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Pediatric lecture (2)

Pediatric lecture (2). Dr. Hanan AlHarbi Mrs. Rania Alsabi. Family Influences on Child Health Promotion. FAMILY STRUCTURE AND FUNCTION. Family Size and Configuration. Sibling interactions

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Pediatric lecture (2)

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  1. Pediatric lecture (2) Dr. HananAlHarbi Mrs. Rania Alsabi

  2. Family Influences on Child Health Promotion

  3. FAMILY STRUCTURE AND FUNCTION

  4. Family Size and Configuration • Sibling interactions • The narrower the spacing between siblings, the more children influence one another, especially in emotional characteristics • The wider the spacing between siblings, the greater the influence of the parents • Ordinal position: Effect on personality

  5. Multiple Births • Twins • Identical (monozygotic) • Fraternal (dizygotic) • Higher-order multiples • Increasing incidence related to maternal age and reproductive intervention

  6. PARENTING • Motivation for parenthood • Preparation for parenthood • Transition to parenthood • Parental factors affecting transition to parenthood • Age • Resources • Coping

  7. Parenting Situations • Parenting in dual-earner families • Working mothers

  8. Community-Based Nursing Care of the Child and Family

  9. COMMUNITY HEALTH CONCEPTS • Community • Demography • Epidemiology

  10. Economics • Measure the amount of resources needed to pay for good health • Prioritize health care needs • Methods for defining and estimating cost • Measurement of cost and effects

  11. Distribution of Disease, Injury, or Illness • Morbidity • Incidence: NEW events in a population during a time period • Prevalence: EXISTING events in a population during a time period • May be reported as rates per 1000, 10,000, or 100,000 population, depending on their frequency

  12. Epidemiologic Triangle Environmental Factors Agent Host Factors

  13. Levels of Prevention • Primary: Health promotion, prevention of disease or injury • Immunization, safety • Nutrition • Sanitation measures, environmental efforts • Community parenting classes • Secondary: Screening, early diagnosis of disease • Tuberculosis and lead screening programs • Mental health counseling for stressful events such as divorce, death, or community natural disasters • Tertiary: Rehabilitation, disease management • Asthma, sickle cell disease, cancer • Special education programs for children

  14. Screening • Risk vs. benefit analysis • Psychologic risk associated with false-positive results • Treat a child with a positive screen differently even after further diagnostic testing determines the child is normal

  15. COMMUNITY NURSING PROCESS • Community needs assessment • Community planning • Community implementation • Community evaluation

  16. Health Promotion of the Newborn and Family

  17. ADJUSTMENT TO EXTRAUTERINE LIFE

  18. Respiratory System • Initiation of respiration • Chemical factors stimulate breathing • Hypoxemia • Hypercarbia • Low pH • Thermal stimuli • Newborn leaves warm environment to relatively cooler atmosphere. Sensory impulses to skin are transmitted to respiratory center in the medulla.

  19. Newborn Respiration • Fetal lung fluid removal • Compression of chest with passage through birth canal • Lymphatic vessels and pulmonary capillaries • Expansion of alveoli • Occurs with initiation of breathing • Role of surfactant in keeping alveoli expanded

  20. Do’s and Don’ts in Newborn Management • Do provide tactile stimulation by drying the wet skin of the newly delivered infant. Remove wet linens immediately after drying the newborn. • Do rub or flick the soles of the newborn’s feet if additional stimulation is required. • Don’t slap the newborn’s buttocks (no beneficial effect; can cause cerebral trauma).

  21. Newborn Circulation • Circulatory changes allow blood to flow through lungs • Pressure changes in heart, lungs, and vessels • Functional closure of fetal shunts • Foramen ovale • Ductus arteriosus • Ductus venosus

  22. Sequential Circulatory Changes in the Newborn • Inspired oxygen dilates pulmonary vessels • Pulmonary vascular resistance decreases, and pulmonary blood flow increases • Pressure in RA, RV, and pulmonary arteries decreases • Gradual increase in systemic vascular resistance after clamping of cord

  23. Further Circulatory Changes in the Newborn • LA pressure greater than RA pressure leads to closure of foramen ovale • Increase of pulmonary blood flow and dramatic reduction of pulmonary vascular resistance begins to close the ductus arteriosus

  24. Typical Times for Newborn Circulatory Changes • Foramen ovale: functional closure soon after birth • Ductus arteriosus: functional closure in about 4 days after birth; anatomic closure takes considerably longer • Failed closure of the above shunts takes blood away from newborn’s pulmonary circulation

  25. Thermoregulation • Critical to newborn’s survival • Principal thermogenic sources • Heart • Liver • Brain • Brown adipose tissues (BATs)

  26. Factors Predisposing the Newborn to Excessive Heat Loss • Large surface area results in heat loss to the environment • Newborn’s thin layer of adipose is poor insulator • Newborn cannot shiver to increase heat production

  27. Hematopoietic System • Blood volume of NB depends on amount of blood transferred via the placenta before clamping of the cord • Full-term infant • Total blood volume = 80 to 85 ml/kg of body weight • Immediately after birth • Total blood volume = approximately 300 ml • Depending on how long after delivery infant remains attached to the placenta, as much as 100 ml can be added to the blood volume

