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Effacement not > 50% Fetal assessment/ THE BABY OF DRUG ADDICTED MOTHERS
monitoring
• Common Causes
- Narcotics
• If Labor cannot be stopped - Mathadone
- Analgesics given with caution - Heroin
- Do not perform artificial rupture of membranes - Cocaine
- Episiotomy - Infant is not breastfed by the drug addicted mother
- Clamp the cord • Nursing Considerations
- Assess for withdrawals sx
If baby is premature, CLMAP THE CORD ASAP - Cluster Care
you dont need the blood because if it breaks down it will only add the bilirubin that - Dec. CNS stimulating activities
will be difficult to breakdown for the baby
INFANT WITH FAS
POST MATURE
• Causes • Alcohol crosses the placenta in the same concentration that it is present in the
- Faulty due dates maternal blood stream
- Long Menstrual Cycles
- Trigger initiating labor did not work • 2 oz of alcohol a day
- Increased does of salicylates (severe sinus headaches/rheumatoid arthritis) • Long Term Effect:
- Mental Retardation
- Myometrial Quiescence - Behavioral Probs, Hyperactivity in school
• Postmature Syndrome
- SGA, loss of weight
- Dry, Cracked, almost, leather-like skin GROWTH AND DEVELOPMENT
- Absence of vernix
- Fingernails have grown beyond the ends of the fingertips • Growth: inc in physical size
- Alert (like a 2 week old baby) • Development: progressive inc in skills and capacity to function
- Less amniotic fluid during delivery • Maturation: Increase in comptence and adaptability
• Factors influencing G&D
• Maternal Assessment - Heredity
- Ultrasound
- Serum Estriol Levs - Neuroendocrine Factors
- Determine adequacy of fetal-placental unit - Nutrition
- Interpersonal Relationship
Falsely High: impaired renal function
Mothering Person: single most influential person (early infancy)
Low: anencephalic fetus
Parents: helps child on sex-role behavior
Low: GDM mother - Socioeconomic Level
- Amniocentesis
- Disease
• If the child is term upon assessment: - Environmental Hazards
- Induction of labor
- Prostaglandin gel • Developmental Task: tasks that arises at certain periods in life
- Oxytocin • Critical Periods in life: Points at which the maximal capacity for an aspect is
- Close fetal heat rate monitoring present
• Neural Tube: Embryonic structure that matures to form the CNS CARE OF CHILD WITH PROBLEMS IN OXYGENATION RELATED TO
• Forms first as a flat plate in utero RESPIRATORY DYSFUNCTION
• Folic Acid: Can be found in vegtables and supplements • Common in infants and children - due to lack of antibodies
• Causes in and out of hospital CP arrest
1. Spina Bifida • Upper Respi Tract
• Occurs because of lack of fusion of the posterior surface of the embryo in early - Oropharynx
intrauterine life - Pharnyx
• Common at 5th lumbar or 1st sacral level - Larynx
• Spina Bifida Occulta - Upper Part of Trachea
- With Sac • Lower Respi Tract
- Intervention neccessary - Lower Trachea
• Myelomeningocele: sac-like cyst of meninges filled with spinal fluid - Main stem bronchi
7! of 9! DE JESUS, M.B.
- Segmental bronchi - Post-op
- Subsegmental bronchi Position: Prone/Lateral
- Terminal brionchioles WOF bleeding (Frequent swallowing, restlessness and stopping
- Alveoli down)
• 4 Signs of Respi Distress - Signs of Hemorrhage
- Tachypnea Increased pulse
- Grunting Pallor
- Retractions Frequent clearing of throat
- Nasal Flaring - Post op Nursing Mgmt
• Nursing Interventions for Children w/ DOB With bleeding: Elevate HOB, turn to sides
- Position px UPRIGHT Check ability to swallow, gag reflex
- kept calm and quiet as possible (prevent generation of turbulent airflow > Avoid suctioning, throat clearing, blowing of nose
increased WOB) Analgeesics (rectally or IV)
• Factors leading to Respi Illness in Children - Critical periods post-surgery:
- Infectious Agents first 24 hrs: clot formation
- Age 5-7 days: Clots begin to lyze or dissolve
- Size - Diet
- Resistance Cold, Clear non irritating drinks
- Seasonal Variations Soft foods 1-2 days post op
No Dairy
1. Common Colds - Nasopharyngitis yes ice pops
- Toddlers: 10-12 colds a year 4. Croup syndrome
- School age to adolescent: 4-5 yearly - A symptoms complex characterized by:
- Prevention: protext px from exposure, avoid contact Hoarseness of voice
- Management resonant cough (barky, croupy, brassy)
Home management Varying degrees of inspiratory stridor
Antipyretics for fever Varying degrees of respi distress
Saline nose drops (liquefy and drain) - Acute Epiglottitis: Acute, Severe inflammation of the epiglottis
Suction with bulb syringe Cause: Virus, Bacteria
Decongestion Manifestation:
Bedrest Excessive drooling
- Nursing Management Cherry red epiglottis
Elevate head of bed Wheexe inspiratory stridor
Maintain adequate fluid intake - Diagnostics
prevent dehydration Throat culture
2. Pharyngitis: Infection and inflammation of the throat, often accompanied by CHILDREN WITH CARDIAC PROBLEMS
common cold
- Causative Agents: Virus, GABHS • Classification
- Diagnostics: Throat Culture - Congenital
- Manifestations: Tonsils and pharynx inflammed and covered with exudate Idiopathic
- Complications: Sinusitis, Parapharyngeal peritonsillar or retro pharyngeal Infection
abscess Alcoholism
- Nonsupportive complications: Acute Nephrits Maternal Age
- Treatment Diabetes
Oral Penicillin (10 days) > First line Parent or sibling with CHD
Erythromycin (oral) if allergic Down Syndrome
Intramuscular Benzathine Penicillin G Born with other congenital defect
- Nursing Management • Factors
Cold or warm compress (Neck part) - Teratogenic Agents
Warm saline gargles - Maternal Factors
Dont force children to eat solids Maternal Medical Conditions
Complete antibiotic treatment Maternal Age
Warm compress at the injection site - Family History
change of toothbrush • Physical Assessment
- Height and Weight: Short and Thin
3. Tonsilitis - Inc. HR and RR
- most common tonsils removed: palatine and adenoids - Displaced Apex beat
- Management - Heart murmur
Antipyretics - Hepatomegaly
Antibiotics - Easily Fatigued
- Nursing Mgmt - Faint peripheral pulses
Promote comfort (Soft, non-irritating diet) - Frequent epistaxis
- Surgical Management - Cyanosis/Polycythemia
Tonsillectomy - Absent Femoral Pulses/Pain in legs
Adenoidectomy • General Appearance
- Contraindications - Clubbing
Cleft palata - Slow Capillary Refill
Acute infections - Cyanosis
Uncontrolled systemic disease or blood dyscrasias - Ruddy complexion
- Pre-op - Prominence of the left side and obvious heart movement
Check for bleeding and clotting time - Murmurs
CBC and Urinalysis for general status of health, check for infxns
Dental status
8! of 9! DE JESUS, M.B.
