2. Current Concept of Pediatric Nursing
Introduction:
In the beginning of this topic, we need to know more about pediatric through
orientation about health of the child , during childhood period numbers of
concepts related to this period &then talk a bout nursing of pediatric
&concepts related to it .
Definition of health
Health, Is state of complete physical, mental& social well –being and not the
absence of disease (W.H.O) .
3. Current Concept of Pediatric Nursing
Most people accept that health can be divided into two broad aspects - physical and mental health.
Physical health.
-For humans, physical health means a good body health, which is healthy because of regular physical activity
(exercise), good nutrition, and adequate rest.
.
Mental health.
Mental health refers to people's cognitive and emotional well-being. A person who enjoys good mental health does
not have a mental disorder.
-Morbidity:
It means ,any deviation from normal , include, mental ,physical D,& social D, that leads to ( illness).
-Mortality:
It means exposure of the child to certain factors, chemical, biological, social &psychological that can cause sudden
illness &death.
5. Importance of Studying Growth and Development for nurses
1-Knowing what growth and development would be expected from the child and adult at any given age
2-The knowledge of growth and development would help the health personnel to better understand the
reason for particular condition and illness, which occur in various age groups.
3- Help the health personnel in formulating the plan for total care, which the physician and other health
team members outline for each child or adult.
4- Help the health personnel in teaching mothers how to use such knowledge in achieving their
children’s optimal growth and development
6. Concepts of Growth and Development
Definitions
Growth
Growth refers to an increase in physical size of whole body or any
of its parts. which can be measured accurately in kilograms,
meters, inches, etc...} usually expressed quantitatively (descriptive)
Development
Development refers to a progressive increase in skill and capacity
of function. through maturation, and learning.) usually expressed
qualitatively (descriptive)
7. Principles of Growth and Development
1- Growth and development are continuous processes.
2- It have predictable sequence, as all human beings go through the same stages
3- do not progress in the same rate. There are periods of rapid growth and other period of slow growth.
4- Not all body parts grow in the same rate at the same time
5- All types of growth and development do not occur at the same rate
6- Each child grows in his own unique and personal way.
7- Each stage is affected by those preceding and affects those that follow.
8- Growth and development proceed in regular related directions,
8. Directional Trends
1- Cephalocaudal, where growth proceeds from head-to-tail, direction.. The infants
achieve control of head before the extremities.
2. Proximodistal, or near-to-far,where growth proceeds from the center or midline
of the body to the periphery. The infant’s control of shoulder precedes mastery of
hands and control whole hands before fingers.
3. Simple to Complex (General to specific), where development proceeds from
the simple operations to more complex activities and functions
9. Types of Growth and Development
1. Types of Growth:
A-Physical Growth, e.g., weight, height, head- chest circumferences…etc
B-Physiological Growth, e.g., vital signs, senses.
2. Types of Development:
1- Motor development: It is either gross or fine motor behaviors.
A- Gross motor behaviors include head balance, sitting, standing and walking.
B- Fine motor behaviors include the use of hands and fingers
2- Cognitive development, (intellectual development
3- Emotional development,
4- Social development,
5- Language development.
6- Moral development.
10. Factors Affecting Growth and Development
A. Heredity
Heredity of a man and a woman determines that of their children.
Race and nationality also determines the individuals’ physical
B. Environmental Factors
1- Prenatal Environment
A- Factors related to mothers during pregnancy, such as:
1- Mothers’ age; premature children of teenage mothers are more likely than those of older
mothers to have neurological defects. In addition, mothers who are over 40 years of age.
2- Nutritional deficiencies of the mother.
3- Diabetic mother. 4- radiation 5- Smoking
6- Infection (German measles during pregnancy) 7-Use of drugs.
B- Factors related to fetus, such as:
1-Malposition in uterus. 2- Faulty placental implantation
11. Factors Affecting Growth and Development
2. Postnatal environment:
A. External Factors , such as:
1- Socio-economic status of the family
2- Child’s nutrition as malnutrition (under-nutrition or obesity).
