Pediatrics- Normal Flashcards
Most rapid Growth
Infant
Preterm Weeks
28-32wks
Preterm Characteristics
Frog leg/ Lax Position
Hypotonic Muscle Tone
Square Window Wrist
Scarf sign (elbow passes midline)
Heel to ear sign
Abundant Lanugo
Prominent Labia Minora
Prominent Labia Majora
Prominent Clitoris
Post-term weeks
> 42wks
Post-term characteristics
Old man’s face (classic sign)
Desquamation ( peeling of the skin) / (extreme dryness starting from the sole and palm)
Normal birth weight
2.5-4kgs
Weight doubles at
6months
Weight Triples at
12months
Weight quadruples at
2 and 1/2 years
Normal measurements in Newborn
Length:
Head Circumference:
Chest Circumference:
Length: 46-54cm
Head Circumference: 33-35cm
Chest Circumference: 31-33cm
Neonate in Nursing
- Upon receiving- proper identification
- Take anthropometric measurements
- Bath the baby. Full bath if mom is (+) Hepa
- Dress umbilical cord
- Adm. Credes Prophylaxis
- Adm. Vit. K
- Take weight
Indication of 2 Vein and 1 Artery in Neonate
Suspect Kidney Malformation
Indication of 2 Vein and 1 Artery in Neonate
Suspect Kidney Malformation
Failure of the umbilical cord to fall between the first 7th-10th day
Umbilical Granulation
30mL blood loss from umbilical cord
Ompalagia
What drug is adm for umbilical granulation
Silver nitrate
What does failure of startle/Moro reflex to disappear at 5-6months indicate
Brain damage
Persistent Primitive Reflex
Cerebral Palsy
Rapid eyelid closure when strong light is shown
Blink reflex
Baby grasps solid objects placed on palm
Palmas Grasp Reflex
Purpose of palmar grasp reflex and when does it normally disappear
To Cling to mother for safety
D: 6wks - 2months
Neonate places on a vertical position with their face touching a hard surface will take few quick alternating steps
Step in/ Walk in Place Reflex
Almost the same with step in reflex only that you are touching anterior surface of a newborn’s leg
Placing Reflex
When newborn lie on their backs, their heads usually turn to one side or the other. The arm and the leg on the side to which the head turns extend, and the opposite arm and leg contract.
Tonic- neck reflex
When an object touches the sole of newborn’s foot at the base of toes, the toes grasp in the same manner as finger do
Plantar grasp reflex
Disappears at 8-9 months in preparation for walking
Test for neurological integrity (jarring crib loud voice) assume a letter C position
Moro Reflex
Disappear at 4-5months
When there is pressure at the sole of the foot, the baby pushes back against the pressure
Magnet Reflex
When the sole of the foot is stimulated by a sharp object, it causes the foot to rise and the other foot extend (test for spinal cord integrity)
Crossed Extension Reflex
While in prone position and the para vertical area is stimulated, it causes flexion of the trunk and swing his pelvis toward the touch
Truck Incurvation Reflex
While prone position and the trunk is being supported, the baby exhibit muscle tone
Landau Reflex
-Test for muscle tone and present by 6-9months
While on ventral suspension with the sudden change of equilibrium, it causes extension of the hands and the legs
Parachute Reflex
- present by 6-9months
When the sole of foot is stimulated by a inverted “J”, it cause fanning of the toes
Babinski Reflex
- disappear by 2months but may persist up to 2years
Immediate Care of Newborn
- Initiation and maintenance of respiration
- Establishment of extrauterine circulation
- Control of body temperature
- Intake of adequate elimination
- Establishment of waste elimination
- Prevention of infection
- Establishment of an infant-parent relationship
- Development care that balances part and stimulation for mental development
Lung function begins
After birth
Baby’s head position to facilitate drainage
Side
Suction what first?
How many seconds is suctioning
Nose
5-10s
Prolong deep suctioning may result to
Hypoxia, bradycardia, and laryngospasm
If suctioning is not effective, then?
