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Theories of Development Freudian Stages: Developmental Stage Time Period Critical Behaviors
Theories of Development Freudian Stages: Developmental Stage Time Period Critical Behaviors
Theories of Development Freudian Stages: Developmental Stage Time Period Critical Behaviors
FREUDIAN STAGES
Developmental Stage Time Period Critical Behaviors
• NB losses 5-10% body weight within the first few days, then
regains weight in 10 days.
• • Pathologic-possible abnormalities
• – Within 1st 24 hrs
• –May indicate early hemolysis of RBC
• or underlying disease process
• –Duration:
• • FT: 1 wk
• • PT: 2 wks
BIRTHMARKS
• Hemangiomas- vascular tumors of the skin
• Nevus Flammeus- “port wine stain”
* Macular purple or dark red lesion level with skin
usually do not disappear
STORK BEAK MARKS
• Lighter pink patches at the back of the neck
Strawberry hemangiomas
• Elevated areas formed by immature capillaries and
endothelial cells. Usually disappears.
Cavernous hemangiomas
• Dilated vascular spaces
• Raised, don’t disappear, may lead to bleeding
Mongolian spots
• Pigment cells(melanocytes); slate-gray patches across
sacrum or buttocks
Lanugo
• Fine downy hair, term babies have lesser lanugo. More lanugo
indicate prematurity, disappears by 2 weeks.
VERNIX CASEOSA- white chessy substance that covers the
skin of newborn. May also indicate maturity, term babies have
lesser vernix caseosa.
DESQUAMATION- peeling of the skin
MILIA- pinpoint white papule on cheeks or over nose; disappears
by 2-4 weeks
MILARIA- clear vesicles on face, scalp & perineum due to
retention of sweat in unopened sweat glands.
*Remove excess clothing & room in a cooler environment
•Lanugo
• • Found after 20
• weeks of gestation
• on the entire body
• except the palms &
• soles
• • Fine downy hair that
• covers the
• shoulders, back &
• upper arms
• 051104 Neonatal Care 68
• Vernix Caseosa
• • Protective cheesy-like, gray-white
• fatty substance
• • FT: skin folds under the arms and
• in the groin under the scrotum or in
• the labia
• • Nursing Considerations:
• –Use baby oil
• –DO NOT attempt to remove
• vigorously
• D e s q u a m a t io n
• • Dryness/ peeling of the skin
• • Usually occurs after 24-36 hours
• • Marked scaliness & desquamation =
• signs of postmaturity
• Milia
• • Multiple, yellow or pearly
• white papules approx. 1
• mm wide
• • Due to enlarged or
• clogged sebaceous gland
• • Usually found on the
• nose, chin, cheeks,
• eyebrows and forehead
• PETECHIAE OR PURPURA RASH- red or
purple rashes over the body that may be present
in child with thrombocytopenia(platelet
deficiency)
• ERYTHEMA TOXICUM- newborn rash;
“fleabite rash”
• BRUISING- occurs from breech extractions, or
use of forceps. It may decrease circulating
blood– anemia--hypotension
• Mottling
• • Cutis marmorata
• • reticulated pattern of
• constricted capillaries
• and venules due to
• vasomotor instability in
• immature infants
• • Bluish mottling or
• marbling of skin in
• response to chilling,
• stress or overstimulation
• Erythema toxicum
• • Newborn rash
• • Small, white,
• yellow, or pink to
• red papular rash
• • Trunk, face &
• extremities
• • Within 48 hrs
• Petechiae
• • Pinpoint hemorrhages
• on skin
• • Due to increased
• vascular pressure,
• infection or
• thrombocytopenia
• • Within 48 hrs
• Ecchymosis
• • Bruises
• • As a result of rupture of
• blood vessels
• • May appear over the
• presenting part as a result
• of trauma during delivery
• • May also indicate infection
• or bleeding problems
• Harlequin Sign
• • When on side,
• dependent side
• turns red and upper
• side/ half turns pale
• • Due to gravity and
• vasomotor instability
• or immature
• circulation
• • Skin resembles a
• Café-au-lait spots
• • Tan or light brown
• macules or patches
• • NO pathologic
• significance, if <3cm
• in length and <6 in
• number
• • If > 3 or 6 =
• Cutaneous
• neurofibromatosis
• FONTANELLES
1. Anterior- diamond shaped
• Soft spot
• Should not be indented or bulging
• Closes at 12-18 mos
2. Posterior- triangular shaped
• Closes at 2nd month
SUTURES- overriding, separates line of the skull
• Wide, separated sutures indicates increased ICP or accumulation of
blood.
