Maternal PreFi 1st Part

• 3 Focus in Caring of a hospitalized child

  • Alleviating the anxieties of children
  • Major factors in support of coping during illness and hospitalization
  • Preparation of children and families for hospitalization
• Alleviating the Anxieties of Children - apprehensive and frightened when they anticipate or experience pain.

  Use pain free or topical anesthetics.

  Use of sedative to prevent and moderate pain environment.
• For neonates - use oral glucose pacifiers.

  Use Procedural Information - description of treatment and it's step by step process.

  Use Sensory Information - about how they feel.
• Four Coping Strategies

  • Use of puppets
  • Medical play
  • Children's literature
  • Audiovisual media
• Pain Management in Children

  • Pain in children is not only a hurting sensation, but also be a confusing one because a child does not anticipate the pain, does not have words to explain how it feel, and cannot always understand it's cause.
• Nociceptors - free nerve-endings with specific receptors found in tissue throughout the body.
• Four Reasons of Pain

  • reduced oxygen in tissues from impaired circulation
  • pressure on the tissue
  • external injury
  • overstretching of body cavities with fluid or air
• Pain Receptor - a sensory neuron that responds to damaging or potentially damaging stimuli by sending " possible threat" signals to the brain and spinal cord.
• A-alpha and A-beta fibers - large fibers that are myelinated.

  • conduct a response at a rapid rate
  • transmit sharp and well localized pain
• A-delta nerve - fiber that are smaller and conduct at a slower rate like light pressure and vibration
• C-nerve - fibers-slowly conducting un-myelinated axons that transmits diffuse, dull, burning and chronic pain.
• Acute pain - sharp pain
• Chronic Pain - pain that lasts for a prolonged period (often defined as 6 months)
• Somatic Pain - originates form deep body structure like muscles and blood vessels
• Visceral Pain - involves sensation that arises from internal organs.
• Referred Pain - a pain that is perceived at a site distant from its point of origin
• Gate Control Theory - pain impulses travel and interpreted in the body.
• Pain Interview and History

  P - Presence of Pain "Are you hurting?"

  Q - Quality " How do you describe the pain?" (sharp, dull, burning, tingling)

  R - Radiation or Location " Where is the pain?" "Does it shoot or radiate anywhere else?"

  S - Severity " From 0-10 "

  T - Timing " How long have you had this pain"
• Pain Management

  1. Nonpharmacologic - distraction, preparation, relaxation, cutaneous stimulation, self-exercises, hypnosis
  2. Pharmacologic - Analgesics (NSAIDs), Local or regional anesthesia
• LBW (low birth weight) - less than 2,500g or less than at birth regardless of gestational age
• SGA (small for gestational age) - have intrauterine growth retardation (IUGR)
• SFD (small for date)- birth weight fall below 10%on intrauterine growth charts
• AGA - appropriate in weight for gestational age
• LGA - large for gestational age, weight above 90%on intrauterine growth chart.
• Premature (preterm) infants - regardless of birth weight are those delivered before 37 weeks from 1st day of LMP
• Full Term Infant - 37 to 40 weeks gestation
• Postmature Infants - those born after prolonged gestation (42 weeks and above) regardless of birth weight
• Premature infant - born before 37 weeks and weigh less than 2,500g
• It may be necessary to deliver a premature infant if evidence of maternal complication exsts
• Clinical Manifestation of Premature Infant

  • Tachypnea
  • Grunting
  • Nasal Flaring
  • Retractions
  • Cyanosis
  • Decreased oxygen saturation
• Iatrogenic Anemia - lowered hematocrit and hemoglobin count resulting from large or frequent removal of blood samples.
• Hyperbilirubinemia - rapid destruction of red blood cells. Cause of jaundice
• Kernicterus - the deposition of unconjugated bilirubin in the brain cells and is associated with mental retardation
• Diagnostic Tests

  • Chest x-ray
  • ABG analysis
  • Head ultrasound
• Medical management for premature neonates

  • cared by a special trained staff in NICU.
  • Top priority is supporting cardiac and respiratory system
  • Provide thermoregulation
  • Start IV
  • Gavage nutrition
• Nursing interventions for premature neonates should focus on maintaining an environment like the intrauterine environment.
• Nursing Management

  • Provide adequate fluids and electrolytes and nutrition
  • Maintain neutral thermal environment
  • Prevent infection
  • Initiate photo therapy as required
• Respiratory Distress Syndrome (RDS) - leading cause of morbidity and mortality among premature neonates.

  • Lungs lack surfactant, which prevents alveolar collapse at the end of respiration.
  • Treatment - administration of surfactant, oxygen administration, and mechanical ventilation.
• Retinopathy of Prematurity (ROP) - disease cause by normal growth of retinal blood vessels. Prematurity may cause abnormal blood vessels to grow.

  • Supplemental oxygen is also thought to contribute to this growth
  • ROP can cause mild to severe eye and vision problems
  • Treatment - laser surgery or cryotherapy
• Patent Ductus Arteriosus - The ductus arteriosus reopens after birth due to lowered oxygen tension associated with respiratory impairment.

  • Treatment - fluid regulation, respiratory support, administration of indomethacin, surgical ligation ( if neonate does not rrespond to other therapies)