正常足月新生兒的護(hù)理 (兒童護(hù)理課件)

正常足月新生兒的護(hù)理

TermInfantsCare漢中職業(yè)技術(shù)學(xué)院臨床護(hù)理教研室足月兒的特點(diǎn)TheCharacteristicsofTermInfants2足月兒TermInfants胎齡（Gestationalage）37~42周體重（Weight）2500~4000g身長(zhǎng)（Height）＞47cm無(wú)畸形和疾?。∟odeformityordisease）活產(chǎn)（Living）外觀特點(diǎn)（Appearance）四肢屈曲flexion皮膚紅潤(rùn)red皮下脂肪豐富fat毳毛少hairless外觀特點(diǎn)（Appearance）耳軟骨發(fā)育好cartilage耳舟成形scapha耳廓直挺auricle外觀特點(diǎn)（Appearance）平均breast7mm乳腺結(jié)節(jié)breastnodule＞4mm外觀特點(diǎn)（Appearance）跖紋遍及整個(gè)足底Footprints外觀特點(diǎn)（Appearance）陰囊多皺摺Wrinkledscrotum睪丸已降Testiculardescent外觀特點(diǎn)（Appearance）大陰唇遮蓋小陰唇Labiamajora體溫調(diào)節(jié)（Temperatureregulating）體溫隨著環(huán)境溫度升降A(chǔ)mbienttemperature新生兒體溫調(diào)節(jié)中樞發(fā)育不完善易發(fā)生“脫水熱”Dehydrationfever新生兒通過皮膚蒸發(fā)和出汗散熱，室溫過高時(shí)，引起體內(nèi)水分過多丟失，出現(xiàn)發(fā)熱呼吸系統(tǒng)（Respiratorysystem）以腹式呼吸為主Abdominalrespiration呼吸較淺Shallow頻率較快Rapid，40次/分左右喉軟骨尚未發(fā)育完全Thelaryngealcartilageisnotfullydeveloped呼吸系統(tǒng)（Respiratorysystem）循環(huán)系統(tǒng)(Circulatorysystem)心率(heartrate)通常為90～160次/分，平均120~140次/分血壓(BP)平均為70/50mmHg（9.3/6.7kPa）消化系統(tǒng)(Digestivesystem)消化道面積相對(duì)較大Largeareaofdigestivetract管壁薄，通透性高Thinwallhashighpermeability消化系統(tǒng)(Digestivesystem)溢乳(spitup)胃呈水平位Thestomachishorizontal賁門松弛Cardiacrelaxation幽門發(fā)育較好Pylorusiswelldeveloped消化系統(tǒng)生后24小時(shí)內(nèi)開始排出胎糞Meconiumexcretionbeginswithin24hoursafterbirth約2~3天過渡到正常糞便Last2~3days泌尿系統(tǒng)生后24小時(shí)內(nèi)排尿Urinatewithin24hoursafter易水電解質(zhì)紊亂、酸堿失衡EdemaordehydrationHypocalcemiaMetabolicacidosis神經(jīng)系統(tǒng)(Nervoussystem)腦相對(duì)較大Largebrain大腦皮層興奮性低Corticalexcitabilityislow神經(jīng)系統(tǒng)(Nervoussystem)出生時(shí)暫時(shí)性原始反射覓食rootingreflex神經(jīng)系統(tǒng)(Nervoussystem)出生時(shí)暫時(shí)性原始反射吸吮suckingreflex神經(jīng)系統(tǒng)(Nervoussystem)出生時(shí)暫時(shí)性原始反射握持graspreflex神經(jīng)系統(tǒng)(Nervoussystem)出生時(shí)暫時(shí)性原始反射擁抱Mororeflex神經(jīng)系統(tǒng)(Nervoussystem)出生時(shí)暫時(shí)性原始反射正常情況下，生后數(shù)月這些反射自然消失Afterafewmonthsthesereflectionsdisappearnaturally神經(jīng)系統(tǒng)(Nervoussystem)巴氏征等病理反應(yīng)可呈陽(yáng)性Barbinskitestedpositive免疫系統(tǒng)（Immunesystem）胎兒可通過胎盤從母體獲得IgGThefetusreceivesIgGfromthemotherthroughtheplacenta出生數(shù)月后逐漸消失TheydisappearafterafewmonthsIgA和IgM則不能通過胎盤IgAandIgMcannotpassthroughtheplacenta故新生兒易患呼吸道、消化道感染Newbornsarepronetorespiratoryanddigestivetractsensations免疫系統(tǒng)（Immunesystem）人的初乳中含較高SIgAHumancolostrumcontainshigherSIgA增強(qiáng)呼吸道、消化道抵抗力enhanceneonatalrespiratorytract,digestivetractresistance免疫系統(tǒng)（Immunesystem）特殊生理狀態(tài)

