high risk newborn 2

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  1. Acquired disorder v congenitial disorder
    • Acquired:
    • - happens at or soon after birth
    • - problems or conditions experienced by the woman during pregnancy or at birth
    • - possibly no identifiable cause for this disorder
    • Congenital
    • - present at birth. usually due to some malformation occuring during the antepartum period, typically some people with inheritance
    • - majority with complex etiology
    • high risk babies
  2. Acquired conditions of the newborn
    • neonatal asphyxia
    • transient tachypnea of the newbor
    • respiratory distress syndrome
    • meconium aspiration
    • persistent pulmonary hypertension of the newborn
    • peri-intraventricular hemorrhage
    • necrotizing enterocolitis
    • infants of DM moms
    • birth trauma
    • newborns of perinatal substance abuse moms
    • hyperbilirubinemia
    • newborn infections
    • (identifiable; what does the baby look like how does this differ from other things)
  3. Transient Tachyapnea of the newborn TTN
    • mild respiratory distress; pulmonary liquid removal slowly or incompletely. resolution by 72 hours age; ducts need to close
    • Nursing assessment:
    • maternal sedation or c-section (bc they don't get the squeeze to get liquid out), tachypnea, expiratory grunting, nasal flaring, mild cyanosis, RR possibly 100-140, barrel,shape chest, decr breath sounds, at risk for low BS (anytime baby looks stress check sugar
  4. TTN nursing management
    • oxygenation: never put them on 100% oxygen it should be blended O2. titrate oxygen level down
    • supportive care
    • IV fluids of gavage feedings
    • supplement O2
    • neutral thermal enviroment
    • (preterm risk: stat low 92% bc of their eyes)
    • symptoms start to resolves..can titrate O2 down.
  5. Respiratory Distress Syndrome (RDS)
    • Preterm
    • Lung immaturity and lack of alveolar surfactant
    • Nursing Assessment:
    • - risk factor (preterm)
    • - expiratory grunting (trying to get alveoli open), nasal flaring, chest wall retractions, see saw respirations, generalized cyanosis, HR > 150 to 180; fine crackles during inspiratory, tachyapnea >60, silberman-anderson index score > 7 (chest wall movement)
    • chest x-ray shows hypoaeration, under expansion, ground glass pattern (high levels of oxygen)
    • Oxyhood humidify
  6. RDS nursing management
    • supportive care (stress), close monitoring
    • respiratory modalities RR: ventilation (cpap, PEEP); exgenous surfactant; oxygen therapy
    • antibiotics for positive cultures; correction of metabolic acidosis
    • fluids and vasopressory; gavage IV feedings
    • blood glucose level monitoring
    • cluster of care; prone position (so you don't over stimulate)
    • parental support and education
  7. Meconium aspiration syndrome
    • inhalation of particular meconium with aminiotic fluid into lungs; secondary to hypoxic stress (1st), gets down in the alveoli and messing with surfactant
    • Nursing assessment:
    • - risk factors: postterm, term
    • - staining of amniotic fluid, nails, skin, or umbilical
    • - barrel shape chest: prolonged tachypnea, incr respiratory distress, coarse, crackles and rhonchi
    • - chest x-ray: patchy fluffy infiltrates, hyperaeration with atelectasis, ABG's metabolic acidosis
    • thick and sticky
  8. meconium aspiration syndrome
    nursing management
    • suctioning at birth
    • adequate tissue perfusion
    • decrease in oxy demand and energy expenditure
    • neutral thermal enviroment
    • parental support and education
    • monitor glucose
  9. Persistant Pulmonary Hypertension of the newborn (PPHN)
    • marked pulmonary hypertention causing right to left extrapulmonary shunting and hypoxemia- preterm babies. baby is not getting oxygenated blood from the lungs (bc it doesn't touch the lungs)
    • Nursing assessment
    • tachyapnea 12 hours after
    • marked cyanosis, grunting and retraction
    • systolic ejection murmur (PDA stayed open)
    • echocardiogram will show right to left shunting
    • risk- baby asphyxia, meconium (bc you need to breath to get the shunt to close)
  10. PPHN nursing management
    • monitoring of oxy level, respiratory support, perfusion
    • immediate resuscitation, oxygen therapy
    • cluster care
    • education, support parents
    • medications
  11. Periventricular- Intraventricular Hemorrhage (PVH/IVH)
    • bleeding in the brain due to fragility of cerebral vessels, most common in the first 72 hours after birth; grades I to V
    • Nursing Assessment
    • possibly no symptoms
    • risk factor: premature baby
    • unexplain drop in HCT (where did the blood go), pallor, poor perfusion, seizures, lethargy, weak suck, high pitched cry, hypotonia
    • cranial U/S
    • the more bleeding the more damage
  12. PVH/IVH nursing management
    • prevention- prevent preterm birth, head trauma
