Newborn Complications

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Maternity/OB Nursing

Late Preterm Infants

• Incidence and etiology
• Characteristics of late preterm infants
- Appearance:
~34-36.6 weeks
~Can look full-term, you may expect them to do what a full-term baby can, but they can't
~At risk for respiratory issues, hypothermia (low brown fat), jaundice
- Behavior
- Handled like a premie. Cannot do everything a term baby can.

Late Preterm Infants:
Assessment and Care of Common Problems

• Thermoregulation (will unstable, so check temperature 1-4 hours. If they are low or high, check more frequently. Encourage kangaroo-care.)
• Feedings (Limited, slow, weaker suck, periods of awake are much shorter than term baby. Be conscious if they are breast feeding. Check sugars on sides of heels.)
• Discharge (around 4-5 pounds. Educate mom to wake baby up to feed! Carseat test. Teaching parents to look for jaundice-peak day is 4-5 days. Frequent feeds.)

Preterm Infants

• Incidence and etiology: Disorders related to short gestation and low birthweight are second leading cause of infant mortality.
• Causes: Smoking, Infection, GDM, Trauma, HTN, multiple babies.
• Prevention: Prenatal care. Identify and treat risk factors.
• Characteristics of preterm infants: Lethargic, weak, flaccid tone, diminished reflexes, vernix and lanugo present, undescended testes, easily exhausted. Feeble cry. (Limit feedings to 20 minutes)

Preterm Infants:
Assessment and Care of Common Problems

•Respiration
-Surfactant. Put down ET tube.
•Assessment:
-Nursing interventions: Assess for apnea spells. (20 seconds) Check for cyanosis. Check for RR, nasal flaring. Assess cough reflex. Check ventilator settings. Checking nasal canula/CPAP. Suctioning (~3 seconds).

•Problems with thermoregulation:
•Assessment: Thin skin, limp body, lethargic, 98º axillary, first sign of a low temperature is respiratory distress.
-Nursing interventions: Neutral thermal environment, weaning to open crib.

•Problems with fluid and electrolyte balance:
•Assessment: Will not maintain water in skin (insensible water loss)
-Nursing interventions: dilute, keep area humidified, weigh diapers (1g=1mL), check mucous membranes, UAUV central line (aseptic techniques, watch med doses, check connections, check tubing, buretrol

• Problems with the skin: press the nose to check for jaundice, mottling (tells that baby is cold), skin is paper thin so be careful with tape!

• Problems with infection 3-10 x greater than full term

• Problems with pain:
-Feet very sensitive due to blood sticks, use sweeties to calm them down

Application of the Nursing Process: Preterm Infant

Environmentally caused stress
- Assessment
- Analysis
- Planning
- Interventions
- Evaluation

Nutrition
- Assessment: Check O2 levels, weight gain, diapers. Try and get them to breast feed. Cannot do oral feedings if they are having respiratory distress. Start with trophic feeds, then check residuals. Encourage breast feeding/pump.
- Analysis
- Planning: eat and gain wt
- Interventions: Parenteral feedings, Enteral feedings, Gavage feedings, Oral feedings, Facilitate breast-feeding
- Evaluation


Parenting
- Assessment: attachment and bonding
- Analysis:
- Planning:
- Interventions: Advanced preparations, Assist at birth, Support, Information, Kangaroo care, Interaction, Increase decision making, Alleviate concerns, Ongoing problems (developmental, respiratory status), Discharge
- Evaluation

Respiratory Distress Syndrome

• Pathophysiology: less than 28 weekers or less than term, Risk (prolonged rupture of membranes, infection, GDM, maternal drug use)
• Manifestations:
• Therapeutic management:
• Nursing considerations: pulse ox 88-92, position changes, decrease O2 demand by putting in thermo-neutral environment, humidified air, check sugars, feed no longer than 20 min, clustered care, limit kangaroo-care according to baby's tolerance.

