lecture 7 clinical aspects of maternal and child nursing nur 363
TRANSCRIPT
Premature NewbornsPremature Newborns
Definition: The premature newborn is a
baby born before completion of 37 weeks of gestation. The cause of
prematurity is unknown.
Newborns who do require resuscitation are transferred immediately to the NICU in a heated incubator where they are weighed. Intravenous lines, O2 therapy, and other therapeutic interventions are initiated as needed. Subsequent care is determined by the status of newborn.
Therapeutic Management:
Mechanism of ThermoregulationMechanism of Thermoregulation::
Thermoregulation is a balance between heat loss and heat gain. The main goal is to control the neonate’s environment to maintain a neutral thermal environment and minimize energy expenditure. If heat production exceeds heat loss, the temperature rises and vice versa.
Body temperature is above 37.5ºC axillary, it occurs when conditions associated with hyperthermia are:1. Infection.2. Dehydration.3. Intracranial hemorrhage.4. Hot weather.5. When incubators‘ temperature
itself are closely for incorrect high as well as low temperature.
Hyperthermia
HyperbilirubinemiaHyperbilirubinemia
Hyperbilirubinemia is a condition in which the bilirubin level in the blood is increased. It is characterized by a yellow discoloration of the skin, mucous membrane, sclera, and various organs
HypoglycemiaHypoglycemia
Definition of Hypoglycemia: Hypoglycemia is defined as a
blood glucose level of less than 40 mg/dl in the term newborn or less than 30 mg/dl in the
preterm newborn.
Definition: It is a type of infection, which
occurs when bacteria or their poisonous products known as endotoxins, gain
access to the blood stream. Sepsis or septicemia refers to a generalized
bacterial infection in the blood –stream.
Neonatal Sepsis
Diagnosis MeasurementDiagnosis Measurement::
Blood culture.Urine culture.
Tracheal culture.Cerebo-spinal fluid culture.
CBC with different and platelet count
Nursing Care of Nursing Care of Children with Children with
Altered Altered Hematological Hematological
Function Function
Definition: Condition in which the concentration of hemoglobin or the number of red blood cells are reduced below normal
ANEMIASANEMIAS
1) Inadequate production of HB or RBC’s which may be due to
A- lack in the bone marrow (BM) of some substances necessary in the Formation of cells( Iron,Folic acid ….etc)
B- Decreased number of red cell precursors in the BM, which may be congenital or acquired (eg. Toxic or Chemical agents)
2) Excessive loss of RBC’s( hemolysis or hemorrhage)
ANEMIAS--ClassificationANEMIAS--Classification
3) Red blood cells indices:
-Mean corpuscular volume (MCV)=(80-100)
-Mean Corpuscular Hemoglobin( MCH) =Normal 27-31
-Mean Corpuscular Hemoglobin Concentration (MCHC= Normal 32-35 %
ANEMIAS-Diagnostic testsANEMIAS-Diagnostic tests
4) Reticulocytes count = reflect the state of activity of the BM (Normal value is 0.5-1.5%
of the red blood cells ) Level < 0.5 represent inactive BM , High
level represent BM regeneration
5) Other specific tests include: HB electrophoresis, Serum iron,B12,Folic acid…etc
ANEMIAS-Diagnostic testsANEMIAS-Diagnostic tests
Etiology: Lack of iron in the diet or the child’s inability to use the iron he ingest
1- Low birth weight, Prematurity, twins = decreased storage of iron2- Continued or excessive milk administration
without iron enriched food
3- Blood loss.4- Malabsorption
IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
Clinical manifestations
- Pallor, irritability, anorexia
- Low HB, RBC’s count, & Low hematocrit
- Low serum iron
IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
- Enlarge heart
- Enlarge spleen
- Low level of activity
- Systolic murmur
Clinical manifestationsClinical manifestations
* TREATMENT- Oral administration of simple ferrous salt: 6 - 10 mg / kg / day of elemental iron
- Parenteral iron is seldom indicated
- Severely anemic children with HB level < 4 gm / dl may be given blood transfusion
- Treat the underlining cause
IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
* PREVENTION
- Adequate diet include vegetables, meat and vitamins for full term infants
- Administration of iron (2 mg/kg/day) from the age of 2 months for low birth weigh and premature infants
IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
Etiology :
1. Decrease intake 2. Decrease absorption: chronic diarrhea
3. Increase demand: chronic hemolytic anemia
Folic acid deficiencyFolic acid deficiency
Clinical manifestations:MCV >100, low reticulocyte count
DiagnosisDecreased serum folic acid, deceased
red cell folate
TreatmentFolic acid 2-5 mg /kg/day for 3-4 weeks
Etiology
- Dietary deficiency is rare (Vegetarians)
- Failure to absorb vit. B 12
Vitamin B 12 deficiencyVitamin B 12 deficiency
Clinical manifestations: Same as folic acid deficiency
DiagnosisLow serum vit. B 12
TreatmentAdministration of vit. B 12 (1-5
mg/kg/day) for 2 weeks then once monthly 1 mg IM
* The fundamental basis of the hemolytic anemia is a shortened survival time of the RBC,s (RBC normally spend 120 days in the circulation)
* The normal BM response to hemolysis is by an increase of reticulocytes to > 2%
HEMOLYTIC ANEMIAHEMOLYTIC ANEMIA
Glucose-6-phosphate Dehydrogenize (Enzyme which helps red blood cells
(RBCs) function normally).
This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even
-Transmitted as a sex-linked recessive.
G 6 P D deficiencyG 6 P D deficiency
Clinical manifestations:Usually no evidence of hemolysis is
apparent until 48-96 hours after the patient has ingested a substance which has oxidant properties
An acute and severe hemolytic syndrome called FAVISM, Hb. level become very low, presence of hemoglobinemia, mild jaundice, splenomegally and increased reticulocyte count
G 6 P D deficiencyG 6 P D deficiency
Diagnosis Low G6PD activity in red blood cells
Treatment When hemolysis has occurred => Red
blood cell transfusion
Prevention Avoiding ingestion of fava beans or
oxidant substances
G 6 P D deficiencyG 6 P D deficiency
What is leukemia?Leukemia is cancer that starts in the tissue that forms blood.
Leukemia CellsIn a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells.
LeukemiaLeukemia
Swollen lymph nodesFevers or night sweatsFrequent infectionsFeeling weak or tiredBleeding and bruising easilySwelling or discomfort in the abdomen (from
a swollen spleen or liver)Weight loss for no known reasonPain in the bones or joints
SymptomsSymptoms
People with leukemia have many treatment options. The options are: chemotherapy, biological therapy, radiation therapy, and stem cell transplant, etc….
TreatmentTreatment