Laryngoscopy. Then ET is inserted
After ET insertion due to airway problems in neonate, what is the pressure and the percent of 02
Positive pressure bag
Mask with 100 % at 40-60 bpm
Overdose of oxygen
Retrolental fibroplasia (retinopathy of the prematurity)
Scarring
Never adm. O2 when meconium stained because it will force the meconium to the alveolar sac causing
Atelectasis
Circulation is initiated by ______ and is completed by _____
Pulmonary ventilation
Cutting of umbilical cord
Pressure on left of the heart causes closure of the
Foramen Ovale
2 ways to facilitate closure of foramen ovale
- Tangential foot slap
- Proper positioning - right side lying
Foramen ovale closes at
24hrs complete by 1year
Ductus arteriosus closes at
24hrs complete by 1 month
Ductus venosus closes at
2months
Umbilical arteries
2-3months
Umbilical vein
2-3months
Best position after birth
Nsd: trendelendberg
Cs: supine or crib level position
Signs of Inc ICP
Abnormally large head
Bulging and tense Fontanel
Projectile vomiting ( surest sign of cerebral irritation)
Inc BP but widening pulse pressure
Dec RR
Dec PR
High pitch shrill cry (late sign)
Diplopia ( sign of ICP from 6month to 1 year old)
Hypothermia in preterm and sga leads to
Hypothermia and cold stress
Factors leading to hypothermia
Poikilothermic (babies are born cold blooded)
Inadequate subcutaneous fats
Not capable of shivering
Born wet
Process of heat loss
Evaporation
Conduction
Convection
Radiation
Body to air
Evaporation
Body to cold solid object
Conduction
Body to cooler surrounding air
Convection
Body to cold object and in contrast with body
Radiation
Effects of hypothermia
Hypoglycemia
Metabolic Acidosis
High risk for kernicterus
Additional fatigue due to stressful heart
Prevention of cold stress
Dry and wrapped newborns
Mechanical Measures
Prevent unnecessary exposure
Use tin foil in absence of electricity
Embrace baby (kangaroo care)
Due to catabolism of brown fats
Metabolic Acidosis
Mechanical measures
Radiant measures
Isolette
Square acrylic sided incubator, must be preheated first
Isolette
When to breastfeed
Nsd:
CS:
NSD: immediately
CS: after 4hrs
When is colostrum present on CS
3rd Trimester
Dec. level of _____ and ______ stimulates the _____, that stimulates the ____ of the _____ (alveoli) to produce the foremilk store in _____
Estrogen and progesterone
Anterior pituitary gal d
Prolactin
Acinar cells
Lactiferous tubules
Advantages of breast milk
Very economical
Always available
Promotes bonding
Helps in rapid involution
Decrease incidence of breast cancer
Breast fed babies have higher IQs
It contains anti body (IgA) lactobacillus bifidus that interfere attach of pathogenic bacteria in GIT
Contains macrophages
Breasmilk available for 2 days after delivery
Colostrum
COlostrum contains
Low fat
Low carbohydrates
High protein
High fat-soluble vitamins
High immunoglobulin
High minerals
4-14 days breasmillk
Transitional
Transitional breastmilk contains
High Lactulose
High minerals
High water-soluble vitamins
Breastmilk available for 14 days and above
Mature Milk
Mature Mill contains
High Fats
High Carbohydrates
Low Protein
Linoleic acid responsible for integrity and development of skin
High fats in breastmilk
Lactose, easily digested responsible for sour milk smelling odor of stool
High carbohydrate in breasmilk
Protein in breastmilk
Lactalbumin
Disadvantages of cow’s milk and breast milk
No iron
Possibility of HIV and Hepa B transmission
Father cannot feed/ bond as well
Contents of cow’s milk
High fat
Low carbs
High protein
High minerals
High phosphorus
Cow’s milk content in protein that has a courd that is hard to digest
Casein
Cow milk content that has traumatic effect on baby’s kidney
High minerals
Position for breast feeding
Upright sitting
Touch side of lips or cheek and baby will turn to stimulus
Rooting reflex