A7: Congestive Heart Failure
Left Sided Failure Right Sided Failure • Prevention:
- Improve CO: Digoxin
- Promote elimination of excess fluids
Pulmonary congestion Systemic congestion ACE inhibitors
symptoms symptoms Diuretic
Early symptoms: Hepatojugular reflux
- Low Na Diet
- Refusal to feed
- Promote Nutrition
- Profuse scalp sweating while
- Decrease O2 Demand
nursing Cluster Care
Control of environment temperature
Decrease stress and anxiety
• Diagnostics SFF
- ECG Prevent respi infection
- Echocardiography
- Exercise training (Stress test) C1: Tetralogy of Fallot
- Blood Tests • Vetricular Septal Defect
- Cardiac catherterization • Pulmonary Stenosis
• R Ventricular Hypertrophy
A1: Atrial Septal Defects • Overriding of the Aorta
• Hole between the R Atria and L Atria • “Tet Spells”
• Slow weight gain - Supplemental O2
• Frequent LRTI - Morphine Sulfate
• Hyperdynamic precordium - Wasoconstrictors
• CXR: Cardiomegaly & Pulmonary Artery enlarged - B-Blockers
• Increased pulmonary vascularity - Volume administration
- Let the child squat
A2: Vetricular Septal Defect • Treatment
• Hole between the L Ventricle and R Ventricle - Phlebotomy: 10-20 ml removed
• Normal pulmonary artial pressure - Blalock-Taussig Shunt
- Growth failure - Closure of the VSD and pulmonary valvotomy
- CHF
- Chronic LRTI C2: Transposition of the Great Vessels
• Increase pulmonary arterial pressure • Surgical Emergency
- SOB • Aorta and pulmonary artery are switched
- dyspnea on exertion • When the baby is delevered he is immediately cyanotic > Prostagalandin
• Management: administered to keep Ductus Arteriousus open
- Close the Hole via open heart surgery • The Ductus Arteriousus keeps the baby alive
- Insert a septal occluders
C3: Truncus Arteriousus
A3: Patent Ductus Arteriosus • management:
• Connection between Pulmonary Artery and Aorta - Improve cardiac function - Ace Inhibitors, B-Blockers, Cardiac Glycosides
• Treatment: Indomethacin - Remove accumulated fluid and Na - Diuretics
• Surgery: Ligation - Decrease cardiac Demands
- Improve oxygenation and decrease O2 demands
A4: Coarctation of the Aorta
• Narrowing beyond the blood vessels of the aorta THE CHILD WITH GASTROINTESTINAL PROBLEMS
• Higher pressure on the UE compared to LE
• Manifestations: 1. Cleft Lip and Cleft Palate
- Different pulses • Cleft Palate: Males
- Frequent Pulses • Cleft Lip: Females
- Headaches • Vit A, Intake of Anticonvulsants, Hereditary
- UE HTN • Can cause problems with airways
- Ruptured Aorta • Cleft palate: speech, defects in air, hearing problem
- Aortic Aneurysm • Surgery is a priority
- Stroke • Will have coping problems as they grow up
• Treatment: Ballon Angioplasty, End to End Anastomosis • Rule of Ten
- 10 weeks
A5: Aortic Stenosis - 10 lbs
• Masikip ang Aorta - 10 gms of hemoglobin
• Lessen the diameter of the Aorta so that blood could pass through - Less than 10,000 WBC
• Manifestations: • Surgery
- Decreased CO - Cheiloplasty/Z-Plasty
- Hypotension Cleft Lip Repair
- Tachycardia Usually done 3 times
- Poor Feeding Not urgent procedure, not life threatening
- Pulmonary Edema Delayed until they are no longer surgically at risk
- LVH • Post-op Care
• Treatment: Open Surgical Valvotomy, Balloon Valvuloplasty - Position: Never on Prone to prevent tension on suture
A6: Pulmonary Stenosis
• Stenosis of the Pulmonary Artery
9! of 9! DE JESUS, M.B.