: <1 yr, unexplained after autopsy, LCD, peak age 2-4 months, risk include stomach sleeping, male, hx of prematurity, 2-4 mo, mom less than 20, second hand smoke, lack of breastfeeding, safe bedding Pathological Jaundice Physiological Jaundice Abnormal Normal, color change First 24 hrs after birth First 24 hrs, sometime in first wk Causes severe- liver inf, bile duct obstruction, metabolic disorder Cause simple- immature liver cannot break down and excrete hgb quickly Phototherapy : bring bilirubin down with lights & blankets, sunglasses used- bilirubin build up (secrete in stool) Plagiocephaly/Brachecephaly : when infants soft skull bc flattened in one area, due to repeated pressure on that particular part of head, doesn’t affect brain, premature, tummy time Neonatal Fever : emergency! Immune system weak 2-3 mo, r/o sepsis- meningitis, RSV, less than 60-90d, temp of 38.5 or higher/below 36.5
Pan culture: blood, urine, CSF (should be clear), ESR/CRP, RVP Manage: broad spec abx, antivirals, close monitoring of VS & neuro status, family support Neuro Disorders S&S of ICP Infant : tense bulging fontanel, separated cranial sutures, irritability, high pitched cry-weak, head circumference (get baseline on admission), distended scalp veins, changes in feeding, sunset eyes Child : HA, N&V, diplopia (doubled vision), blurred vision, seizures Late signs of ICP : Cushing’s triad (bradycardia, irregular RR, widening pulse pressure- systolic , diastolic low), decreased LOC, decreased motor response to command, decreased sensory response to pain, altered pupil size/reactivity, decerbrate (extension, hands turned out) posture, Cheyne strokes respirations (shallow to apnea), papilledema, coma TX : Mannitol (fluid & Na excreted), 2/3 rd maintenance fluid, CO2 30-35 (hypocapnia=cerebral vasoconstriction), O2 within normal limits, ventriculostomy, HOB elevated 30-40, **aggressive fever tx Care of the Unconscious child : pain control, quiet environment, low lighting, control icp, minimal stimulation (whisper, no young kids, drapes pulled, tv off, calming music & touch) Nursing Interventions: maintain airway, position for optimal ventilation & ICP (increase HOB), avoid activities that increase ICP, speak to pt, hygienic care (normal), family support, ROM exercise Hydrocephalus : CSF collects abnormally in brain, swollen ventricles, pushes on brain **4 ventricles in the brain, connected allows CSF to drain & be reabsorbed by the bloodstream Congenital or Acquired (communicating- flow btwn ventricles blocked or non communicating- CSF blocked within ventricles) S&S : ICP, bulging fontanel, separated sutures DX : CT or MRI, size of ventricles or obstruction, sedation for MRI (careful!! Adequate neuro checks needed) TX : surgery- shunt, diverts flow of CSF from brain to another part of body to be reabsorbed by bloodstream Post OP : position on unaffected side, keep flat, HOB 10-15, assess frequently- site & neuro status q 1hr, edu parents throughout (S&S of ICP) Complications= infection (2wks-1mo), can feel valve, defective valve Neural Tube Defects: in brain & spinal cord during fetal development, 1 st
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- Spring '17
- The Maids, fine motor skills, yrs