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56 terms

High Risk newborn

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Apnea
without breathing for longer than 20 sec. accompanied with cyanosis and bradycardia
premature
before 38 weeks
tocolytic agents
stops labor
Maternal risk factors
diabetes, HTN, drug use, smoking, age, nutrition, peridontal disease
hx of previous preterm births, infections, pre-eclampsia, chronic illness
Fetal risk factors
multiple gestation
placental risk factors
placenta previa, abruptio placenta
uterine risk factors
incompetent cervix, PROM(premature rupture of membranes) poly/oligohydramios (too much/too little amniotic fluid)
Premature infant characteristics
frail and weak, underdeveloped flexor muscles
large head in comparison to body
lack subcutaneous fat
vernix and lanugo plentiful
nipples and areola faintly visible
premature infant characteristics 2
plantar creases are absent
ears soft and flat, little cartilage
male- undescended testes, smooth scrotal sac
silverman-anderson index
related to respirations 10=bad
early signs of resp. distress
retractions and grunting
nursing interventions for baby in resp. distress
high frequency O2 ventilation
inhaled nitric oxide and liquid ventilation
(perfluorochemical fluid)
change positioning frequently.
normal newborn-on back
premature-side and prone
nursing interventions for baby in resp. distress 2
suction secretions
chest physiotherapy-using very light vibration to loosen secretions
maintain hydration - thinner=better
thermoregulation in premature infants
due to skin, less fat.
extended posture- dont have flex position
lack of O2
thermoregulation interventions
constant monitoring by a skin probe.
abdominal temp is ideally 36-36.5 degrees
normal BG in newborns
40-50
Dehydration symptoms
dry skin, poor skin turgor, fontanels depressed
elevated sodium and HCT levels
hypotension
weight loss, decreased urine output
Overload symptoms
edema, weight gain
bulging fontanels
decreased sodium and HCT levels
moist breath sounds
difficulty breathing
Skin problems
fragile, permeable, and easily damaged
dont use adhesive tape, benadine or alcohol
potential for infection
3-10 times greater in preterm infants
pain in infants
cry, vitals increase, high pitched cry, "cry face" O2 sats decrease, increased intracranial pressure
nutrition of preterm infants
do not have storage of calcium and iron
30-90% develop hypocalcemia
hypoglycemia develops rapidly
need average of 110kcal/day
freq swallowing/gulps=sign of trouble
nutritional interventions
parenteral nutrition-IV solutions
gavage used <34 weeks
oral feedings once they reach 34 weeks and are at least 1500 grams
provide carbs, amino acids, fatty acids, calories, vitamins and minerals
parental bonding
encourage touch-kangaroo care (skintoskin)
Respiratory distress syndrome
severe retractions, grunting
atelectasis and hypoxia, decreased blood flow
evident within a few hours of birth
nasal flaring, cyanosis
surfactant
plentiful by 34 weeks, produced by 22 weeks. without surfactant lungs become sticky
interventions for resp. distress syndrome
surfactant replacement
mechanical ventilation (cpap)
IV fluids
continuous airway pressure
periventricular-intraventricular hemorrhage
< 32 weeks with hydrocephalis
results from a rupture of blood vessels in the brain, associated with hypoxia
grade 1-4
peri-intra ventricular hemorrhage symptoms
lethargy, change in resp. status with cyanosis, decreased reflex, full or bulging fontanels and seizures
ventricular hemorrhage interventions
watch to see if head is getting bigger
measure head circumfrence
screening by US
may need shunting
handle the infant minimally and gently
Retinopathy of prematurity
can result in blindness or severe impairment
caused by damage to immature blood vessels in the retina of eye
can result from too much or not enough oxygen, acidosis, prolonged mechanical ventilation, sepsis
MONITOR pulse ox readings
at risk <28 weeks, 1500 grams
necrotizing enterocolitis (NEC)
necrotic lesions of the mucosa of the intestines
caused by interference with blood supply to the intestinal mucosa
