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Maternal Newborn

Newborn Complications

QuestionAnswer
____ is the newborn of an alcoholic or drug-addicted woman drug-dependent infant
____ effects is the less severe fetal mainfestations of maternal alcohol ingestion, including mild to moderate cognitive problems and physical growth retardation fetal alcohol effects (FAE)
____ syndrome is caused by maternal alcohol ingestion and characterized by microcephaly, intrauterine growth retardation, short palpebral fissures, and maxillary hypoplasia Fetal alcohol Syndrom (FAS)
____ work - the inner process of working through or managing the bereavement Grief work
____ - a hereditary deficiency of a specific enzyme needed for normal metabolism of specific chemicals Inborn error of metabolism
____ - At-risk infant born to a woman previously diagnosed as diabetic, or who developes symptoms of diabetes during pregnancy Infant of a diabetic mother (IDM)
____ - Fetal undergrowth due to an etiology, such as intrauterine infection, deficient nutrient supply, or congenital malformation. Intrauterine growth restriction (IUGR)
____ - excessive growth of a fetus in relation to the gestational time period large for gestational age (LGA)
____ - number of deaths of infants in the first 28 days of life per 1000 live births neonatal mortality rate
____ - the chance of death within the newborn period (first 28 days) Neonatal mortality risk
____ - a common metabolic disease caused by an inborn error in the metabolism of the amino acid phenylalanine Phenylketonuria
____ newborn - any infant born after 42 weeks' gestation Postterm newborn
____ infant - any infant born before 38 weeks' gestation preterm infant
____ - inadequate weight or growth for gestational age; birth weight below the tenth percentile Small for gestational age (SGA)
____ dysplasia - chronic pulmonary disease of multifactorial etioloty characterized initially by alveolar and bronchial necrosis, which results in bronchial metaplasia and interstitial fibrosis. appears in x-ray films as generalized small cysts Bronchopulmonary dysplasia (BPD)
____ stress - excessive heat loss resulting in compensatory mechanisms (increased respirations and nonshivering thermogenesis) to maintain core body temperature cold stress
____ fetalis - hemolytic disease of the newborn characterized by anemia, jaundice, enlargement of the liver and spleen, and generalized edema. Caused by isoimmunization due to Rh incompatability or ABO incompatibility Erythoblastosis fetalis
____ - hyperbilirubinema secondary to Rh incompatibility Hemolytic disease of the newborn
____ - yellow pigmentation of ody tissues caused by the presence of bile pigments jaundice
____ - an encephalopathy caused by deposition of unconjugated bilirubin in brain cells; may result in impaired brain function or death kernicterus
____ syndrome - respiratory disease caused by inhalation of meconium in amniotic fluid in the lungs, respiratory distress, hyperexpansion of chest, hyperinflated alveoli and secondary atelectasis Meconium aspiration syndrome
____ - respiratory disease resulting from right to left shunting of blood away from the lungs and through the ductus arteriosus and patent foramen ovale Persistent pulmonary hypertension of the newborn (PPHN)
phototherapy is treatment of ____ by exposure to light jaundice
Polycythemia is an abnormal increase in the number of total ____ in the body's circulation RBC
Respiratory distress syndrome (RDS) is a respiratory disease of the newborn characterized by interference with ventilation at the ____ level alveolar
____ neonatorum - is infections experienced by a neonate during the first month of life sepsis neonatorum
why is low socioeconomic level of mother a newborn risk factor limited access to healthcare and education
what are some environmental danges that make a newborn at risk toxic chemicals and illicit drugs including alcohol
What are some preexisting medical conditions that puts the newborn at risk heart disease, diabetes, hypertension, and renal disease
Maternal factors that affect newborn risk factor very young, very old and parity (number of privious births)
name 2 devices that detect distress in fetus electronic fetal heart monitor and fetal heart ausculation by doppler