MOLDING- head molds into the shape of cervix to fit—after birth,
appears to be asymmetric and for primi—dunce cup” shape
CAPUT SUCCEDANEUM- edema of the scalp
CEPHALHEMATOMA- collection of blood between the skull bone
and bone itself due to break of capillaries black and swelling
absorbed in weeks.
CRANIOTABES- localized softening of cranial bones caused by
pressure on bone on older child, it indicates faulty metabolism and
kidney dysfunction
• Caput Succeedaneum
• • Swelling of soft
• tissues of the
• scalp
• • Due to pressure
• • Crosses the
• suture lines
• • Presenting part
• • 3 days after birth
• Cephalhematoma
• • Subperiosteal
• hemorrhage with
• collection blood
• • Due to rupture of
• capillaries as a result
• of trauma
• • Does not crossed
• suture lines
• • Several weeks
• Molding
• • Overlapping of skull
• bones
• • Due to compression
• during labor and
• delivery
• • Disappears in few
• days
• Forcep Marks
• • U –shaped
• bruising usually
• on the cheeks
• after forcep
• delivery
• EYES
• Dark pupils
• Normal on 3RD-12 month
• Should be clear without purulent
discharge or redness
• Red spots on sclera disappears in 2-3 days
until kidneys are capable of draining body
fluids
EARS
• Pinna not completely found
• Top part of the ear should be in line drawn
from inner canthus to back of the head
• Low set ears indicates chromosal disorder
• Test hearing by ringing a bell held at 6th from
crib; take note of negative response.
NOSE
• Large for face
• Test patency by covering mouth and one nostril.
MOUTH
• If one side of the mouth moves more than the other, it may
indicate cranial nerve injury
• Palate should be intact
• Eipstein pearls- glistening, well circumscribed cyst due to
calcium deposits, considered as normal
• Thrush-grayish white adherent milk-curd like plaques found in
the tongue and buccal cavity
CHEST
• Enlarge breast with thin watery fluid( witch
milk) due to maternal hormone
• Retraction during inspiration indicates
respiratory distress
• Ronchi is normal (harsh innocent sound of air
passing over mucus)
• Grunting is abnormal (high-crowning sound;
stridor)
• NECK
• Short and chubby with skin folds
• Head freely rotates; if not– it indicates congenital
torticollis-injury to the sternocleidomastoid muscle.
• 24 hours ROM- nuchal rigidity indicates meningitis
• Makes momentary effort to lift head
• It is normal that trachea is bulging because of
enlarged thymus gland
ABDOMEN
• Sunken abdomen may indicate missing
contents like in diaphragmatic hernia
• Bowel sound should be present within 1 hour
after birth
• Cord falls off by 6th-10th day( about a week)
ANGOGENITAL AREA
• Note passage of meconium within 24 hours. No passage may
mean imperforate anus
• Scrotum- edematous & rugaeted
• 2 descended testes
• Cryptorchidism- one or both testes have not descended
• Penis- if lesser than 2 cm, refer to endocrinologist
• Shortage of urethra:
*Epispadias-opening at dorsal aspect
*Hypospadias- opening at ventral aspect
• PREPUCE(foreskin)- should not be stenosed
* It normally slides back poorly. Do not
attempt to slide
• FEMALE GENITALIA- swollen
*Pseudomenstruation- presence of mucus
secretion, blood tinged is normal due to maternal
hormones
CORD should remain dry
EXTREMITIES
• Appear short
• Fingernails soft, smooth and long
• Conditions associated with Chromosomal disorders:
1. Syndactyly- webbing of toes
2. Polydactyly- extra toes or fingers
3. Unusual spacing of toes
LEGAL RESPONSIBILITIES FOR NB