decreased blood supply can be caused by hypoxia
symptoms of NEC
increased abdominal girth
increased gastric residual
decreased or absent bowel sounds
loops of the bowels seen through abd. walls
vomiting, bile stained residuals
blood in stools
change in VS, infection
x-ray shows gas in intestinal wall
NEC interventions
antibiotics, d/c oral feedings, surgery
enteral feedings, ostomy
post-term infant
those born after the 42 week of gestation
SGA
fall below the 10th percentile
IUGR due to many reasons-often poor placental functioning
LGA
above the 90th percentile
weigh more than 4000g-8lbs,13 oz
longer labor
injury common during birth
look for injuries,hypoglycemia,polycythemia(abnormal # erythrocytes)
c-sections are common
Meconium aspiration syndrome(MAS)
10-15%
occurs in infants who have decreased amniotic fluid and are prone to cord compression
rare before 38 weeks
results in obstruction of the airways, pneumonitis, and persistant pulmonary hypertension
MAS causes
most often seen when hypoxia causes increased peristalsis and relaxation of the anal sphincter previous to or during labor
meconium in the amniotic fluid enters the fetuss lungs during episodes of hypoxia
MAS assessments/treatment
dark staining, x ray findings=patchy infiltrates of adelectasis, barrel chest
-clear the airway
scope is passed and infant is suctioned before its first breath, ET tube is placed if needed
extracorporeal membrane oxygenation
hyperbilirubinemia
pathologic jaundice
bilirubin level 5-7mg jaundice is visible
incapitibiltiy between blood of mother and fetus. rh- mom/rh+ baby
kernicterus
deposits of bilirubin in the basal ganglia, cerebellum and hippocampus
(bilirubin encophalogy)
nursing interventions for hyperbilirubinemia
diagnose babys blood type-coombs test
follow bilirubin levels closely
phototherapy-special fluorescent lights
exchange transfusions
phototherapy
bilirubin in the skin absorbs the light and is changed into water soluble products-limirubin
then limirubin is excreted in stool and urine
side effects- eye damage, frequent loose stools , green stools
at risk for dehydration
exchange transfusions
done when phototherapy isnt working
removes antibodies,bilirubin, and sensitized RBCs before they breakdown
type O rh neg blood is used to replace blood removed
vertical infections
rubella, CMV, alovirus, syphilis, toxoplasmosis, group B streptococci, hep B and herpes
horizontal infections
nosocomial infections or from family
sepsis infections
bacteria in blood stream during or after birth
collect many cultures. CBC, c&s
pre terms at risk
be vigilant-watch behaviors and temp
CRP C-reactive protein=sign of inflammatory process going on.
infant of diabetic mother
may be SGA if mom has had DM for a long time and has vascular changes
congenital anomalies are more common
high risk for asphyxia and RDS
HYPOGLYCEMIA!
BG levels need to be at least 45
IDM interventions
infants need to be fed immediately if hypoglycemia occurs
gavage if infant is not sucking well or has tachypnea
use of formula or breast milk-prevents rapid rise in BS that comes from dextrose in water feedings
Hypocalcemia
serum blood levels less than 7 mg
be alert for tremors,irritability,poor feeding,high pitched cry, apnea, muscle twitching, seizures, tachycardia,jitters,EKG changes
IV- calcium gluconate-watch for bradycardia or arrythmias
drug exposed infant
most drugs cross placenta
abuse in first 2 months can cause congenital anomalies, later interferes with development
assess for neonatal abstinence syndrome
cocaine exposed infants
experience neurotoxicity but not withdrawal
S&S of drug babies
jittery, exaggerated rooting reflex, freq vomiting, weak uncoordinated sucking, resp. signs, nasal stuffiness, sneezing, tachypnea, retractions. high pitched cry
nursing care for drug babies
collect ordered specimans-urine , blood
look for co-morbid conditions
administer meds as ordered
may need gavage or IV nutrition-increase Kcal.
referrals are needed
Phenylketonuria
genetic disorder that causes toxic levels of amino acid-phenylalbumin in blood.
deficiency in liver enzymes
"heel stick"