Clinical risk factors for SGA newborns perinatal asphyxia, aspiration syndrome, hypothermia, hypoglycemia, hypocalcemia, polycythemia, congenital anomalies, intrautererine infection
Etiology of SGA newborns maternal or newborn factors, maternal disease, environmental factora, placental factors
T/F SGA newborns need more calories per oz than regular newborns True (more than 20cal/oz of formula and if breastfeeding, add human milk fortifier
SGA babies ned small frequent feedings - why smaller stomach
Why might SGA newborns need gavage feeding if they do not breathe well, helps preserve energy
Why should a SGA newborn have cluster care allow baby to get longer stints of rest - also decrease stimuli - hospital background noise, lighting
How should a nurse look for signs and complications of polycythemia keep on top of Hb/Hct, O2 stat, mucus membranes, pulse will decrease with polycythemia, viscous and sluggish
Assessment findings for the SGA newborn soft tissue wasting, loose dry and scaling skin, perinatal asphyxia, resp distress, CNS prob, congenital anomalies and labs sowing low BS increased Hct as a result of chronic hypoxia
What is used to help close the ductus arteriosus of a premature infant prostaglandin inhibitor - They have too much prostaglandin
Why do premies have reflux cardiac sphincter is immature
Hypoxia at at premie's birth causes bowels Necrotizing entercolitis (NEC)
What is a big problem with premies in which the incidence needs to be decreased MRSA
What causes anemia of prematurity rapid rate of growth, shortened RBC lifespan in premies (baby has 80ml/kg body weight and premies even lower)
When is apnea considered too long in an infant more than 20 seconds
What causes intraventricular hemorrhage in premies less than 1500g, less than 34 wks hypoxic events - ventricles more susceptible and brain bleeds
long-term problems of premies bronchopulmonary dysplasia from use of mecanical vent, neurologic defects such as sensorineural hearing loss and speech defects
Why is a IDM large exposure to high levels of maternal glucose = high level of fetus insulin = growth hormone effect
Why is a IDM suseptible to hypoglycemia exposure to high levels of maternal glucose = higher insulin in fetus and when born has all this extra insulin and no maternal nutrition coming in
What causes hyperbilirubinema 48-72hrs after birth of a IDM Decrease in extracellular fluid = increase in hematocrit levels,
What kind of birth trauma is seen in IDM fractured skulls, clavicles, pinched facial nerves and brachial plexus
Why is polycythemia seen in IDM increased RBC due to tissue hypoxia
T/F congenital birth defects risks are higher for IDM True
IDM infants must have their blood sugar tested at what level is hypoglycemia 40mg/dl - hosp protocol will determain how often. Make sure infant gets early feedings
5% of post term babies get postmaturity syndrome what does it include hypoglycemia, asphyxia, meconium aspiration, polycythemia, congenital anomalies, seizure activity and cold stress due to placenta not functioning
postmatur newborn continued exposure to amniotic fluid causes what manifestations skin wrinkled leathery dry parchment-like and cracked, long nails (may be meconium stained), skinny (emanciated), eyes are wide open - looks like ET
what may be done during labor to dilute the meconium in amniotic fluid and decrease the risk of meconium aspiration amnioinfusion
A preterm newborn is one who is born before the completion of ____ weeks gestation 37 - therfore a baby born at 37 1/2 weeks gestation is considered a premature
At what week of gestation does the fetus start producing serfactant 32 weeks. By 35 weeks may have enough surfactant
What are the 2 factors in development of respiratory distress to a preterm infant not enough surfactant and pulmonary blood vessles have incomplete muscular coat
bounding fermoral pulses, carbon dioxide retention, increased respiratory efort, pulmonary congestion and increased blood voume to lungs is due to what patent ductus arteriosus
Preterm babies dont have enoug ____ in the liver to help with shivering thermogenesis to generate heat glycogen
What physiologic and anatomic factors increase heat loss in preterm infant high body surfact to body weight ratio, not flexed, low subQ fat, BV close to skin, thin skin