Bronchopulmonary Dysplasia

• Pathophysiology: loss of cilia
• Manifestations: kids are going to need O2 and you can't wean them off. Bronchospasms, increased mucous production.
• Therapeutic management:
• Nursing considerations: Give surfactant, give as minimal as needed O2, keep O2 sat around 88-92, prevent fluid overload, increase calories and protein (22-24 calorie formula)

Periventricular-Intraventricular Hemorrhage

• Pathophysiology: rupture of blood vessels in the dermal matrix. Hypoxic injury to the vessels. Can occurs with increase or decreased blood pressure. Graded from 1 (least) - 4(most). Diagnosed by ultrasound (through fontanel).
• Manifestations:
• Therapeutic management:
• Nursing considerations: evaluate early and do repeated screenings. Important to keep respiratory status and blood pressure stable. Don't overly stimulate or irritate baby. If they have a significant bleeds, they will have a shunt from head to the stomach. Keep handling to a minimum by clustering care. Elevate head 30º. Take care of pain issues before nurse causes pain.

Buretrol

type of infusion set used to prevent fluid overload and control volumes when IV pumo is not available.

Retinopathy of Prematurity (ROP)

• Pathophysiology: Visual impairment or blindness. Especially if baby is less than 1500g. Injury to the premature vessels in the eye. Cause unknown, but O2 is a contributing factor. 90% of babies can go blind. Painful procedure.
• Therapeutic management:
• Nursing considerations: Check O2 levels. Keep baby bundled and give sweeties. Support parents.

Necrotizing Enterocolitis

• Pathophysiology: inflamation and/or infection of the GI tract. Mortality is 35-40%. If baby survives, they may have short gut. Death to intestines by ischemia.
• Manifestations:
• Therapeutic management:
• Nursing Considerations: Check abdominal girth every feed. Check bowel sounds every diaper change. Check if baby is vomiting. Check for bile. What are the residuals? Free air in the peritoneum is bad! Encourage breastfeeding because lest common in breastfed babies. Stop feeds, put NG tube down, and suction! Go back on IV fluids and antibiotics. Slowly start milk back. Check I&O. Check position. Don't want diaper or inflamed bowels pressing on the diaphragm.

Postterm Infants:

• Scope of the problem: Can be large for gestational age (LGA), at risk for C-section, placenta is not working as well so the baby is not getting oxygen. If the baby is stressed, they will pass meconium which puts at risk for infection! Umbilicord is thin, little wartons jelly.
• Assessment:
• Therapeutic management:
• Nursing considerations: Check clavicles for broken bones (shoulder dysplacia). Check glucose. Check for meconium aspiration. Pay attention to decelerations. If the heart rate goes down, it is a toxic environment for baby and get out of Mom! Polycythemia--jaundice.

Small-for-Gestational-Age Infants

• Causes: GDM, HTN, alcohol or drug use
• Scope of problem: Greatest problem for those who are preterm and SGA.
• Characteristics: What drugs was mom taking? was it head sparing? Any kind of hypoxic events? Are they well nourished? Brain needs glucose! pay attention to blood sugar and jaundice
• Therapeutic management:
• Nursing considerations:

Large-for-Gestational-Age Infants

• Causes:
• Scope of problem: Shoulder dystocia, long labor
• Therapeutic management
• Nursing considerations: Check for injuries, polycythemia and jaundice.

Respiratory Complications

• Asphyxia: Condition caused by insufficient intake of oxygen. Interferes with cardiac status. Check respirations, heart rate via umbilical cord, color and O2 sat. May be able to give narcan depending on what meds mom was on during labor.

• Transient tachypnea of the newborn: appears soon after birth.. accompanied by retractions, expiratory grunting, cyanosis. Retained lung fluid. Resolves in 12-72 hours. Because of respiratory status, baby may not be able to feed. Nursing interventions: providing o2, ensuring warmth, observing respiratory status frequently, provide explanation to reassure parents, provide surfactant.

• Meconium aspiration syndrome: Abnormal inhalation of meconium produced by a fetus or newborn. Already took some sort of insult while inter. Surfactant is diminished or absent. Tachypnia, cyanosis, retractions, nasal flaring. Even if it is light meconium. Depending on how thick the fluid is, try and suction before they take the first breath. Suction Mouth first! Take to warmer bed and intimate with ET tube and use meconium aspirator.

