Module 4 - ppt (Common Disruptions by Age and Developmental Stage)

Symptoms and Nursing Management of Common Disruptions by Age and Developmental Stage

Newborn: Birth Injuries

  • Types of Birth Injuries: Common conditions seen in newborns that can impact health during the early stages of life.

    • Soft Tissue Injury

    • Erythema: Skin rash often resolving on its own.

    • Petechiae: Small red or purple spots caused by bleeding under the skin.

    • Ecchymoses: Bruises resulting from bleeding.

    • Subcutaneous Fat Necrosis: Hard lumps under the skin that can occur due to trauma.

    • Subconjunctival (Scleral) Hemorrhages: Bleeding underneath the clear membrane of the eye.

    • Retinal Hemorrhages: Bleeding in the retina, serious condition affecting vision.

    • Head Injury

    • Caput Succedaneum: Swelling of the soft tissue on a newborn's head that crosses suture lines.

    • Subgaleal Hemorrhage: Bleeding beneath the galea aponeurotica that crosses the suture lines, a severe condition. (CAN BE LIFE THREATENING)

      • change in BP is a LATE stage of hemorrhage, HR and RR are affected first

    • Cephalohematoma: Blood accumulation between the skull and its periosteum that does NOT cross suture lines.

    • Fracture (Depressed or Linear): Physical fractures in the skull; Crepitus: Grating sound or sensation.

    • Intracranial Hemorrhage: Bleeding within the skull, including subdural or epidural hematoma.

Newborn: Birth Injuries Continued

  • Nerve Injury

    • Facial Paralysis (7th Cranial Nerve): Can impair movement of facial muscles.

    • Brachial Palsy: Injury to the upper arm nerves; affects arm movement.

      • Erb-Duchenne Paralysis: Specific arm paralysis due to brachial plexus injury.

      • Klumke Palsy: Paralysis of the lower arm and hand.

    • Phrenic Nerve Damage: Affects breathing due to diaphragm involvement.

    • Spinal Cord Paralysis: Paralysis resulting from spinal injuries.

    • Vocal Cord Paralysis: Weakness in vocal cord function affecting swallowing and cry patterns.

  • Other Birth Injuries

    • Fracture: Similar to before but includes common birth-related fractures.

    • Scalp Abscess: Infection of the scalp.

    • Subconjunctival (Scleral) Hemorrhage: Similar to previous sections.

    • Liver/Spleen Rupture: Internal injury to abdominal organs causing internal bleeding.

Cranial/Craniofacial Abnormalities

  • Conditions and Management

    • Craniostenosis/Microcephaly: Conditions where cranial shape or size is abnormal.

    • Shape Abnormalities Include:

      • Plagiocephaly: Asymmetrical head shape.

      • Oxycephaly: High head shape caused by early closure of the skull bones.

      • Brachycephaly: Shortened head shape caused by positional molding.

      • Scaphocephaly: Long and narrow head shape.

    • Pierre Robin Sequence:

    • Description: Characterized by retroposition of the tongue and mandible, causing feeding difficulties.

      • Consequences: Can lead to respiratory obstruction.

      • Management: Surgery, feeding support, and monitoring.

    • Clefts:

      • Cleft Lip: Incidence is 1 in 600.

        • Post-op Care: Protect surgical site, avoid prone position, feeding methods include syringe, breastfeeding, and bottle.

      • Cleft Palate:

        • Incidence: 1 in 2500, characterized by a midline defect.

        • Post-op Care: Monitor for airway obstruction, hemorrhage, and laryngeal spasm.

        • Feeding Protocols: Clear liquids initially, liquid diet for 2 weeks, and a soft diet for 6 weeks.

        • Recommended Tools: Open cups allowed, no rigid utensils.

Dermatological Concerns

  • Common Conditions

    • Erythema Toxicum Neonatorum (Newborn Rash): Common rash seen in newborns.

    • Candidiasis: Includes oral and diaper-related infections.

      • will have one satellite lesion

    • Herpes Simplex Virus: Serious viral infection requiring management.

    • Bullous Impetigo: Caused by staph aureus; presents with blisters.

    • Nevus: Birthmarks needing evaluation; size, location, and number may indicate need for biopsy.

      • Melanoma Indicators: Reddish-brown solitary lesions on face/upper arm could suggest melanoma.

    • Café Au Lait Spots: Associated with neurofibromatosis (love brain tissue) and Albright syndrome.

