Lecture 7 Clinical aspects of Maternal and Child Nursing NUR 363

Premature 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 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.

Hypothermia It 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

Hyperbilirubinemia 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

Hypoglycemia 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 Measurement: Blood culture. Urine culture. Tracheal culture. Cerebo-spinal fluid culture. CBC with different and platelet count

Nursing Care of Children with Altered Hematological Function

Definition: Condition in which the concentration of hemoglobin or the number of red blood cells are reduced below normal ANEMIAS

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--Classification

1) HB level and RBC’s count 2) Hematocrit ANEMIAS-Diagnostic tests

3) Red blood cells indices: -Mean corpuscular volume (MCV)=(80-100) -Mean Corpuscular Hemoglobin( MCH) =Normal Mean Corpuscular Hemoglobin Concentration (MCHC= Normal % ANEMIAS-Diagnostic tests

4) Reticulocytes count = reflect the state of activity of the BM (Normal value is % 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 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 iron 2- Continued or excessive milk administration without iron enriched food 3- Blood loss. 4- Malabsorption IRON DEFICIENCY ANEMIA

Clinical manifestations - Pallor, irritability, anorexia - Low HB, RBC’s count, & Low hematocrit - Low serum iron IRON DEFICIENCY ANEMIA

- Enlarge heart - Enlarge spleen - Low level of activity - Systolic murmur Clinical manifestations

* TREATMENT - Oral administration of simple ferrous salt: 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 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 ANEMIA

Etiology : 1. Decrease intake 2. Decrease absorption: chronic diarrhea 3. Increase demand: chronic hemolytic anemia Folic acid deficiency

Clinical manifestations: MCV >100, low reticulocyte count Diagnosis Decreased serum folic acid, deceased red cell folate Treatment Folic 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 deficiency

Clinical manifestations: Same as folic acid deficiency Diagnosis Low serum vit. B 12 Treatment Administration 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 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 deficiency

Clinical manifestations: Usually no evidence of hemolysis is apparent until 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 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 deficiency

What is leukemia? Leukemia is cancer that starts in the tissue that forms blood. Leukemia Cells In a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells. Leukemia

Swollen lymph nodes Fevers or night sweats Frequent infections Feeling weak or tired Bleeding and bruising easily Swelling or discomfort in the abdomen (from a swollen spleen or liver) Weight loss for no known reason Pain in the bones or joints Symptoms

People with leukemia have many treatment options. The options are: chemotherapy, biological therapy, radiation therapy, and stem cell transplant, etc…. Treatment

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 Treatment