PRESENTED BY:ROS ANGELES

LECTURERTMM COLLEGE OF

NURSING

DIFFERENCE BETWEEN PRETERM AND TERM INFANT

CHARACTERISTICS PRETERM TERM

Posture The preterm infant lies in a relaxed attitude , limbs more extendedThe body size is smallHead may appear somewhat larger in proportion

Term infant has more subcutaneous fat tissues and rests in a more flexed attitude

Ear, hair PRETERM Ear Cartilages are

poorly developed Ear may fold easily Hair is fine and

feathery Lanugo may cover the

back and face

TERM The mature infants ear

cartilages are well formed

Hair is more likely to form firm , separate strands

Sole

PRETERM More rigid Fine wrinkles TERM Well and

deeply creased

FEMALE GENITALIA

PRETERM Clitoris is prominent . Labia

majora are poorly developed and gaping

TERM Labia majora fully developed Clitoris not prominent

Male genitaliaPRETERM

Male infant’s scrotum is undeveloped and not pendulous

Minimal rugae are present Testes may be in the inguinal

canal or in the abdominal cavity

TERM

Scrotum well developed Pendulous Rugated Testes well down in the

scrotal sac

Grasp reflex The preterm infant’s grasp is weak; The term infant’s grasp is strong, allowing the

infant to be lifted up from the mattress

BALLARD SCORE

Posture

Square window

-1 0 1 2 3 4

Wrist flexibility and/or resistance

Arm recoil

-1 0 1 2 3 4

measuring the angle of recoil following very brief extension of the upper extremity.

Popliteal angle This maneuver assesses maturation of

passive flexor tone about the knee joint by testing for resistance to extension of the lower extremity-1 0 1 2 3 4 5

Scarf Sig

Preterm Elbow may be easily brought across the chest with little or no resistance

Term resisting attempt to bring the elbow past the midline-1 0 1 2 3 4

Heel to Ear

-1 0 1 2 3 4

DIFFERENCE BETWEEN ADULT AND CHILD

INTRODUCTION:

Children and adults differ physically and mentally.

As a nurses it is necessary to learn the differences to deliver the care accordingly.

CLASSIFICATION:

Anatomical differences Physiological differences Psychological differences

ANATOMICAL DIFFERENCES:

SIZE - size of children differ according to age.

Greater size and weight of the newborn’s head as compared to the body length and weight.

Immaturity and inadequate ossification - prone for injuries

Sutures and skulls are not united.

Fontanels are not closed The infant’s bone is neither

as firm nor as brittle as those of the older child.

Thus when the intracranial pressure develops in the infant, the head enlarges as the sutures separate. This is not possible in the older children and adult.

Shape of the head and chest can be altered by constant pressure from lying in one position.

Muscles are 25% of weight in infants and it is 40% in adult.

Integumentary system

Sweat glands function irregularly during infancy and toddler period. They increase in activity during adolescence

DRUG DOSAGE: Excessive IV fluids and medications easily causes

pedal edema. Hence rate of flow should be adjusted. Dosage calculation of drug is also necessary.

EYES:

No tears in early infancy- due to poor functional development of lacrimal gland. Tear production starts by 2 months of age

TRACHEA: Short and narrow trachea under 5

years- susceptible to foreign body aspiration.

EUSTACHIAN TUBE: It is short and straight in children (10 degree in

children and 40 degree in adults). Air sinuses are not fully developed Sore throat extends to otitis media because of the

closeness of it to throat.

GI TRACT:

In children cardiac sphincter of the stomach is relaxed.

Vomiting is so frequent, hence proper positioning of the child during feed is so important.

Poor protection of the liver and spleen – prone for trauma.

EXCRETION:

Kidney function is reduced. Urine is not concentrated

PHYSIOLOGICAL DIFFERENCES:

ABSOLUTE MEASUREMENTS:

Rapid loss of 35 ml of blood by a newborn baby represents 10% of blood volume.

This much loss can lead to circulatory failure.

BASAL METABOLIC RATE

BMR rate is high in newborn. In neonate 6-8ml of oxygen/ kg/ min is

normal whereas 2-4 ml of oxygen/kg/min is normal in adults.