Preterm babies are at greatest risk for aspirations due to underdeveloped gag reflex, incompetent esophageal cardiac spincter, poor sucking and swallowing reflex
T/F preterm infants have a decreased basal metablolic rate False it is raised as well as O2 requirements
why do preterm babies have anuria or oliguria and limited ability to concentrate urine low glomerular filtration rate (GFR) - metabolic acidosis
Why is drug calc accuracy imperative for preterm babies inability to excret drugs in kidneys
preterm babies may be hypotonic and ____ for several days after birth unreactive - prepare parents for it
What is the range of caloric intake for preterm baby 95-130 ml/kg/day - early feedings maintain normal metabolism
gavage - tube feeding is measured how ear to nose to xyphoid process to make sure it goes into stomach do not x-ray
fluid therapy for preterm babies for the first three days 80-100 mL/kg/day - day 2 100-120, day 3 120-150
long-term needs of preterm baby includes a team for what retinopathy of prematurity, bronchopulmonary dysplasia, speech defects, neurological defects, and auditory defects - nurse helps inform about the infant
T/F there is more vernix caseosa and languo with premies True
what part of the skull fills with hydrocephalus ventricles
manifestations of hydrocephalus enlarged head (measure daily) >90% growth cart, bulging fontanelle, split or widened sutures, setting sun eyes, NV
____ atresia is when one or both nares is closed off Choanal Atresia - to assess, close off one at a time and try to pass an NG tube gently
____ is a fissure connecting the oral and nasal cavity cleft palate - prevent aspiration and infection and plot weight gain
an infant with tracheoesophageal fistula has a hx of mother having _____ hydramnios (excessive amniotic fluid)
manifestations of tracheoesophageal fistula excessive mucous secretions, constant drooling, abdominal distention, choking and cyanotic episodes, regurgitation
nursing mgt for tracheoesophageal fistula maintain respiratory status in warmed humidified incubator with HOB elevated 20-40 degreess, access patency before putting to breast, place suction cannula on low intermittent suction to control saliva and mucus, and keep quiet
bowel sounds heard in thoracic cavity, gasping respirations with nasal flaring, barrel chest and scaphoid adomend asymmetric chest expansion, breath sound on left side with heart sounds on right are manifestations of ____ hernia diaphragmatic hernia
nursing interventions for diaphragmaic hernia Never ventilate b/c lungs are obstructed - but should give blow-by O2, initiate gastric decompression, place in high fowlers, turn to affected side for lung expasion of unaffected lung and alleviate acidosis
____ is a saclike cyst in thoracic and or lumbar area and hydrocephalus is often associated mylomeningocele - no or varying response to sensation below level of sac
Interventons of myelomeningocele prevent trauma or infection, clean after elimination, observe for oozing or pus and crede (massage) bladder in immediate NB period
manifestations of fetal alcohol syndrome (FAS) - some of these are due to withdrawl sleeplessness, excessive arousal, unconsolale cry, abnormal reflexes, hyperactivity, jitteriness (blood sugar levels), and exaggerated mouthing behaviors
nursing care of FAS newborn avoid heat loss, provide adquate nutrition and reduce environmental stimuli - breastfeeding is not contraindicated but alcohol will inhibit letdown reflex
why do you not want to give narcan to a mother or baby with drug abuse mothers precipitates acute withdrawal
what symptoms can go on for months of newborns from drug abuse mother withdrawl, bone pain, diarrhea
nursing mgt of newborn from mother with drug abuse test for syphilis, HIV and HepB, urine and meconium analysis for drugs, social service referral (MD order not needed), quiet environment and swaddle
Drugs used to control withdraw symptoms in infant of mother with drug abuse phenobarbital for seizures, oral morphine sulfate for pain, and diazepam to relax them - do not give narcan can make withdraw worse
Newborn exposed to HIV/AIDS are what size small - premature, SGA or both and failure to thrive during neonatal (first 28days)
Signs of exposure to HIV/AIDS during pregnancy: enlarged spleen and liver, swollen glands, recurrent respiratory infections, rhinorrhea, intestitial pneumonia, recurrent GI (diarrhea and wt loss), UTI, Thrush (oral candidiasis) and loss of achieved developmental milestones
