical - poor artery from the repair growth and left ventricle developme nt - rapid respirations , fatigue - failure to thrive - severe TRUNCUS - Failure of pulmonary normal ARTERIOSU edema and S septation and division of the heart failure embryonic bulbar trunk into the pulmonary artery and aorta Neural tube defects (NTDs) occur in the first month of pregnancy when the structure that develops into the brain and spinal cord is forming. Normally, this structure folds into a tube by the 29th day after conception. When the tube doesn't close completely, the baby has an NTD; many babies with these defects are stillborn or die soon after birth. The two most common forms of NTDs are: Spina bifida, which happens when the spinal column doesn't close completely around the spinal cord. It ranges from mild to severe and can be associated with loss of bladder and bowel function, paralysis, and, in some cases, death. Anencephaly, which occurs in 3 out of 10,000 births, involves the lack of development of parts of the brain. (T.O.F) hypertrophy Overriding of the aorta Ventricular Septal Defect (VSD)

MYELOMENINGOCELE - Type of Spina Bifida, a fissure in spinal column leaving meninges and spinal cord exposed - Unknown etiology - Clinical manifestation: - partial to complete paralysis depending on the location of defect - clubfoot, scoliosis, - bowel and bladder problems - elevated AFP - visible sac Nursing management: - Preoperative: main goal is to prevent rupture of sac - keep infant in prone position - cover sac with gauze moistened with sterile saline - check sac for tears and cracks - do not cover sac with cloth and diaper - monitor for s/s of meningitis Postoperative: main goal is to promote healing and reduce neurological complications place infant in prone position with head slightly lower than the body place protective barrier across incision to prevent contamination be aware of long-term problems of infection related to urinary retention reflux, chronic UTI Monitor for s/s of IICP CEREBRAL PALSY - Chronic , nonprogressive caused by malformation of the motor pathways of the brain - Clinical manifestations: - common clinical manifestation in all types of cerebral palsy is DELAYED GROSS MOTOR DEVELOPMENT - infantile reflexes do not go away - delayed speech development - lack of head control - hearing and visual deficits mental retardation Nursing management: - Prevent physical injury - Prevent physical deformity - Administer prescribed meds: sedative, muscle relaxants and anticonvulsants - Encourage self-care - Refer to OT and speech therapy - behavioral problems CONGENITAL DYSPLASIA OF THE HIP (CDH) - imperfect development of the hip of varying degrees - etiology unknown, females are 8 times more likely to develop

- Clinical manifestations: - shortening of affected leg assymetrical gluteal folds limited abduction ortolanis click Nursing Management: - If diagnosed within 2-3 mos, abduction of the hip is maintained via DOUBLE DIAPERING and Pavlik harness to be worn 24 hrs/day - Frequent CMS checks. (circulation, motion, sensation) - Routine cast care (hip spica) - Routine traction care (Bryants)

Growth and Adjustment Problems of Infants

COMMON HEALTH PROBLEMS OF INFANCY SUDDEN INFANT SYNDROME - Defined as sudden unexpected death of an infant under 1 year of age - Leading cause of death in children between the ages of 1 month and 1 year - Death usually occurs during sleep - Infants at grater risks for SIDS: - have a family hx of SIDS (esp siblings) - have a hx of seizure - are born prematurely - closely spaced pregnancies - twins - Etiology : remains unknown Nursing Management : - Teach parent how to minimize the risks of SIDS - avoid smoking during and after pregnancy - encourage putting infants to sleep in supine position unless contraindicated. Sidelying position may also be used - avoid soft, moldable mattress - avoid use of pillows LARYNGOTRACHEOBRONCHITIS - Inflammation of the larynx, trachea and bronchi - Characterized by a narrowing of the air passages which causes edema of the the respiratory mucosa - Most often seen in children ages 3 months to 3 years and usually of viral origin - Clinical Manifestation: - irritability - brassy or barking cough - hoarseness - restlessness