Increased CO2 due to more metabolic rate.

TEMPERATURE REGULATION:

Poor thermo regulation is attributed to immaturity of the hypothalamus.

Shivering and sweating mechanisms are absent in newborn.

Brown adipose tissue in newborn: Reserve of brown

fat from which heat can be liberated by non shivering thermogenesis.

Once used brown fat cannot be replaced.

VOLUNTARY CONTROL: No voluntary control over the environment or

activity. (Eg.) On cold day adult used to wear socks,

woolen clothes etc. but the child depends on the care takers.

PROPORTION OF WATER:

ICF- Less ECF- More

(double than the adults)

Easily fluctuates during the GI infections.

BLOOD VOLUME:

Neonate- 85 ml/kg of BW.

Adult- 60-70 ml/kg of BW.

GLOMERULAR FILTRATION RATE: Concentration of urine in

newborn is 800 mOsmol/L whereas in adults it is 1400 mOsmol/L.

GFR and tubular functions are lower in neonates than adult because low blood supply to kidney, smaller pore size and less filtration power across nephron.

GFR- 38 ml/ min (neonate)

GFR- 125 ml/min (adult)

ALIMENTARY TRACT: Stomach capacity

of newborn – 90 ml Water absorption

is poor – faeces of the child is watery.

Dehydration leads to circulatory failure within 24 hours if treatment is inadequate.

CARDIO VASCULAR SYSTEM:

Change from fetal to normal circulation. Functional closure- within few hours after delivery Structural closure- within 6 weeks

Foramen ovale- fossa ovalisDuctus arteriosus- ligamentum arteriosumDuctus venosus- ligamentum venosumUmbilical veins- ligamentum teres

The weight of heart

increases rapidly after

4th month of gestation. During the newborn period there is little

gain in the weight of the heart, but from the age of 4 week to puberty the heart increases steadily in the size and weight.

It increases to adult size soon after the end of the adolescent growth spurt.

Heart rate is more in children.

Newborn – 110-160 beats/ min.

Hematologic system The red blood cells of the

newborn infant are quite different from those of the adult in that they are macrocytic

Life span of RBC Adult – 120 days Neonate – 90 days

RESPIRATION:

Respiratory rate is 35-40 breaths/ min.

The alveolar sacs are shallow in neonate The amount of dead air space, where air

passes but gases are not exchanged, is large during neonatal and infant life, therefore proportionately more air must be

moved in and out of the lungs than is necessary in the older child.

This is the reason the respiratory rate is so rapid.

The alveolar surface area of adult is about 20 times that of new born infant.

The weight of adult lung is also 20 times that of newborn.

As the volume of the lung increases with the child’s growth, the respiratory rate gradually decreases

HEPATIC FUNCTION:

•Immature- physiological jaundice.•Production of albumin, clotting factors and vitamin K are less.•Iron reserve is less.

CENTRAL NERVOUS SYSTEM:90% of brain growth

takes place by 2 years of age.

Nerve endings in the retina (rods and cones) are not fully developed. Thus the images are blurred and colourless for few weeks.

PSYCHOLOGICAL DIFFERENCES: Fear , escape and avoid strangers

till 5 years of age. Explore the environment. INFANCY- more bonding with

parents. Seperation anxiety is very

common. TODDLERS – Negativistic

behaviours

CONTD..

PRE SCHOOLER- short attention span, easily distractable.

ADOLESCENTS- Identity of peer, confusion.

Differences between adult

and pediatric nursing

Pediatrics differs from adult medicine in many respects.The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern in pediatrics than in adult

Treating a child is not like treating a miniature adult. A major difference between pediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure.

In a sense, pediatricians often have to treat

the parents and sometimes, the family, rather than just the child.

The respiratory rate of a child is faster than that of an adult.A child's trachea opening and the

esophagus opening are closer together

than in an adult.Children dehydrate easily.Children have less blood than adults. This makes children at greater risk than adults from bleeding to death or developing severe shock from a relatively minor wound