Purpose- to look for food
When does rooting reflex disappear
6weeks because can already feed
By touching the mouth of lip then baby will suck
Sucking
Purpose of sucking
Take in food
Disappear when not stimulated
Sucking
Food touches posterior portion of tongue automatically swallow
Swallowing Reflex
Food touches anterior portion of tongue and tongue automatically extrude/ protrude
Extrusion/ Protrusion Reflex
Purpose of extrusion/ protrusion reflex
Prevent for food poisoning
When does protrusion/ extrusion reflex didappear
4months because can already spit
When does protrusion/ extrusion reflex didappear
4months
Criteria of effective sucking
Baby’s mouth is hike well up to areola
Mother experiences after pain
Other nipple is flowing with milk
Breast feeding techniques
Begin 2-3mins/ breast
Inc 1min/ day each breast until you reach 10mins each breast or 20mins/ feeding
Proper emptying
Feed baby on the last breast that you fed him
Problems in breastfeeding
Engorgement
Sore nipple
Mastitis
Management for engorgement
Warm compress
Sore nipple manangement
Exposure to air or 20watt bulb
Avoid wearing plastic liner bra, instead wear cotton bra
Physiologic stool passed within 24-36hrs
Meconium
Meconium characteristics
Blackish free
Odorless
Sticky
Tar like
No bacteria
Failure to pass Meconium
Suspect GIT obstruction
-hirschsprung
-imperforate anus
-Meconium ileu (cystic fibrosis)
Transitional stool caharacteristic
Green
Loose
Slimy
Stool that Appears to be slight diarrhea to the untrained eye
Transitional stool
Breastfed stool characteristics
Golden yellow
Soft
Mushy with sour milk smelling odor
Bottle fed stool
Light yellow
Formed, hard with typical offensive odor
Passed 2-3times/ day
W/ supplementary food added stool
Brown
Odorous
Light stool
Jaundice baby
Bright green
Phototherapy
Mucous mixed with stool
Allergy
Clay colored
Obstruction to bile duct
Chalk clay/ whitish clad
Barium enema
Black stool
GIT hemorrhage
Blood flecked
Anal fissure
Red currant jelly
Intususception
Ribbon-like
Hirschsprung
Steatorrhea in stool
Fatty, bulky, foul smelling
Suspect malabsorption
Cystic fibrosis or celiac disease
HR of N
110-180
I HR
110-160
T HR
80-110
P HR
70-110
S HR
65-105
A HR
60-100
N HR
30-60
I RR
30-60
T RR
24-40
P RR
22-34
S RR
18-30
A RR
12-18
N systolic BP
60-90
I systolic BP
70-105
P systolic BP
90-110
S systolic BP
97-120
A systolic BP
110-130
N diastolic BP
20-60
I diastolic
35-55
T diastolic BP
40-65
P diastolic BP
45-70
P diastolic BP
45-70
S diastolic BP
55-70
A diastolic BP
65-80
Rectum temp
36.6 - 38 degrees C
Rectum temp
36.6 - 38 degrees C
Oral temp
35.5 - 37.5
Axillary temp
36.5- 37.5
Eat temp
36.7-38.0
Austrian neurologist
Founder of psychoanalysis
Sigmund Freud
Mouth Site of gratification
Oral Phase (0-18months)
Oral Phase
Biting, crying, sucking
Provide oral stimulation
Never discourage thumb sucking
Under satisfied oral phase
Dependent
Passive
They love kissing more than sex
Antisocial
Stubborn
Nail biting
Drinking
Suspicious person
Pessimistic
Envious
Smoking
Oversatisfied oral phase
Full of admiration
Optimistic
Gullible
Sigmund Freud theory
Psychosexual Theory
Psychosexual Theory
Oral Phase (0-18months)
Anal Phase (18-3yrs)
Phallic Phase (4-6yrs)
Latent Phase (7-12yrs)
Genital Phase (12-18yrs)
May show exhibitionim
Phallic Phase
Male to mother attachment
Oedipus
Female to father
Electra Complex
Holding on in anal phase
Child wins, hard headed, antisocial, and stubborn
Holding on in anal phase
Mother wins > kind, perfectionist, obedient, obsessive compulsive
Strict toilet training (Anal Retentive)
Kind
Perfectionist
Obedient
Very organized
Punctual
Lenient (anal expulsive)
Messy
Destructive
Rebellious
Disorganize
Wasteful
Hard headed
Period of suppression
Latent Phase
Achieved sexual maturity
Genital Phase
Achieved sexual maturity
Genital Phase