3- Child’s health deviation; Congenital conditions, illness and injury may result in altered level of growth and
development
4- Exercise
5- Child’s position in the family
6- Number of siblings in the family
7- Play 8- School:
B. Internal Factors , such as:
1- Child’s intelligence.
2- Hormonal influences, e.g., influence of growth hormone or thyroid hormone.
3- Emotional status
12. Stages of Development
- Prenatal period: It is the period from conception to birth. It is divided into:
- Embryonic period: From 2 weeks to 8 weeks.
- Fetal period: From 8 weeks to birth (40 – 42 weeks of gestation).
- 1- Infant
- Newborn age: First 24hours
- Neonatal stage: From birth to 4 weeks (28 days).
- Infancy stage: From 1 – 12 months of age.
2 – Early Childhood—1 to 6 Years Old
- Toddler: From 1 – 3 years of age.
-Pre-school: From 3 – 6 years of age.
2- Middle Childhood—6 to 11 or 12 Years Ol
-- School age period from 6 - 12 years of age.
3-Later Childhood—11 to 19 Years Old
- Prepubertal: 10 to 13 years old
-Adolescence: 13 to approximately 18 years old
13. Normal Newborn
Newborn stage is the first 4 weeks of life. It is transitional period for an
individual as he transfers from intrauterine life to extra – uterine environment.
Physical growth:
a. Weight: 2.700 to 4.000 gm. They lose 5% to 10 % of weight by 3 to 4 days
after birth as result of:
1- Withdrawal of hormones from mother.
2- Loss of excessive extra- cellular fluid.
3- Passage of me conium (feces) and urine.
4- Limited food intake.
Gains 150/210 g weekly for the first month.
14. Physical Growth cont
B. Length (head to heal): Average boy’s is 50 cm and 49 cm for girls (normal range for both sexes
48 to 53 cm).
-Gain 2.5 cm by the end of the first month(65 cm).
Head circumference: 33 to 35.5 cm.
- head circumference may be somewhat less, immediately after birth, because of the molding
process that occur during a vaginal delivery, usually by the second or third day the skull is
normal in size and contour.
- Head is ¼ of the total body length. The skull has two fontanels: the anterior and the posterior
fontanels.
• - Head circumference increases 2 cm by the end of the first month.
- Chest circumference: 30.5 to 33 cm (usually 2-3 cm less than head circumference).
16. Physiological Growth
Vital signs:
a. Temperature:
36.5 to 37.3 oC.
b. Pulse:
Apical 120 to 140 b/ min. it is usually rapid and irregular.
c. Respiration:
30 to 60 c/min. It is usually irregular in depth, rate, and
rhythm.
d. Blood pressure:
65/45mmHg in arm and calf
17. General Appearance
Posture:
Flexion of head and extremities while rest on chest and abdomen
Skin:
-At birth, bright red, puffy smooth.
-Second to third day dark pink and dry.
1-vernix caseosa:
It is soft yellowish cream; which covers the neonates at birth to protect the skin from infection. It
is formed of sebaceous gland mixed with old epithelial cell.
It may thickly cover the baby or it may be found only in the body creases and between the labia.
It dries off within 24-48 hours and fades spontaneously and rubs off on the infant's clothes.
18. General Appearance cont
2 - Lanugo hair:
It is along soft growth of fine hair observed on the shoulders, back,
extremities and forehead. The more premature baby is, the
heavier the presence of lanugo is. It disappears during the first
weeks of life.
3-Mongolian spots:
Mediterranean and Negro babies often manifest black coloration on
the lower back, buttocks, anterior trunk and rarely on fingers and
feet. They disappear during preschool years without treatment.
19. General Appearance cont
Head
The fontanels are soft spots. Consist of openings at the point of union of the
skill bones.