    • flexed contained condition (how they are in utero)
    • daily head circumstance
    • correction of anemia
    • fontanels
    • cluster care
    • parental support
    • big unknown- outcome brain damage delayed
    • usually bleed into their ventricular
  13. Necrotizing enterocolitis NEC
    • 3 pathologies mechanism: bowel ischemia, bacterial flora, and effect of feeding
    • Nursing assessment
    • risk factor: preterm- baby not breathing, no transition, they are going to perfuse their vital organs first so the tummy is left out
    • s/s: abd distention and tenderness, bloody stools, feeding intolerance (bilous vomiting- not making it to thru intestine), sepsis, lethargy, apnea, shock (remember there is dead tissue there)
    • Kidney Urine Bladder x-ray KUB: air in bowel wall, dilated bowel hoops
  14. NEC nursing management
    • maintenence of fluid and nutritional status (IV)
    • bowel rest and antibiotic therapy IV
    • surgery with proximal enterostomy (colonosomy)
    • support care
    • family
  15. infants of DM moms
    • high levels of maternal glucose crossing placenta; stimulating increase glucose production and leading to somatic fetal growth
    • Nursing assessment:
    • mom with DM
    • risk: hypoglycemia bc you cut them off from their mom. Initiating feedings for them as soon as possible, birth trauma
    • full rosy cheeks, ruddy skin color, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subcutaneous fat tissue, hypoglycemia, polycythemic,
    • hypocalcemia, hypomagnesemia, hyperbilirubinemia
  16. Infants of DM nursing management
    • prevent hypoglycemia (feed baby, neutral thermal environment and rest periods)
    • maintenance of fluid and electrolyte balance (calcium balance, fluid therapy, bilirubin level monitoring)
    • parental support education
    • s/s of hypoglycemia: poor feeding, jitterness, hypothermia, weak cry, lethargy, flaccid tone, seizure leading to coma
  17. common problem infants with DM mom
    • Macrosomia
    • respiratory distress- lungs immature
    • hypoglycemia
    • hypocalcemia
    • hypomagnesium
    • polycythemia HCT > 65
    • hyperbilirubinemia > 12
    • congenital anomales
    • mom need glycemic control
    • Normal LSA ratio 2:1
    • DM 3:1
  18. birth trauma
    • injuries due to birth and labor
    • types: factures, brachial plexus injury, cranial nerve trauma, head trauma (cephalohematoma , caput succeedaneum table 24.3)
    • Nursing Assessment:
    • Risk factor:how is the baby moving
    • physical and neurological assessment: bruising, bumps, swelling, paralysis, symmetry or structures and function
    • LGA DM babies
  19. Birth trauma: nursing management
    • supportive
    • assessment for resolution or complications
    • support and education; realistic appraisal of situation
    • community referral for ongoing f/u and care
  20. Newborns of Substance-Abusing mothers
    • most common: tobacco, alcohol, and marijuana
    • fetal alcohol syndrome: physical and mental disorders, appearing at birth and remaining problematic through out child's life
    • fetal alcohol spectrum disorders- developmental issue
    • alcohol related birth defects
    • neonatal abstinence syndrome: drug dependancy acquired in utero manifested by neurological and physical behavior
    • smoke- small
  21. Facial features of fetal alcohol syndrome
    small eyes flat thin upper lip
  22. Newborns of substance- abusing mothers
    nursing assessment/management
    • Assessment:
    • maternal hx, risk behaviors- not going to prenatal appts, toxicology screen baby's pee and meconium
    • newborn behaviors: withdrawl assessment (find out ahead of time what they were using)
    • management:
    • comfort production; stimuli reduction
    • nutrition
    • neonatal abstinence scoring and meds or ordered
    • prevention of complications decr RR, check O2 stat
    • parent newborn interaction
    • psych meds can cause this...
  23. Medications for baby addicts
    • neonatal morphine- opioid addiction (monitor cardiac and O2 stat) CNS depress- assess RR, O2 stat
    • Phenobarbital- decre CNS stimulants- babies can go home on this...
  24. Symptoms of Neonatal abstinence
    • W- wakefulness, sleeps a duration 1-2 hours after sleeping
    • I- irrability
    • T- temp variation, tachycardia, tremors
    • H- hyperactivity, high pitch cry, persistant cry, shill cry, hyperreflexia suck to hard, hypertonia (no head lag)
    • D- diarrhea, diaphoresis, disorganized suck
    • R- respirato(sneezing alot)ry distress, rub marks, rhinorrhea , incr RR
    • A- apneic attack, autonomic dysfunction
    • W- weight loss or failure to gain weight (incre calorie intake)
    • A- alkalosis (respiratory)
    • L- lacrimation
    • scoring tool based on what they do. do every four hours
Card Set:
high risk newborn 2
2015-04-03 23:54:59

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