    • Vascular Lesions:

    • Strawberry Hemangioma: Red mark needing monitoring but usually resolves. (likes liver tissue)

    • Port Wine Stain: Requires evaluation due to potential syndromic associations.

Neonatal Jaundice: Hyperbilirubinemia

  • Types of Jaundice

    • Physiologic Jaundice:

      • Causes: Bruising or liver immaturity.

    • Timing: Begins within 24 hours of life, peaks at days 2-5.

    • Breastfeeding Jaundice:

    • Causes: Decreased intake leading to decreased stooling.

    • Timing: Appears around days 3-4, peaks at days 3-5.

    • Breast Milk Jaundice:

    • Mechanism: Prevents bilirubin conjugation.

    • Timing: Begins on day 4, peaks at days 10-15.

    • Hemolytic Disease:

    • Causes: ABO incompatibility seen within 24 hours of life with variable peak timing.

    • Symptoms of Hyperbilirubinemia:

    • Cephalocaudal presentation with icteric skin tones and sclera.

    • Risk of Bilirubin Encephalopathy, characterized by deposits of unconjugated bilirubin in the brain leading to Kernicterus.

      • Consequences: Yellow staining of brain cells can lead to cell necrosis and permanent changes.

Hemolytic Disease

  • Types of Hemolytic Disease

    • ABO Incompatibility:

    • Description: Maternal and fetal antigen incompatibility leading to hemolysis and jaundice.

    • Symptoms: Anemia, hepatosplenomegaly, and potentially hydrops.

    • Complications: Can cause hypovolemic shock.

    • RH Incompatibility:

    • Clinical Scenario: Occurs when an RH negative mother carries an RH positive fetus.

      • Management: RhoGAM can destroy fetal blood cells before maternal immune reaction.

      • First pregnancy usually unaffected; subsequent pregnancies at risk for maternal antibodies development.

    • Erythroblastosis Fetalis: Characterized by accelerated erythropoiesis due to hemolysis leading to generalized edema.

      • Potential Treatments: Maternal Rh immunoglobulin (RhIg), blood transfusions, and high doses of IVIG.

Other Neonatal Concerns

  • Hypoglycemia:

    • Causes: Based on gestational age, weight, metabolic demands, health status.

    • Threshold: <45 mg/dl; golden hour target: 50-100 mg/dl.

    • Symptoms: CNS symptoms include jitteriness, tremors, twitching, high-pitched cry, lethargy, hypotonia, seizures, or coma.

  • Hypocalcemia:

    • Timing: Occurs 24-48 hours after birth, impacts preterm or SGA infants.

    • Symptoms Include: Jitteriness, prolonged QT interval, apnea, cyanosis, high-pitched cry, and distention.

    • Late Onset (3-4 Days of Life): More common in lower-income countries due to dietary causes.

  • Hemorrhagic Disease of Newborn:

    • Type: Vitamin K deficiency presents 1-2 days post-birth.

    • Symptoms: Oozing from umbilical or circumcision site, blood in stool, hematemesis, ecchymosis, epistaxis.

  • Teratogenic Effects: Exposure to alcohol, drugs, medications, and infectious diseases in utero affecting infant development.

High-Risk Neonate Physiological Data

  • Vital Signs: Includes temperature, heart rate, blood pressure, respiratory rate, SpO2, and pain score readings.

  • Measurement of Weight & Length: Important indicators of neonatal health.

  • Laboratory Tests: Routine checks include Intake & Output (I & O).

  • Respiratory Support: Surfactant administration and oxygen therapy.

  • Thermoregulation: Neonates are unable to shiver; use radiant warmers and incubators to maintain a neutral thermal environment.

  • Hydration: Premature infants have a high extracellular water content (90%) compared to term infants (70%).

    • Supplementation Needs: Include IV fluids, PICC lines, UVC lines, UAC lines, and arterial lines as needed.

  • Nutrition Approaches:

    • Parenteral Nutrition and Feeding Tubes: Gavage/pump methods for feeding; suck/swallow/breathe coordination typically develops at 32-34 weeks.

    • Oral Colostrum Priming: Encouraged to improve gut health early.

    • Improved Outcomes & Bonding: Breastfeeding is recommended, shown to reduce feeding intolerance.

High-Risk Neonate Developmentally Appropriate Care

  • Focus on Gestational Age: Implementing care strategies based on individual developmental stages.

