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Hyperbilirubinemia
- imbalance in rate of bilirubin production and elimination. total serum bilirubin level > 5
- Physiologic jaundice (3rd to 4th day)
- - early onset breast feeding jaundice
- - late onset breast feeding jaudice
- Pathological Jaundice (within the 1st 24hr of life)
- - Kernicterus- bilirubin is soo high, yellowing of the brain and can cause brain damage, ear loss result
- - Rh isoimmunization/ABO incompatibilities- mom blood type (Rh-) and baby blood (Rh+)= moms and baby's blood mix- moms antigens are in the baby's RBC and it is attacking it.
- ABO incomp: o type mom A/B baby...different typing. mom body attacks baby
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Hyperbilirubinemia nursing assessment/management
- Assessment:
- Risk factors:
- jaundice
- signs of RH incompatiability
- check bilirubin level (you have to graph..they come back high but you need to grapH)
- management
- reduction: early feedings, phototherapy, exchange transfusions
- education and support. home phototherapy teach guidlines 24-2
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Rh isoimmunization
- Rh incompartibility develops when mom is negative and baby is positive.
- The blood mixed and destroys baby;s red blood cells
- which leads to fetal anemia and hemolytic disease of the newborn
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treatment of Rh isoimmunization
- intrauterine transfusion with Rh-, type O blood may be life saving if done in time
- the widesprad of Rhogam combined with aggresive fetal survelliance and transfusion has reduced the incidence of hemolytic disease of the newborn
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ABO incompatibility
- Mom is O and baby is A, B, AB
- when O type mom develops an Anti A or B antibodies in her body due to food she has eaten and exposure to infections thru out her life
- some Anti A or B antibodies can cross over the placenta and attacks baby- first pregnancy cause hemolysis of fetal blood
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What to look for RH and ABO
- getting blood type and Rh factor
- Evaluate results or Coombs test
- - indirect coombs test
- - direct coombs test
- - if positive you have an ABO incomp
- Physical Assessment
- - normal color initially
- - enlarged liver or spleen
- - Anemia: severe may cause heart failure, edema, hydrops fetalis (organ failure with it)
- - Progressive pathological jaundice: Kernicterus occurs when bili is > 20 term or > 12 preterm
- - hypoglycemia
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How is hemolytic disease of the newborn managed
- initiate early feedings: early and frequent to promote perstalis
- Phototherapy
- - protect eye
- - infant should be undressed
- - stools maybe green (bili)
- - change position q 2 hours- skin check
- - promote bonding during feedings
- - incr fluids intake
- - monitor temp q 2hrs
- - strict I&O
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how is hemolytic disease managed exchange transfusion
- used to quickly decr high bili
- transfuse Rh - only
- warm blood to room temp
- admin calcium gluconate
- asses vital signs before procedure, q 15 during, and post procedure
- record time, amt to blood withdrawn, time and amt injected, meds given
- assess: dyspnea, listlessness, bleeding, cyanosis, bradycardia or arrthumias
- labs: glucose, lytes, bilil, CBC
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hemorrhagic disease of the NB
- results from Vita K def
- symptoms:
- - petechia
- - eye hemorrhage
- - blood vomit, black tarry stool
- occurs
- 2-5 of life
- prevention
- Vita K at birth
- Treatment:
- severe transfusions
- Vit K IM or sc daily
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NB infections
- neonatal sepsis: bacterial, fungal, or viral microorganism or their toxins in blood or other tissues
- classification:
- - congenital (intrauterine)
- - early onset (perinatal)
- - Late onset (comparision chart)
- Assess: who is at risk, nonspecific symptoms, elev c-reactive protein(bacterial infection, inflammation), positive cultures
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Neonatal infection: managemet
- antibiotics
- circulatory, respiratory, nutritional, developmental support
- education for prevention and early recognition
- primary disease prevention
- family education
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mechanism of infection
- organism crossing the placenta (GBS), organism residing in amniotic fluid
- ascent of organism via vagina- infecting membranes causing rupture leading to respiratory and GI tract infection
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what is neonatal sepsis
- generalized infection that has spread rapidly thru the blood stream
- pathophysiology
- immature immune system, inability to localize infection, and lack of IgM immunoglobin
- treat early- prophatically until the culture comes back negative
- negative for 48hrs
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Early onset infections
- risk factors:
- UTI
- preterm labor
- prolonged or difficult labor
- maternal fever
- GBS
- maternal infection
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Congenital (intraunterine) infection
- risk factors: immature immune system IgM, Ig A and t lymph
- decre gastric acid which is need to reduce organism
- common causative organism
- - cytomegalovirus- moms don't always know they have it- small head baby
- - rubella
- - toxoplasmosis
- -syphillis
- - TORCH
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common causative organisms
- E. coli
- - GBS
- - klebsiella pneumonia
- - listeria monoc- unpaterized milk
- - other enteric gram negative bacilii
- good education
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congenital conditions
- esophageal atresia and tracheoesphageal fistula (at risk for aspiration_
- omphalocele (intestines coming out with umbilcal cord) and gastrochisis (stomach contents coming out)- need surgery
- imperfonate anus- look when wipe babies, see where poop is coming from.
- bladder exstrophy
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mechanism of infection
- most occur during birthing process
- nb comes into contact with infected birth canal
- nb susceptibility to infection by exogenous organisms possibly due to inadequancy of physical barrier- thin skin
- lack of gastic acid
- more common in NB undergoing invasive procedure like endotracheal intubation, catheter, break in skin
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late onset infection risk
- low birth weight
- prematurity
- meconium staining
- need for resuscitation
- birth asphyxia
- improper hand washing
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beta hemolytic, GBS
- from birth canal to fetus
- dx: screening all women at 36-37
- give antibiotics when in labor
- if you think you water broke come in esp GBS positive
- early onset: tachyon, apnea, shock, decre urine outout
- late onset:lethargy fever loss of appetite bulging fontanels
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Ophthalmia neonatorum
- maternal vagina
- eye infection
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