- inspiratory stridor - anorexia - low-grade fever - nausea and vomiting - rales, wheezing, crackles Nursing Management: - Assess for airway obstruction by evaluating respiratory status - Keep emergency equipment at bedside (tracheostomy and intubation tray - Administer prescribed medications which may include bronchodilator and antiinflammatory drugs - Family teaching may include telling the parents to place the child in the bathroom and to run hot water to produce steam. EPIGLOTITIS - Inflammation of the supraglottis and epiglottis generally caused by Haaemophilus influenza bacteria. Echovirus and respiratory sncytial virus can also cause this disorder - Abrupt onset and progresses rapidly - Clinical Manifestations: - sudden onset of fever, lethargy and dypnea - restlessness and anxiety - hyperextension of the neck, drooling and severe sore throat with refusal to drink - stridor and hoarseness - tripod position - red and inflamed throat with a large, cherry red, edematous epiglottis Nursing Management: - Closely monitor respiratory status to ensure airway patency. The throat of a child with epiglotitis should only be examined by a trained professional under extreme care - Emergengency endotracheal or tracheostomy equipment should be available. - Administer prescribed medications which may include an antibiotic, and antiinflammatory such as steroids - Recommend that all children receive Hib conjugate vaccine beginning at 2 months of age

Growth and Adjustment Problems of Toddler

COMMON HEALTH PROBLEMS OF EARLY CHILDHOOD ACUTE OTITIS MEDIA ( AOM ) - Inflammation of the middle ear - One of the most common health problems in childhood due to the short, straight eustachian tube of children aged 6-24 months - Clinical Manifestations: - Nasopharyngitis - nasal congestion - watery rhinitis

low grade fever difficulty breathing secondary to edema and congestion enlarged cervical lymph nodes Pharyngitis Viral pharyngitis manifestations are generally mild s/s include sore throat and general malaise Bacterial pharyngitis manifestations vary s/s include severe sore throat, high fever and lethargy child usually looks sick and may have difficulty swallowing Tonsillitis Viral Tonsillitis is characterized by a gradual onset, low-grade fever, mild headache, sorethroat, hoarseness and cough - Bacterial Tonsillitis is a more dramatic disorder marked by rapid onset of high fever, headache generalized muscles aches and vomiting Nursing Management: - Assess respiratory status - Provide liquids and soft foods - Administer prescribed medications. A 10-day old course of antibiotic (Penicillin or Erythromycin if allergic to Penicillin) - Provide preoperative and postoperative nursing care if surgery is performed - Preoperative nursing care (Tonsillectomy) - prepare the child according to his developmental level - explain that the child will have sore throat after surgery but he will be able to talk and swallow - Postoperative - observe and report unusual bleeding - monitor v/s - discouraging the child from coughing and use of straw for fluids - position child on his side or the abdomen to facilitate drainage - medicate for pain as ordered. Ice collar may be used. - Encourage fluids but not with red color ALTERATIONS IN RESPIRATORY FUNCTION URGENT RESPIRATORY THREATS:RESPIRATORY DISTRESS AND RESPIRATORY FAILURE - Clinical Manifestations - Signs of respiratory distress: tachypnea, retractions, nasal flaring, inspiratory stridor, and expiratory grunting. - Signs of respiratory failure include: - Early signs: restlessness, tachypnea, tachycardia, and diaphoresis - Early decompensation: nasal flaring, retractions, grunting, wheezing, anxiety and irritability, mood changes, headache, hypertension confusion - Signs of imminent respiratory arrest: dyspnea, bradycardia, cyanosis, stupor, and coma