  • Arousal States & Sensory Environment: Sensory systems should be accommodated for newborn preferences.

  • Therapeutic Handling and Positioning: Recommendations include kangaroo care to regulate temperature, heart rate, respiratory rate, and increase maternal milk production.

  • Family-Centered Care: Involves parental involvement and support groups, emphasizing family bonding during the perinatal period.

  • Considerations for Neonates Over 42 Weeks Gestation:

    • Physical Findings: Lack of lanugo, vernix, excessive hair, and long fingernails, indicating maturity.

    • Risks: Increased mortality rates, fetal distress, placental insufficiency, anoxic events, macrosomia, nuchal cord, and meconium aspiration syndrome (MAS).

High-Risk Neonate - Respiratory Issues

  • Respiratory Distress Syndrome (RDS):

    • Pathophysiology: Surfactant deficiency leading to alveolar instability and impaired gas exchange.

    • Assessment Findings Include: Tachypnea, intercostal/subcostal/sternal retractions, accessory muscle use, nasal flaring, and grunting during respiration.

  • Meconium Aspiration Syndrome (MAS): needs careful monitoring.

  • Persistent Pulmonary Hypertension of the Newborn (PPHN): requires immediate attention.

  • Conditions Associated with RDS:

    • Bronchopulmonary Dysplasia (BPD): Lung-related issues often resulting in long-term complications.

    • Apnea of Prematurity: Common among preterm infants, requiring stimulation and possibly medication like caffeine.

High-Risk Neonate - Sepsis

  • Definition: Bacterial infection of the blood may arise from maternal sources or postnatal contamination.

  • Symptoms Include: Non-specific symptoms such as hypothermia, hypotension, and lethargy, presenting as a “not right” appearance.

  • Complications of Sepsis: Necrotizing enterocolitis (NEC) due to vascular compromise impacting bowel integrity.

  • Risk Factors: Include prematurity, gastrointestinal dysmotility, impaired digestive capacity, frequent antibiotic and antacid use.

  • Treatment Approaches: Bowel rest, sometimes necessitating surgical resection.

High-Risk Neonate Concerns Continued

  • Polycythemia: Resulting from hemoconcentration, characterized by high hematocrit (>65%).

  • Retinopathy of Prematurity (ROP): Specific to premature infants due to hyperoxygenation.

  • Hypoxic Ischemic Encephalopathy (HIE): often results from an anoxic birth event; may require cooling therapies.

  • Intracranial Hemorrhage (ICH): can present with a variety of symptoms, identify specific types (grades I-IV) and management strategies.

    • Seizure Types:

    • Clonic: Rapid jerking movements.

    • Tonic: Stiffening of muscles.

    • Myoclonic: Brief, shock-like jerks of muscles.

    • Subtle: Less intense movements such as eye blinking.

High-Risk Neonate - Infant of Diabetic Mother

  • Common Symptoms: Include hypoglycemia, macrosomia (full plump face), excess vernix, and large umbilical cord.

  • Longer-Term Monitoring: Required for potential long-term complications such as hyperbilirubinemia and respiratory distress syndrome (RDS).

Drug Exposed Infant

  • Types of Prenatal Exposures: Include opiates, methadone, cocaine, methamphetamine, and marijuana.

  • Neonatal Abstinence Syndrome (NAS): Scoring systems tailor individualized treatment protocols.

  • Common Withdrawal Symptoms Include: irritability, sleeplessness, tachypnea, tremors, frequent stooling, skin breakdown, yawning, sneezing, poor feeding, temperature instability, shrill cry, mottling, and hypertonicity.

Early Childhood (Toddler & Pre-School)

Age 1-5 Years

Sleep Disturbances of Early Childhood

  • Common Sleep Disturbances Include:

    • Nightmares: Occur during REM sleep; child can recall the nightmare and is aware of caregivers but may cry out for support and needs time to go back to sleep.

    • Night Terrors: Occur during deep non-REM sleep; typically the child is unaware and does not remember the event; characterized by sitting up, thrashing, or sleepwalking.

  • Consequences of Poor Sleep: Daytime tiredness may lead to hyperactivity, behavioral changes, or difficulty concentrating and impaired learning.

  • Improvement Methods Include:

    • Sleep Hygiene: Ensuring a consistent sleep routine and environment, and limiting media exposure prior to sleep.

Ingestion Injuries

  • Statistics Show: 49% of poisoning cases happen in children under 6 years, with 90% occurring at home.