  28. Fluid and Electrolytes • Newborn body weight is 73% fluid (adult is 58% fluid) • Infant has higher ratio of extracellular fluid than adult • Infant has higher levels of total body sodium and chloride • Infant has lower levels of total body K, Mg, and phosphate

  29. Implications • Rate of fluid exchange in newborn much faster than in adult • Rate of metabolism in newborn twice as great related to body weight • Acid forms very quickly, leading to rapid development of acidosis • Immature kidneys cannot concentrate urine to conserve body fluid

  30. Newborn Resultant Problems • Infant prone to dehydration • Infant prone to acidosis • Infant prone to overhydration/fluid overload

  31. Gastrointestinal System • Newborn has deficiency of pancreatic lipase for fat absorption, making cow’s milk indigestible • Stomach capacity approximately 90 ml in term newborn • Colon has small volume, leading to frequent stools • Progressive changes in stool pattern in newborn

  32. Stool Patterns in Newborns • Meconium • Should occur within 24 to 48 hours after birth • Description • Transitional stools • Usually appear by day of life (DOL) 3 • Transition from meconium to milk • Milk stools • Usually appear by DOL 4 • Differences in breast milk and formula stools

  33. Renal System • Functional deficiency in kidney’s ability to concentrate urine • Normal newborn urine production 1 to 2 ml/kg/hr • Bladder capacity approximately 15 to 30 ml • First void occurs within 24 hours after birth • Newborn may void 10 to 20 times per day

  34. Newborn Skin • Immature integumentary function • Active sebaceous glands • Eccrine (sweat) glands • Apocrine glands small and nonfunctional • Hair follicles • Amount of melanin low at birth—lighter skin than in later life; UV susceptibility

  35. Musculoskeletal System • Skeletal system contains larger amount of cartilage than ossified bone • Rapid ossification in first year of life • Muscular system almost completely formed at birth • Muscle growth is by hypertrophy rather than hyperplasia

  36. Immune System • Skin and mucous membranes are first line of defense from invading organisms • Second line of defense is cellular elements of the immunologic system: neutrophils, eosinophils, lymphocytes • Third line of defense is formation of antibodies • Breast milk provides passive immunity (IgG)

  37. Endocrine System • Endocrine system developed, but function is immature • Antidiuretic hormone (ADH, vasopressin) production is limited • Risk of dehydration • Effects of maternal sex hormones in newborn

  38. Neurologic System • At birth the nervous system is incompletely integrated • Primitive reflexes • Autonomic nervous system crucial in newborn • Myelination of nerves follows cephalocaudal and proximodistal progression

  39. Sensory Functions • Vision • Pupils react to light; blink and corneal reflexes • Tear glands—minimal function until 2 to 4 weeks of age • Hearing • Smell • Taste • Touch

  40. Newborn Assessment • Apgar score at ages 1 minute and 5 minutes • Reflects general condition of infant • Not used to determine need for resuscitation at birth • Factors affecting Apgar score • Low tone • Reduced reflex irritability • Infection • Congenital anomalies • Maternal sedation or analgesia • Hypovolemia • Neuromuscular disorders

  41. Apgar Scoring System

  42. Transitional Assessments • Periods of reactivity • First reactivity period • 30-60 minutes after delivery: alert, interested in environment • Full-term infant may breast-feed • 2-4 hours after delivery: sleepy and relatively calm • Second reactivity period • Lasts 2-5 hours: alert and responsive • Physiologic changes

  43. Behavioral Assessment • Principal areas • Sleep • Wakefulness • Activity • Brazelton Neonatal Behavioral Assessment Scale (BNBAS) • 28 items organized in clusters • Research or diagnostic tool • Requires special training

  44. Patterns • Sleep • Wakefulness • State modulation by infant

  45. Cry • Strong, lusty cry at birth • Sounds of cry vary for hunger, pain, etc. • Duration varies: 5 minutes to 2 hours or more per day • Variations may indicate underlying abnormalities • A weak, groaning cry or grunting during expiration usually indicates a respiratory disturbance. • Absent, weak, or constant crying may suggest pathology. • A high-pitched, shrill cry may indicate increased intracranial pressure. • Crying status alone is not a diagnostic tool

  46. Attachment • Parent-infant bonding • The Neonatal Perception Inventories (NPI) mother’s image of her real infant compared with her image of an “average” infant • Needs to see her infant as better than an “average” baby • If not rated as better than average, may indicate lack of attachment • Feeding time = opportunity to assess attachment

  47. Assessment of Gestational Age (GA) • New Ballard scale • Appropriate for 20 to 44 weeks of gestation • Perform in immediate postdelivery period for highest accuracy • Dubowitz scale

  48. Weight Related to Gestational Age • Birth weight is poor indicator of gestational and fetal maturity • Gestational age reflects fetal maturity • AGA: growth between 10th and 90th percentiles • SGA: less than 10th percentile • LGA: greater than 90th percentile

  49. Other Descriptions of Newborn Maturity • Term = 36 to 42 completed weeks of gestation • Preterm = fewer than 36 completed weeks of gestation • Postterm = more than 42 completed weeks of gestation

  50. General Measurements of Newborns • Head circumference • Chest circumference • Abdominal circumference • Length • Body weight

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