PNEUMONIA - Acute inflammation of the lung parenchyma (bronchioles, alveolar ducts and sacs and alveoli) that impairs gas exchange - Etiology: - Pneumonia most commonly results from infection with bacteria, viruses, or mycoplasmas, or from aspiration of foreign substances - Clinical Manifestation: - a. Common findings in bacterial pneumonia include: -high fever -respiratory signs and symptoms, including cough (nonproductive to productive with whitish sputum), tachypnea, rhonchi, crackles, dullness on percussion, chest pain, retraction nasal flaring and pallor or cyanosis (depending on severity) -irritability, restlessness and lethargy -nausea, vomiting, anorexia, diarrhea, and abdominal pain -meningeal signs (meningism) - b. Common findings in viral pneumonia include: -variations ranging from mild fever, slight cough, and malaise to high fever, severe cough, and prostration -nonproductive or productive cough with whitish sputu -rhonchi of fine crackles - c. Common findings in mycoplasma pneumonia include: -sudden or insidious onset -fever, chills, malaise, headache, anorexia, and myalgia -hacking cough, rhinitis, and sore throat -cough progresses from nonproductive to productive with seromucoid sputum that later becomes mucopurulent or blood streaked Nursing management - Assess for respiratory distress - Administer prescribed medications - Promote adequate oxygenation and a normal breathing pattern - Recommend the pneumococcal vaccine ASTHMA - Asthma is a chronic, reversible, obstructive airway disease, characterized by wheezing. It is caused by a spasm of the bronchial tubes or the swelling of the bronchial mucosa after exposure to various stimuli - Asthma is the most common chronic disease in childhood, most children experience their first symptoms by 5 years of age. - Etiology: Extrinsic (allergic asthma) - pollens, dust spores and animal danders Intrinsic (Idiopathic asthma) - URTI, emotional upsets and exercise Mixed asthma - has characteristics of both allergic and idiopathic asthma. Mixed asthma is the most common form. - Common irritants: - a. allergen exposure (in sensitized persons). Common allergens include: -dust mites , molds, animal dander

b. viral infections c. irritants, which include: air pollution,smoke, perfumes, laundry detergents d. certain foods (especially food additives) e. rapid changes in environmental temperatures f. exercise g. psychological stress Assessment findings: Clinical manifestations: -increased respiratory rate -wheezing (intensifies as attack progresses) -cough (productive) -use of accessory muscles -distant breath sounds -fatigue -moist skin -anxiety Nursing management: - assess respiratory status - administer prescribed medications. - promote adequate oxygenation and a normal breathing pattern - explain possible use of desensitization - make the child live a normal life - enroll child in swimming CYSTIC FIBROSIS - Cystic fibrosis (CF) is a chronic, multisystem disorder of the exocrine glands characterized by abnormally thick pulmonary secretions. CF affects the pancreas, respiratory system, GI tract, salivary glands, and reproductive tract. Etiology: - -CF is an autosomal recessive hereditary disorder by a defective gene. - Assessment findings: - Clinical manifestations: - Respiratory wheezing, dyspnea, cough ,cyanosis - GI - meconium ileus at birth, rectal prolapse, loose,bulky, frothy, fatty stool - Voracious appetite, wt. loss, ftt,distended abdomen - Reproductive - females will have delayed puberty and decreased fertility - males with few exceptions, are infertile - Cardiovascular - cor pulmonale, rt-sided heart enlargement and heart failure, Hyponatremia - Integumentary - salty taste, hypoalbumineria due to ftt

Nursing management: 1. promote adequate oxygenation and a normal breathing pattern. 2. assess nutritional status 3. promote desired nutritional intake 4. administer prescribed medications such as pancreatic enzymes, bronchodilators, antibiotic and fat soluble vitamins

Republic of the Philippines Maningcol, Ozamis City Medina College

Masters in Nursing N201

( Theories in Nursing Management, Planning Process and Personnel Management)

And N202

and Adjustment Problems of Newborn, Infants toddler)

Submitted by: Cabahug, Al Lovelle K., RN Llamas, Lady Mae P., RN Rato, Christene S.,RN

April 27, 2012

(Growth and Adjustment Problems of Newborn, Infants toddler)

(Theories in Nursing Management, Planning Process and Personnel Management)