high risk newborn 3

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high risk newborn 3
2015-04-03 20:52:51

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  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. Neonatal infection: managemet
    • antibiotics
    • circulatory, respiratory, nutritional, developmental support
    • education for prevention and early recognition
    • primary disease prevention
    • family education
  12. 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
  13. 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
  14. Early onset infections
    • risk factors:
    • UTI
    • preterm labor
    • prolonged or difficult labor
    • maternal fever
    • GBS
    • maternal infection
  15. 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
  16. common causative organisms
    • E. coli
    • - GBS
    • - klebsiella pneumonia
    • - listeria monoc- unpaterized milk
    • - other enteric gram negative bacilii
    • good education
  17. 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
  18. 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
  19. late onset infection risk
    • low birth weight
    • prematurity
    • meconium staining
    • need for resuscitation
    • birth asphyxia
    • improper hand washing
  20. 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
  21. Ophthalmia neonatorum
    • maternal vagina
    • eye infection