OB Newborn STRESSORS

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Author:
jwhughes
ID:
310685
Filename:
OB Newborn STRESSORS
Updated:
2015-10-31 13:44:02
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nursing
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nursing
Description:
Exam 3
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  1. Symptoms of MAS (meconium aspiration syndrome)
    • failure to cry/weak cry
    • bradycardia, pallor/cyanosis
    • Apnea
    • Low apgar
    • floppy
  2. How to prevent MAS
    • If infant vigorous: normal care
    • If infant depressed: intubate, suction w/ mec aspirator (1-2x/day)
    • Watch HR closely
  3. What is the meconium aspirator called that used to be put directly in the mouth to suck out
    DeLee Suction
  4. What occurs with persistent pulmonary HTN (PPHN)
    extreme vasoconstriction of pulmonary arteries increasing PVR and opening fetal shunts at FO and DA
  5. How is PPHN diagnosed
    with ECHO
  6. Treatment of PPHN
    • O2
    • iNO (nitric oxide)
    • Correct acidosis
    • Fluid resuscitation
    • Pressores (afterload reducers)
  7. whats does a baby look like with PPHN
    severe respiratory distress with cyanosis
  8. What is key to successful treatment of congenital heart disease
    early detection
  9. Signs of congenital heart disease
    • cyanosis
    • resp distress (inc w/ feed)
    • Hear murmur
    • CHF signs
  10. What is indicated for an infant with cyanosis with NO resp distress
    CHD
  11. 4 types of inborn errors of metabolism
    • amino acid
    • fatty acid
    • organic acid
    • CHO
  12. When do problems begin with inborn errors of metabolism
    with feedings
  13. What are signs of inborn errors of metabolism
    • unusual smell (cat urine, maple syrup)
    • Hypotonia
    • Neuro progressive
    • Seizures
    • Vomit despite formula changes
    • hypoglycemia prolonged
    • unexplained jaundice/direct
  14. What occurs when newborn fails to clear fetal lung fluid
    TTN
  15. How high will respirations be for newborn
    100-120
  16. What does chest x ray look like for TTN
    lung fluid, good inflation
  17. Treatment for anemia r/t acute blood loss
    • IV bolus for shock
    • Transfuse PRBC (CMV free, washed)
    • Possible erythropoeitin if prents refuse transfusion of blood products
  18. signs of acute blood loss (anemia)
    • pallor
    • low bp
    • tachycardic
    • dec perfusion
    • mottling
    • acidosis
  19. How is physiological anemia treated
    • tolerated well
    • may need to provide iron
    • transfusion rarely needed
  20. How is polycythermia treated
    Partial exchange transfusion where whole blood is replaced with a fluid (NS, albumin, plasmanate, FFP)
  21. Signs of polycythemia
    • BV and hct >
    • CV hct >65%
    • tachycardic
    • resp distress
    • feed intolerance
    • hyperbili, thrombocytopenia
    • renal vein thrombosis (oliguria)
    • jittery, irritable
  22. Signs of cold stress
    • inc movement & resp
    • dec skin temp
    • dec peripheral perfusion
    • hypoglycemia
  23. What is conduction? convection? Evaporation? Radiation?
    • conduction: surface
    • Convection: near vent
    • Evap: heat loss
    • Radiation: near window
  24. cold stress nursing care
    • monitor skin temp
    • warm infant slowly in warmer
    • monitor temp q 15-30 min
    • Remove plastic wrap, hat, clothes when rewarming
    • warm IV fluids
    • maintain NTE
  25. What is considered hypoglycemia
    <40-45
  26. Heel stick for infant
    • warm heel
    • stick before feeding or symptomatic
    • microlancet
    • band aide
    • blot after antiseptic
  27. Goal of jaundice monitoring
    prevent kernictus
  28. What is a distinctive sign of kernticus
    Opisthotonus (severe arching of back)
  29. What significantly reduced Hemolytic disease of newborn in the 1960's-1990's
    RhoGram
  30. What has led to an increase in jaundice
    • early discharge
    • Kinder, gentler approach
  31. What do we keep billi at in significant cases of jaundice
    23.4-29.2
  32. What does billi have to be at for jaundice to be visible in newborn
    >5 mg
  33. 2 forms of jaundice
    • conjugated (kidney, small intest)
    • Unconjugated
  34. What two components added together represent total serum billi (TSB)
    • Indirect (unconjug) >5
    • Direct (conjug) >2
  35. what is the serum billi level in physiological jaundice
    <15
  36. What is pathological jaundice billi level
    • >15
    • increase by 5 mg/dl/day
  37. What color is stool of pathological jaundice
    stool clay/white colored
  38. How long does pathological jaundice persist
    >14 days
  39. What is the lab work up for jaundice
    • total and direct billi
    • Blood group and Rh of mom/baby
    • hct, retic count, peripheral smear
    • sepsis
    • liver/thyroid
    • TORCH titers
    • Liver scan (hyperbilli)
  40. Management of jaundice
    • Reduce billi: phototherapy, exchange transfusion, drugs
    • PREVENTION ESSENTIAL: early feed, adequate hydration!!