  • Commonly Ingested Substances: Include cosmetics, cleaning products, medications, foreign bodies, topical agents, vitamins, antihistamines, pesticides, e-cigarettes/liquid nicotine, and some plants (60% of cases in children under 5).

  • Assessment and Treatment: Focus should be on treating the child, not the poison; assess vital signs and mental status and provide respiratory/circulatory support as needed.

Ingestion Injuries Continued

  • Antidotes: While they are effective, gastrointestinal decontamination is not generally recommended.

  • Ipecac: Previously used to induce vomiting but is not advisable due to risks of aspiration.

  • Gastric Lavage: High risk for perforation and requires controlled conditions.

  • Activated Charcoal: Used in specific ingestions including carbamazepine and phenobarbital; must be given within 1 hour and only when the airway is intact.

Ingestion Injuries: Heavy Metal Poisoning

  • Lead As the Most Common: Can affect any body system but is particularly concerning for neurodevelopmental outcomes.

  • Symptoms of Severe Exposure: Include encephalopathy and cognitive impairment.

  • Routine Screening in Pediatrics: Blood tests for lead levels during well-child visits, especially at ages 1 and 2.

    • Acceptable Level: Less than 10 mcg/dl but further monitoring and prevention efforts are critical.

  • Mercury: Exposure sources include predator fish, thermometers, and batteries, with symptoms such as anorexia, memory loss, and behavior changes.

  • Heavy Metal Toxicity Treatment: Often involves chelation therapy to remove toxic substances from the body.

School Age Child (5-11 years old)

Obesity

  • Definitions:

    • Overweight: BMI between 85th and 94th percentile.

    • Obesity: BMI greater than 95th percentile.

  • Reasons for Increased Risk: Caloric intake exceeds energy needs, compounded by low activity levels.

  • Common Complications Include: Type 2 diabetes, fatty liver disease, pulmonary complications, and psychological impacts from societal stigmas.

Obesity Continued

  • Prevention Strategies Include: Anticipatory Guidance emphasizing nutrition improvement, increased exercise, and behavior modification.

  • Medical Interventions: Limited pharmacological options for adolescents over 12 years old, potential for bariatric surgery in adolescents with careful consideration of risks.

Enuresis

  • Definitions:

    • Primary Enuresis: Child has never achieved dry nights.

    • Secondary Enuresis: Child with previous dry nights experiences bed wetting again.

  • Causes: Family dynamics, delay in toilet training, emotional dependence, structural or neurological issues.

  • Treatment Approaches Include: Use of reward systems, bladder training, and bed alarms.

Encopresis

  • Criteria for diagnosis: Involuntary passing of stool occurring at least once a month for over 3 months in a child over 4 years.

  • Causes Include: Constipation, physiological malformations, and psychological factors.

  • Treatment Strategies: Address constipation, potential surgical interventions, bowel training, and rectal irrigation.

Adolescent (Ages 12-18 Years)

Reproductive System Concerns: Males

  • Common Issues Include:

    • Varicocele: More common on the left side, typically presents as a “bag of worms.”

    • Epididymitis: Infection of the epididymis due to bacterial or viral causes.

    • Testicular Torsion: Presents as swelling and pain; requires prompt surgical intervention if not resolved manually.

    • Gynecomastia: Often transient breast enlargement, seen in up to 70% of males during puberty.

Reproductive System Concerns: Females

  • Amenorrhea Types:

    • Primary Amenorrhea: Failure to develop secondary sex characteristics or menarche by defined ages.

    • Secondary Amenorrhea: Absence of menstruation after previously normal cycles.

  • Dysmenorrhea: Painful menstruation, with primary symptoms described in detail including systemic effects.

  • Vaginal Infections: Include bacterial vaginosis treated with metronidazole, candidiasis treated with antifungals, and sexually transmitted infections (STIs).

Pregnancy in Adolescents

  • Statistics: 41.2% of high school students report engagement in intercourse; only a small percentage report activity before age 13.

  • Teen Birth Rates: As of 2014, averaged 24.2 per 1000 in ages 15-19.

  • Risk Factors for Complications: Include low birth weight, infant death, gestational diabetes, and preeclampsia, particularly during second pregnancies.

  • Additional Considerations: Body stature and physical development affect labor; ongoing support and education contribute to better outcomes.

  • Family-centered care focus: Engages families inclusively in maternal and infant health, aiming for comprehensive support.