OB Newborn at risk

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OB Newborn at risk
2015-10-31 12:05:42
Exam 3
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  1. What is considered preterm
    less than of equal to 36 wks and 6 days
  2. What is considered late preterm
    34-36 6/7 weeks
  3. What is the statistical difference of late-preterm infants verse term infants in regard to infant mortality
    threefold increase
  4. What is most frustrating about premature babies
    difficult feeders
  5. What is of most importance when treating a newborn (basing care on prematurity or weight)
  6. LGA baby verse SGA baby on growth chart
    • LGA >90%
    • SGA <10%
  7. What fetal factors cause SGA/IUGR babies
    • Toxoplasmosis
    • Other
    • Rubella
    • CMV (BIG ONE)
    • Herpes (uncommon)

    • discordant twins, choromosomal abnormalities (EXTREMELY COMMON)
    • IEOM
    • High altitude, radiation, hot tubs
  8. What is affected if growth failure is occurs later in preg? At the early in preg?
    • Size of cells
    • Number of cells
  9. What is the difference in physical chracteristics of symmetrical SGA and Asymmetric SGA
    • Sym: Growth restriction of organs, weighs, and head
    • Asym: Head is spared, weight SGA
  10. What is the cause of symmetric SGA? Assymetric?
    • Sym: Long-term, chronic hypoxia
    • Asym: Acute compromise of placental flow
  11. What are the MAJOR 3 complications of SGA/IUGR babies
    • Hypothermia (no fat stores)
    • Hypoglycemia (no fat stores)
    • Polycythemia (chronic hypoxia)
  12. What does an SGA baby look like (6 things)
    • long, thin, emaciated
    • Loss of sub q fat
    • loose skin folds
    • dry peeling skin
    • thin meconium stained cord
    • Wizened facies
  13. Top 3 nursing diagnosis of SGA/IUGR baby
    • Ineffective thermoregulation
    • Injury risk r/t dec glycogen
    • Imbalanced Nutrition: LESS
  14. 4 things to do to maintain thermoregulation in SGA baby
    • Neutral thermal environment
    • Monitor axillary temp
    • Monitor skin probe (if in warmer) and adjust as needed
    • Minimize heat loss, prevent cold stress
  15. How can injury be prevented for SGA baby (r/t dec glycogen)
    • Monitor BS per protocol especially in first 24 hrs
    • Report <40
    • Signs of hypoglycemia: jittery, lethargy, poor feeding, temp instability, seizures, apnea, resp distress
    • Provide glucose intake (early feedings or IV glucose if unstable)
  16. What is the most common cause of LGA baby
    maternal diabetes (esp gestational)
  17. What type of babies do women with chronic, severe DM have
  18. What does a blue LGA baby boy indicate until proven otherwise
  19. What disorder causes baby to have HUGE tongue and will eat out house literally? Need to lock cabinets/fridge
    Beckwith Wiedemann
  20. What ethnicity is most likely to have LGA
    hispanic women
  21. What are some complications of LGA babies following birth trauma from CPD and macrosomnia
    • Shoulder dystocia
    • Fractured clavicle/humerus
    • Brachial plexus injury (Arbs palsy)
    • Facial paralysis
    • Intracranial hemorrahe
    • Depressed skull fracture
  22. What are some symptoms of LGA babies
    • hypoglycemia, polycythemia, hyperviscosity
    • Macrosomic
    • Ruddy color
    • Excessive fat
    • umb cord thick
    • placental is large
    • dec body water
    • visceral organs enlarged
  23. What are common complications of IDM
    • Hypoglycemia
    • Hypocalcemia
    • Hyperbilirubinemia
    • Birth trauma
    • RDS
    • Cardiac/congenital malformation
  24. What causes variation of BS in IDM babies
    • Maternal control of DM
    • Maternal BS at time of birth
    • Length of labor
    • Class of DM
    • Early vs late feeding
  25. What are signs of hypoglycemia of IDM
    • Tremors/jitteriness/seizures
    • Apnea, Resp distress, cyanosis
    • Poor feeding
    • Hypotonia
  26. What is hypocalcemia value in a baby
  27. When does hyperbilirubinemia occur
    48-72 hours of age
  28. Most common IDM cardiac malformation
    Cardiomyopathy (megaly, BP low, transient and improves with time but significant in newborn)
  29. What are some nursing care actions for IDM babies
    • check BS at 1 hr age
    • If <40, early feedings then check again in 30 min
    • If still <40 tell PCP (Iv glucose may be necessary, transfer to NICU)
    • (if normal, check q 4 hr up to 48 hrs)