The anterior fontanel:
Is diamond in shape and located at the junction of two parietal and fontal bones.
It closes between 12 -18 month of age.
The posterior fontanel:
Is triangular and located between the occipital and parietal bones.
It is closes by two month of age.
Fontanels should be flat, soft, and firm. It bulges when the baby cries or if
there increased intracranial pressure.
21. Head
There are Two conditions may appear in the head.
These are caput succedaneum and cephalohematoma.
22. Comparison
Acephalo Hematoma
A Caput Succedaneum
Comparison
Several Hours After Birth And
Increase In Size 2-3 Cm
At Birth ,No Increase In Size
Appear
After 6 Weeks After Birth
Several Days After Birth
Disappear
Injury , Hematoma
Diffuse Edematous Swelling
Involving Soft Tissue
Cause
Jaundice Underlying Skull,
Fracture ,Intra Cranial
Bleeding, Shock
Rarely Anemia
Complication
23. General Appearance cont
4-Desquamation
Pealing of the skin occurs within 2-4 weeks of life. These are denoted areas where the delicate skin has
been rubbed off the nose, knees and elbows, because of pressure and erosion of sheets.
5- Physiological jaundice:
Appears 2-3 days after delivery; the skin begins to take on a yellow coloration. This jaundice is not
pathological it is associated with excessive destruction of erythrocytes (R.B.C.) that are not needed
after birth. It increases after birth. it increases for a few days and usually disappears by the 7-10 days
6- Milia:
`These are small pinpoint white or yellow spots due to increased fat secretion.
Common on the nose, forehead, cheeks, and chin of the newborn infants. They will disappear within a few
weeks (one to two weeks). They should not be expressed.
24. General Appearance cont
Eyes:
-Lids: usually edematous.
-Color: true eyes color is not determined until the age of 3-6 months.
-Pupil: react to light or touch
-Blinking reflex in response to light or touch
Ears:
-Startle reflex elicited by a loud sudden noise.
-Pinna flexible, cartilage present.
Nose
Nasal patency.
Nasal discharge-thin white mucous.
sneezing
25. General Appearance cont
Abdomen :
-Cylindrical in shape.
-Liver: palpable 2-3 cm below costal margin
-Spleen: tip palpable at end of first week of age
-Umbilical cord: bluish white at birth with tow arteries and one vein.
It is formed of gelatinous connective tissue.
- The cord shrinks, dries and drops off its place of attachment heals
in about 7-10 days.
26. General Appearance cont
Heart:
Apex-fourth intercostals space.
Chest and lungs:
-Slight sterna retraction evident during inspiration.
-Cough reflex absent at birth, present by 1-2 days.
27. General Appearance cont
Possible signs of Respiratory Distress to be aware of are:
- Cyanosis other than hands and feet.
- Flaring of nostrils.
- Expiratory grunt-heard with or without stethoscope.
28. General Appearance cont
Urinary system:
Normally the newborn has urine in his bladder and voids at birth or some hours later. Newborn
pass urine within 24 hours after birth.
Female genitalia:
-Labia and clitoris usually edematous.
-Urethral meatus behind clitoris.
- Vernix caseosa between labia.
Male genitalia:
Urethral opening is at of glands pens.
Scrotum usually large edematous & covered with rugae and pigmented.
29. General Appearance cont
Mouth and throat
- Intact, palate.
- Uvula in midline - Sucking reflex.
- Gag reflex. - Rooting reflex.
- Absence or minimal salivation.
Neck:
- Short, thick, usually surrounded by skin folds
- Tonic neck reflex present
30. General Appearance cont
Extremities:
- Ten fingers and toes.
- Nail pink
- Full range of motion .symmetry of extremities.
- Equal bilateral brachial pulse.
- Creases on anterior two third of sole & Sole usually flat
31. Neonatal Reflexes
Blinking reflex- it is aroused when the infant is subjected to light
Coughing and sneezing –to clear the respiratory tract.