1. Newborn ID & registration
• 2 bands- wrist & foot
• Contains:
1.Hospital number coinciding with mother
2. Mother’s full name, sex, date, time of birth
2. Footprint-placed in chart
3. Birth Registration within 30 days in civil registry
4. Birth record & documentation
NB CARE RESPONSIBILITIES
• KEEP NB WARM
• PROMOTE ADEQUATE BREATHING PATTERN &
PREVENT ASPIRATION
• INSPECT & CARE FOR CORD
• ADMINISTER EYE CARE-CREDE TX
• FEEDING
• BATHING
• SLEEPING
• DIAPER AREA CARE
• NB SCREENING
• PREVENT BLEEDING
• CIRCUMCISION
• done to manage PHEMOSIS- constriction of foreskin of penis
obstructing urinary meatus
• *not essential at birth
• *done 1st or 2nd day of life
• *Don’t‘ wash away yellowish mucus over glans penis
• CAR SAFETY
*use car seat
*If child is already able to sit up without support, seat may face
front car
RECOGNISING THE ILL BABY
• RESPIRATORY DISTRESS SYNDROME(RDS)
Signs
• Difficulty initiating respirations
• Low body temp
• Nasal flaring
• Tachypnea
• cyanotic membranes, grunting
• PRIORITIES:
*respirations- use of ventilator, oxygenation &
humidification
• Suction as every 2 hours or more
• Position: side with neck slightly extended
• Nutrition – TPN, daily weighing
• Prepare for surfactant therapy
HEMORRHAGIC DISEASE OF NB
• Deficiency of Vitamin K
• Signs: petechiae, bleeding at conjunctiva,
mucus membranes, retina, vomit blood, black
tarry stools
• 2nd- 5th day of life
• Management: Vit k 1 mg
SEPSIS
• Infection in blood due to wrong aseptic
techniques
• Signs: pallor, tachypneas, poor feeding-
abdominal distention
• Management: Monitor respirations, prevent
apnea, oxygen administration, keep warm and
assess feeding
MECONIUM ASPIRATION
SYNDROME
• SIGNS:
• Hypoxia of fetus in utero
• Amniotic fluid is greenish black
• Tachypnea, retractions, cyanosis
PRIORITIES
• Suction while at perineum before delivery of shoulders
• Intubate and suction asap
• Do not oxygenate by bag or mask until after intubated & suctioned
• Antibiotics
• Observe for signs of heart failure
• Maintain good temperature
APNEA
• SIGNS:
*Absence of respirations longer than 20 seconds with
bradycardia
*cyanosis
PRIORITIES:
*gently shake infant or rub sole or foot
*maintain good temperature
*handle gently
*burp well
SIDS-SUDDEN INFANT DEATH
SYNDROME
• Unexplained death that peaks on 2nd-4th months of life
• Risk: adolescent mothers, close spacing between pregnancies,
preterm infants.
• Major factor of death: Apnea
• Usually found with blood-flecked sputum or vomitus in mouth
Does not make any sound before death manifesting
laryngospasm.
POSSIBLE PREVENTION:
*Prevent apnea
*Avoid lying on abdomen
OPTHALMIA NEONATORUM
Conjunctivitis due to gonnorheal and
Chlamydial infections (STDs)
*Put eye ointment- erythromycin
*Use gloves
INFANT GROWTH & DEV’T
MONTH MOTOR FINE SOCIALIZAT PLAY
DEVT MOTOR ION&
DEVT LANGUAGE
1 Largely reflex Keeps hands Enjoys watching
fisted, able to face of primary
follow object caregiver,
midline listening to
soothing sounds
2 Holds head up Social smile Makes cooing Enjoys bright-
when prone sounds, diff.cry colored mobiles
3 Holds head and Follows Laughs out loud Spends time
chest up when objects fast looking at hands
prone midline or uses them as
toy
4 Grasp, Need space to
stepping, tonic turn
neck reflexes
fading
MONTH MOTOR FINE SOCIALIZAT PLAY
MOTOR ION
5 Turns front to May say bowel Handles rattle
back, no longer sounds well
has head lag
when pulled
upright, bears
partial weight
on feet when
held upright