  30. What is considered a post-term baby? What is usually the reason?
    Born after 42 weeks, inaccurate dating
  31. What does a post-term baby look like
    • Usually normal size
    • Meconium stain
    • Peeling skin
  32. What is Post-term Postmaturity Syndrome
    Born after 42 weeks and have characteristics (wrinkle, long thin body, advanced maturity, hyperaleart, long nails, oligo)
  33. What causes Postmaturity Syndrome in a Post-term infant
    • advanced gestational age
    • placental aging
    • Decreased placental function (declines after 40 weeks)
    • Continued exposure to AF (dry out and peel)
  34. What occurs during meconium aspiration
    release of meconium, muscle relaxation from hypoxia in utero, goes floppy, muscles in rectum relax, float in amniotic fluid. If hypoxic and gasp in utero, meconium sucked into windpipe and lungs
  35. 4 results from meconium aspiration
    • persistent pulmonary HTN
    • Pneumothorax
    • Chemical Pneumonitis
    • Death
  36. Nursing care for Post-term infant
    • Closely evaluate
    • Amnioinfusion (mec stain)
    • Early feed
    • Monitor CP, temp, sat, BS
    • Obtain hct
  37. What causes RDS in preterm infants
    Unable to produce surfactant in lung to keep alveoli open which leads to collapse of alveoli
  38. Treatment for RDS
    • Administer Surfactant (1 dose in DR) per ETT (not in community hospital) if spontaneous respirations take tube out and see how baby does
    • Avoid suctioning 1 hr after administration
    • CPAP do great
  39. What is the COPD of babies (sort of)
    Bronchopulmonary dysplasia
  40. Care of preterm infant
    • Rapid initial assessment
    • Resusictation measures
    • Minimize stimulation
    • Position in flexion
    • Enforce hygiene
  41. What is the leading cause of preventable, nongenetic, intellectual disabilities in babies
  42. What is the increase of NAS babies in TN compared to nation
    15 fold increase compares to 3 in nation
  43. Who is best qualified to obtain history for NAS baby
    social worker
  44. Care of NAS baby (assessment)
    • Obtained bagged urine (1st sample)
    • Obtain meconium (7-10 days to get back)
    • Monitor feeding
    • Observe behavior
    • Draw labs to differientiate NAS and CNS irritability (CBC, BS, Ca, Mg, TSH, T4, CXR)
    • Use NAS scoring system
    • Most use modified Finnegan score
  45. Signs of NAS baby
    • Increased wakefulness
    • High-pitched, shrill cry
    • Tremors, jittery
    • Hyperactive Moro
    • Increased Muscle tone
    • excessive, uncoordinated sucking
    • Abrasions of skin (put mittens on)
  46. What is scoring of NAS modified Finnegan based off of
    Events of past 3-4 hrs before feeding
  47. Finnegan admission criteria to NICU
    3 scores of >10 or 2 scores >13
  48. NAS care
    • Monitor temp (hyper)
    • VS (temp or rr usually >)
    • Small, frequent feeds (2-3 hrs)
    • Raise HOB
    • Swaddle (hands near mouth with mittens)
    • Vertical rock, reduce stimuli
    • Skin emollient to diaper area
    • Offer pacifier
    • Keep mom informed