(Specialphysiologicalstate)生理性體重下降生理性黃疸乳腺腫大假月經(jīng)“馬牙”“螳螂嘴”生理性體重下降

(Physiologicalweightloss)

皮膚無(wú)黃染生理性黃疸生理性黃疸

(Physiologicaljaundice)母體雌激素影響Maternalestrogeneffect乳腺腫大假月經(jīng)乳腺腫大和假月經(jīng)

(Breastenlargementandfalsemenstruation）“馬牙”“螳螂嘴”馬牙和“螳螂嘴”

(Epithelialpearls&Babyface)足月兒日常護(hù)理DailycareforTermInfantsDailycareforTermInfants維持體溫穩(wěn)定保持呼吸道通暢預(yù)防感染合理喂養(yǎng)日常觀察和記錄維持體溫穩(wěn)定

(Maintainbodytempstability)體溫易隨著環(huán)境溫度而變化Ambienttemperaturevariation環(huán)境溫度達(dá)到中性溫度neutraltemperature避免脫水熱（后頸處無(wú)汗溫暖）NosweatandwarmthatthebackoftheneckNeutralTemperature又名適中溫度指適中的環(huán)境溫度機(jī)體能夠維持體溫正常所需的代謝率和耗氧量最低時(shí)的環(huán)境溫度不冷不熱剛剛好維持體溫穩(wěn)定

(Maintainbodytempstability)在穿衣蓋被的條件下Undertheconditionofcovering房間溫度應(yīng)控制在22~24℃Roomtemperature:22~24℃維持體溫穩(wěn)定

(Maintainbodytempstability)穿多不利于大腦的發(fā)育Wearingtoomuchisbadforbrain應(yīng)著重環(huán)境溫度Focusonambienttemperature少穿衣服Wearlessclothes維持體溫穩(wěn)定

(Maintainbodytempstability)保持呼吸道通暢

(Keepairwayopen)咳嗽反射不佳Poorcoughreflex分泌物難以自行排出Secretiondifficulttoexclude喂奶后豎抱輕拍背部Verticalbabypatback減少溢乳、嘔吐Reducegalactorrhea,vomiting防止引起窒息Preventsuffocation新生兒newborn肩上拍嗝Burpontheshoulder保持呼吸道通暢

(Keepairwayopen)＞6個(gè)月＞6mon手上拍嗝Burpyourhands保持呼吸道通暢

(Keepairwayopen)嗆奶/異物吸入milkchoking腿上拍嗝Burpyourlegs俯臥位Proneposition拍擊肩胛部Hittheshoulderblades保持呼吸道通暢

(Keepairwayopen)預(yù)防感染(Preventinfection)免疫力差Poorimmunity消毒隔離Disinfectionisolation照顧者勤洗手Washhands患病者護(hù)理新生兒時(shí)戴口罩Wearingmask玩具經(jīng)常清潔Toysclean保持臍部清潔干燥Keeptheumbilicalcordcleananddry每天早晚沐浴后消毒Disinfecteverymorning,eveningandafterbathing直至臍部長(zhǎng)好Untiltheumbilicusgrows預(yù)防感染(Preventinfection)皮膚黏膜護(hù)理SkinandmucosaDiaper尿布柔軟，吸水性好Clothes衣服寬松舒適，不用紐扣Cleanuptheshit每次便后清洗臀部Washingeveryday每天洗澡預(yù)防感染(Preventinfection)Ⅰ類疫苗嚴(yán)格按照國(guó)家規(guī)定，按時(shí)完成免疫程序FreeofchargeⅡ類疫苗在經(jīng)濟(jì)允許的條件下，鼓勵(lì)接種，手足口、輪狀，流感Payforcash預(yù)防感染(Preventinfection)合理喂養(yǎng)(Reasonablefeeding)幼年肥胖成年以后的肥胖心血管等疾病Whitefat≠healthy根據(jù)孩子生長(zhǎng)需求Accordingtothechild'sgrowthneeds安排每頓的飯量Planeverymeals滿足孩子的生長(zhǎng)發(fā)育所需Meetthegrowthanddevelopmentneeds不會(huì)導(dǎo)致過度喂養(yǎng)Itdoesnotleadtooverfeeding合理喂養(yǎng)(Reasonablefeeding)合理喂養(yǎng)(Reasonablefeeding)合理喂養(yǎng)(Reasonablefeeding)母乳或