• Persistent pulmonary hypertension of the newborn: Combined findings of pulmonary hypertension, right-to-left shunting, and a structurally normal heart. Is the failure of the normal circulatory transition that occurs after birth; causes hypoxemia. May have abnormal lung development. Cause isn't always known. Baby is in respiratory distressed. Watch O2 sats. Preductal post ductal pulse ox. If different, cardiac issue may be present.

Hyperbilirubinemia
(Pathologic Jaundice)

• Definition:
• Causes:
• Therapeutic management: Pay attention to output and dehydration
- Phototherapy:
- Exchange transfusions
-Complication:

Application of the Nursing Process Hyperbilirubinemia

• Assessment:
• Analysis:
• Planning
• Interventions:
• Evaluation

Infection

• Transmission of infections: before, during, or after birth.

• Sepsis neonatorum: Infection spreads rapidly cause: not always known, predisposing factor = prematurity, mostly caused by UTI, meningitis, or pneumonia
- Causes:
- Therapeutic management

- Nursing considerations: GSB cervical culture at 36weeks pregnant. If premie, treat prophylactically. Hand washing

Infant of a Diabetic Mother

• Scope of problem:
• Characteristics: LGA
• Therapeutic management
• Nursing considerations: hypoglycemia
• Nursing interventions: Check sugar!

Polycythemia

• Causes: preterm, incompatibility between mom and baby blood, LGA

• Manifestations: Enlarged heart, lethargy, poor suck, vomiting, jaundice, hydration

• Therapeutic management:
• Nursing considerations:

Hypocalcemia

• Causes: GDM, asphyxia babies, premies

• Manifestations: babies has jitters. Irritable babies, muscle twitching, seizures, abnormal ekgs, or can be asymptomatic.

• Therapeutic management:

• Nursing considerations: Check sugars, then check calcium level. Give calcium. Baby must be on a heart monitor while giving calcium.

Prenatal Drug Exposure

• Identification: excessive sneezing, rigid tone, excoriation, temperature instability, yawning, poor feeding, excessive sucking, high pitched cry, inconsolable, increased temperature, tremors, water/frequent stools, regurgitation, neonatal abstinence scoring.

• Therapeutic management: scoring, morphine.
• Nursing considerations: Cluster care, swadling, pascifier.
- Feeding:
- Rest:
- Bonding

Phenylketonuria

• Causes: CNS disorder. PKU deficiency in the liver. Can't break down sugars in food.
• Manifestations: Feeding problems. Seizures. Urine may have musty odor. Older children may have eczema. Mom will also be on special diet. Do screening 24-48 hours after delivery. Baby is more irritable.
• Therapeutic management:
• Nursing considerations:

Congenital Cardiac Defects Classifications

• Acyanotic defects: heart problems, but without turning blue. May have murmur, but not always. Is PDA. Baby fatigues more easily and is prone to respiratory infections. Increase work on heart and lungs.

• Cyanotic defects: Blood flow to the lungs is decreased. Hypoxemia, Frequent infections. Easily fatigues. Transposition of the great vessels.

• Left-to-right shunting: Greater work on the heart on the right side and on the lungs. CHF, PHTN.

• Defects with obstruction of blood flow: Stenosis. Blood is not getting out, and is back flowing. Pulmonary or aortic stenosis.

• Defects with decreased pulmonary blood flow: Systemic hypoxia. Cyanotic. Blood is not getting from the right side of the heart to the lungs.

• Cyanotic defects with increased pulmonary blood flow: Only survive if you have a mixing of the blood. Open something up so they get a mixture of the blood. Give prosteglandins.

Congenital Cardiac Defects

• Manifestations
- Cyanosis
- Heart murmurs: are the valves closing or staying open? If baby is on prostiglandins, no murmurs will be present. Heart murmurs in the first 24 hours are normal.
- Tachycardia and tachypnea: Is this interfering with feedings? Diaphoresis?
- Other signs: fatigue

• Therapeutic management:
• Nursing considerations: May need surgery, O2, prostaglandins, Check color, need for O2, provide rest if needed, tube feedings, support parents as needed.

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