Gagging to prevent choking.
Feeding reflexes:
- Rooting reflex starts when the corner of the baby's mouth is stroked or touched. The baby will turn
his or her head and open his or her mouth to follow and root in the direction of the stroking. This
helps the baby find the breast or bottle to start feeding. This reflex lasts about 4 months. Rooting
helps the baby get ready to suck
- Sucking reflex. When the roof of the baby's mouth is touched, the baby will start to suck. This
reflex doesn't start until about the 32nd week of pregnancy and is not fully developed until about 36
weeks.
- Swallowing reflex: it follows sucking reflex
32. Neonatal Reflexes cont
- Moro reflex : The Moro reflex is often called a startle reflex. That’s
because it usually occurs when a baby is startled by a loud sound or
movement. In response to the sound, the baby throws back his or her
head, extends out his or her arms and legs, cries, then pulls the arms
and legs back in. A baby's own cry can startle him or her and trigger this
reflex. This reflex lasts until the baby is about 2 months old.
- Tonic neck reflex. When a baby's head is turned to one side, the arm
on that side stretches out and the opposite arm bends up at the elbow.
This is often called the fencing position. This reflex lasts until the baby is
about 5 to 7 months old.
33. Neonatal Reflexes cont
- Grasp reflex
Stroking the palm of a baby's hand causes the baby to close his or her fingers in a
grasp. The grasp reflex lasts until the baby is about 5 to 6 months old. A similar
reflex in the toes lasts until 9 to 12 months.
- Stepping reflex
This reflex is also called the walking or dance reflex because a baby appears to
take steps or dance when held upright with his or her feet touching a solid surface.
This reflex lasts about 2 months.
35. Neonatal Senses
1- Touch
It is the most highly developed sense. It is mostly at lips, tongue, ears, and forehead.
The newborn usually is comfort with touch.
2- Hearing
During pregnancy, many mothers find that the baby may kick or jump in response to loud noises and may
quiet with soft, soothing music. Hearing is fully developed in newborns. Babies with normal hearing should startle in
response to loud sounds
3- Taste:
Babies prefer sweet tastes over sour or bitter tastes. Babies also show a strong preference for human milk
and breastfeeding. This is especially true if they are breastfed first and then offered formula or a bottle.
4- Smell
Only evidence in newborn infant’s search for the nipple, as he smell breast milk.
5- Sight
Over the first few months, babies may have uncoordinated eye movements. They may even appear cross-eyed.
Babies are born with the ability to focus only at close range.
36. Motor Development
His movements are random, diffuse, and uncoordinated.
Lack muscular strength to hold head steady and erect (his head sink down).
Reflexes carry out bodily functions and responses to external stimuli.
Reflexes: The reflexes are, swallowing and gagging reflex, sucking reflex, grasp reflex, tonic –
neck reflexes .
Gross:
May lift head if prone.
Alerts to high-pitched voices.
Fine:
Holds hand in fist.
When crying, he draws arms and legs to body.
37. Development cont
B. Cognitive Development
The cognitive (intellectual) development of newborn infant is difficult to understand or observe it.
C. Emotional Development
Newborn infant expresses his emotional just through cry for hunger, pain, or discomfort sensation.
D. Social Development
- Cry is his contact with environment to communicate his physiologic needs as hunger.
He is egocentric and depends on persons to meet his needs. As he cry means getting adults’ attention,
whenever he needs their attention, he will cry
38. Basic Needs for Newborn
1- Marinating airway
2- Establish respiration
3- Warmth
4- Protection from hemorrhage
5- Greater identification
40. Apgar Score
Apgar score is 10 that state of cardiopulmonary function , If child score is 4 or less
i.e child cyanosed , heart rate below 100 beats/ min & inadequate or difficulty
respiration , he will needed oxygen . If he has score 7-10 he usually needs no
treatment, that is indicated for gestational age for the neonate
