正常足月新生儿的护理 (儿童护理课件)

正常足月新生儿的护理

TermInfantsCare汉中职业技术学院临床护理教研室足月儿的特点TheCharacteristicsofTermInfants2足月儿TermInfants胎龄（Gestationalage）37~42周体重（Weight）2500~4000g身长（Height）＞47cm无畸形和疾病（Nodeformityordisease）活产（Living）外观特点（Appearance）四肢屈曲flexion皮肤红润red皮下脂肪丰富fat毳毛少hairless外观特点（Appearance）耳软骨发育好cartilage耳舟成形scapha耳廓直挺auricle外观特点（Appearance）平均breast7mm乳腺结节breastnodule＞4mm外观特点（Appearance）跖纹遍及整个足底Footprints外观特点（Appearance）阴囊多皱摺Wrinkledscrotum睾丸已降Testiculardescent外观特点（Appearance）大阴唇遮盖小阴唇Labiamajora体温调节（Temperatureregulating）体温随着环境温度升降Ambienttemperature新生儿体温调节中枢发育不完善易发生“脱水热”Dehydrationfever新生儿通过皮肤蒸发和出汗散热，室温过高时，引起体内水分过多丢失，出现发热呼吸系统（Respiratorysystem）以腹式呼吸为主Abdominalrespiration呼吸较浅Shallow频率较快Rapid，40次/分左右喉软骨尚未发育完全Thelaryngealcartilageisnotfullydeveloped呼吸系统（Respiratorysystem）循环系统(Circulatorysystem)心率(heartrate)通常为90～160次/分，平均120~140次/分血压(BP)平均为70/50mmHg（9.3/6.7kPa）消化系统(Digestivesystem)消化道面积相对较大Largeareaofdigestivetract管壁薄，通透性高Thinwallhashighpermeability消化系统(Digestivesystem)溢乳(spitup)胃呈水平位Thestomachishorizontal贲门松弛Cardiacrelaxation幽门发育较好Pylorusiswelldeveloped消化系统生后24小时内开始排出胎粪Meconiumexcretionbeginswithin24hoursafterbirth约2~3天过渡到正常粪便Last2~3days泌尿系统生后24小时内排尿Urinatewithin24hoursafter易水电解质紊乱、酸碱失衡EdemaordehydrationHypocalcemiaMetabolicacidosis神经系统(Nervoussystem)脑相对较大Largebrain大脑皮层兴奋性低Corticalexcitabilityislow神经系统(Nervoussystem)出生时暂时性原始反射觅食rootingreflex神经系统(Nervoussystem)出生时暂时性原始反射吸吮suckingreflex神经系统(Nervoussystem)出生时暂时性原始反射握持graspreflex神经系统(Nervoussystem)出生时暂时性原始反射拥抱Mororeflex神经系统(Nervoussystem)出生时暂时性原始反射正常情况下，生后数月这些反射自然消失Afterafewmonthsthesereflectionsdisappearnaturally神经系统(Nervoussystem)巴氏征等病理反应可呈阳性Barbinskitestedpositive免疫系统（Immunesystem）胎儿可通过胎盘从母体获得IgGThefetusreceivesIgGfromthemotherthroughtheplacenta出生数月后逐渐消失TheydisappearafterafewmonthsIgA和IgM则不能通过胎盘IgAandIgMcannotpassthroughtheplacenta故新生儿易患呼吸道、消化道感染Newbornsarepronetorespiratoryanddigestivetractsensations免疫系统（Immunesystem）人的初乳中含较高SIgAHumancolostrumcontainshigherSIgA增强呼吸道、消化道抵抗力enhanceneonatalrespiratorytract,digestivetractresistance免疫系统（Immunesystem）特殊生理状态

(Specialphysiologicalstate)生理性体重下降生理性黄疸乳腺肿大假月经“马牙”“螳螂嘴”生理性体重下降

(Physiologicalweightloss)

皮肤无黄染生理性黄疸生理性黄疸

(Physiologicaljaundice)母体雌激素影响Maternalestrogeneffect乳腺肿大假月经乳腺肿大和假月经

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

(Epithelialpearls&Babyface)足月儿日常护理DailycareforTermInfantsDailycareforTermInfants维持体温稳定保持呼吸道通畅预防感染合理喂养日常观察和记录维持体温稳定

(Maintainbodytempstability)体温易随着环境温度而变化Ambienttemperaturevariation环境温度达到中性温度neutraltemperature避免脱水热（后颈处无汗温暖）NosweatandwarmthatthebackoftheneckNeutralTemperature又名适中温度指适中的环境温度机体能够维持体温正常所需的代谢率和耗氧量最低时的环境温度不冷不热刚刚好维持体温稳定

(Maintainbodytempstability)在穿衣盖被的条件下Undertheconditionofcovering房间温度应控制在22~24℃Roomtemperature:22~24℃维持体温稳定

(Maintainbodytempstability)穿多不利于大脑的发育Wearingtoomuchisbadforbrain应着重环境温度Focusonambienttemperature少穿衣服Wearlessclothes维持体温稳定

(Maintainbodytempstability)保持呼吸道通畅

(Keepairwayopen)咳嗽反射不佳Poorcoughreflex分泌物难以自行排出Secretiondifficulttoexclude喂奶后竖抱轻拍背部Verticalbabypatback减少溢乳、呕吐Reducegalactorrhea,vomiting防止引起窒息Preventsuffocation新生儿newborn肩上拍嗝Burpontheshoulder保持呼吸道通畅

(Keepairwayopen)＞6个月＞6mon手上拍嗝Burpyourhands保持呼吸道通畅

(Keepairwayopen)呛奶/异物吸入milkchoking腿上拍嗝Burpyourlegs俯卧位Proneposition拍击肩胛部Hittheshoulderblades保持呼吸道通畅

(Keepairwayopen)预防感染(Preventinfection)免疫力差Poorimmunity消毒隔离Disinfectionisolation照顾者勤洗手Washhands患病者护理新生儿时戴口罩Wearingmask玩具经常清洁Toysclean保持脐部清洁干燥Keeptheumbilicalcordcleananddry每天早晚沐浴后消毒Disinfecteverymorning,eveningandafterbathing直至脐部长好Untiltheumbilicusgrows预防感染(Preventinfection)皮肤黏膜护理SkinandmucosaDiaper尿布柔软，吸水性好Clothes衣服宽松舒适，不用纽扣Cleanuptheshit每次便后清洗臀部Washingeveryday每天洗澡预防感染(Preventinfection)Ⅰ类疫苗严格按照国家规定，按时完成免疫程序FreeofchargeⅡ类疫苗在经济允许的条件下，鼓励接种，手足口、轮状，流感Payforcash预防感染(Preventinfection)合理喂养(Reasonablefeeding)幼年肥胖成年以后的肥胖心血管等疾病Whitefat≠healthy根据孩子生长需求Accordingtothechild'sgrowthneeds安排每顿的饭量Planeverymeals满足孩子的生长发育所需Meetthegrowthanddevelopmentneeds不会导致过度喂养Itdoesnotleadtooverfeeding合理喂养(Reasonablefeeding)合理喂养(Reasonablefeeding)合理喂养(Reasonablefeeding)母乳或