  41. Technique of phototherapy
    • Hand wash
    • Naked baby in cradle/incubator
    • eye shades
    • baby 45 cm from light
    • q 2 hr breastfeed
    • turn after feeds
    • temp q 2-4 hr
    • daily weight
    • monitor urine/billi
  42. Side effects of phototherapy
    • insensible water loss
    • loose stool
    • skin rash
    • bronze baby
    • hyperthermia
    • upset mom/baby interaction
  43. Most common cause of neonate bacterial sepsis
    Group B strep
  44. When does late onset Group B strep meningitis present
    ~1 month of age
  45. Why does sepsis occur in neonates (physiologically)
    • Immature immune system
    • Lack IgM
  46. When does rectal/vag swab for GBS culture get taken
    35-37 weeks
  47. What is the initial lab septic work up? FULL WORK UP?
    • Initial: CBC w/ manual differential, PLA, CRP c-reactive protein
    • Full: Blood, gram stain, urine, CSF culture
  48. What is the normal WBC count of babies in first few days of life
    6,000-30,000
  49. What does presence of left shift indicate (>10 bands on manual differential)
    HIGH RISK FOR SEPSIS
  50. What could low neutrophils and high band count possibly indicate
    sepsis
  51. Nursing care for assessing sepsis
    • obtain BC (peripheral)
    • Antiseptic on skin, allow to dry
    • Assist with LP
    • UC: bladder aspiration
    • Assist with CXR
  52. Treatment of neonate sepsis
    • Broad spectrum AB (IV-penticillin/gentamycin)
    • Maintain IV
    • Treat 48 hrs if neg
    • Treat 10-14 days if pos
    • Treat 21 days if meningitis
    • Serial CRP measurmentts
  53. Partial or complete lack of oxygen in brain or blood stream
    Hypoxia
  54. state in which the placental or pulmonary gas exchange if compromised or ceases
    Asphyxia
  55. Difference between birth and perinatal asphyxia
    • Birth: 1-2 stage of labor
    • Peri: conception-first month of life
  56. Abnormal neuro behavior in neonates arising from hypoxic-ischemic event
    HIE
  57. Profound metabolic or mixed acidosis (pH <7), persistence of Apgar score <3 for >5 min, neonate neuro sequelae, multiple organ involvement
    HIE
  58. 3 things that occur during asphyxia
    • Pulmonary vasoconstriction inc PVR
    • Hypoperfusion of lungs
    • R>L shunt (blood by-passes lungs)
  59. When do interventions need to occur during an asphyxia insult
    within 6 hours
  60. WHat are 4 differences of neonatal brain
    • lower metabolic rate in immature brain
    • immature balance of neurotransmitters
    • Plasticity of immature CNS
    • Glucose only substrate used for energy metabolism
  61. Nursing Care to initially stabilize and resuscitate baby with asphyxia
    • assess 1st grasp, first cry, onset of spontaneous respiration
    • Apgar q 5 min until >7
  62. What are 4 questions to ask to identify baby who may need resuscitation
    • Gestational age?
    • Amniotic fluid clear of meconium/infection?
    • How many babies?
    • Risk factors?
  63. 3 things to ask following birth r/t resuscitation
    • Baby term?
    • Baby breathing/crying?
    • Good muscle tone?
  64. meds for resuscitation
    • epi
    • volume expansion
  65. How should baby be transfered during resuscitation
    with warmer in off position
  66. What body systems does perinatal asphyxia affect
    EVERY BODY SYSTEM
  67. Nursing care for asphyxia if you have help
    • Know role
    • Have plan
    • Document
    • Dry infant
    • Plastic wrap for premie
    • Pulse ox on hand/wrist
  68. Nursing care for asphyxia if you are alone
    • May/may not need O2
    • Room air, let pulse ox guide use of O2
    • 10 min for healthy baby to have a O2 sat of 90
  69. How is epinephrine given for asphyxia in newborn
    ETT or umbilical venous line
  70. What are the benefits of infant cooling for HIE
    • Reduce cerebral metabolism, dec rate of energy use
    • Suppress free radical
    • Reduce vascular permeability/edema
    • Decrease global brain damage
  71. What criteria needs met for infant cooling
    • infant born >/+ 36 weeks
    • <6 hrs or younger
    • Acute injury at time of birth
    • Severe acidosis (ph <7, Base deficit:16)
    • asphyxia
  72. Two types of cooling
    • head (not used as much)
    • total body

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