Lecture 7Lecture 7

Clinical aspects of Maternal and Child NursingNUR 363

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.

HypothermiaIt occurs when body temperature

is below 36.3ºC axillary.

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

1) HB level and RBC’s count

2) Hematocrit

ANEMIAS-Diagnostic testsANEMIAS-Diagnostic tests

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

The choice of treatment depends mainly on the following:

The type of leukemia (acute or chronic)

Patient age

Whether leukemia cells were found in the cerebrospinal fluid

TreatmentTreatment