When caring for a newborn exposed to HIV/AIDS special care includes standard precautions, keep well nourished (will have nutritional probs), special care to protect from infections and prevent skin rashes, facilitate growth development and attachment, Hand Washing
Breastfeeding can cause an increased infection in which case HIV
Feeding Intolerance can happen with infants exposed to HIV/AIDS what are the signs increased regurgitation, abdominal distention, and loose stools
What is given for infants born from mothers infected with HIV/AIDS and when does it begin and how long Antiretroviral drug therapy beginning at 8-12 hours of life and continuing for 6 weeks
A newborn of a HIV/AIDS mother will get a prohylaxis tx to prevent what at 4-6 weeks Pneumocystis carinii pneumonia (PCP)
If PKU is not broken down to tyrosine due to lack of tyrosine conversion enzyme and PKU builds up, what happens Brain damage - do a Guthrie test 24-48 hours after first feed to see if infant has PKU
Characterized in an infant by the presence of sweet-smelling urine, with an odor similar to that of maple syrup, is an inborn error of metabolism called Maple Syrup Disease
___ is a CHO metabolism inborn error, inability to convert glactose and lactose to glucose glactosemia
primary goal of prenatal mgt prevent preterm birth
____ enhances fetal lung development and ___ postnatal therapy glucocorticoids - Beta methasone
If membranes rupture, the first sign of infection ____ is likely C-Section
____ positive pressure ventilaiton is ventilation therapy for infant not breathing and ____ positive airway pressure prevents respiratory failure in spontaneously breathing NB intermittent positive pressure ventilation non breathing - continuous positive airway pressure breathing
which is less invasive with fewer complications, Intermittent positive pressure ventilation or continuous positive airway pressure continuous positive airway pressure
Clinical manifestations of RDS central cyanosis & pale mottling, jaundice, tachypenia >60, grunting, see- saw breathing, nasal flaring, retractions, apnea, systolic murmur, PMI displaced, hypothermia, flaccid, seizures, edema
RDS infant how often check for resp rate, aterial blood gass, O2 sat Monitor respiratory rate ever 1-2 hours, monitor arterial blood gasses at least every 8 hours and PRN, Monitor O2 stat at least every 4 hours and PRN
Transient Tachypnea of the Newborn clinically can resemble RDS
Transient Tachypnea of the Newborn can be caused from Intrauterine or intrapartal asphyxia, maternal oversedation, maternal bleeding, prolapsed cord, breech birth, maternal diabetes, cailure to clear airway of lung fluids, prevalent in CS neborns
Clinical Manifestations of Transcient Tachypnea of the Newborn little or no difficulty at the onset of breathing, shortly after birth difficulties emerge like expiratory grunting, flaring nares, mild cyanosis, resp rate 100-140 breaths/min, mild acidosis, overexpansion of lungs
presence of meconium in amniotic fluid - asphyxia insult is ___ meconium aspiration syndrome (MAS)
When is meconium aspirated either in utero or during the first breath, more common in long labor babies
clinical manifestations of meconium aspiration syndrome fetal hypoxia in utero, slowing of FHR or weak and irregular heartbeat, meconium staining of amniotic fluid, signs of distress at birth such as pallor cyanosis apnea slow heartbeat low apgar score
when to do mechanical ventilation at birth for baby of meconium aspiration syndrome general cyanosis, tachypnea, severe retractions, overdistended barrel-shaped chest, diminished air movement with rales and rhonchi, displaced liver and yellowish staining of the skin, nails and umbilical cord
some nursing interventions of meconium asphyxiation syndrome Performe glucose testing at 2 hrs of age and monitor intravenous antibiotic therapy (ampicillin or gentomyicin)
Preterm and SGA newborns are susptible to cold stress due to decreased adipose and brown fat as well as glycogen
signs and symptoms of cold stress increased movement and respirations, decreased skin temp and peripheral perfusion, hypoglycemia, possible metabolic acidosis
Don't want temp lower than ____F, if below what do you do 97..7, wrap in warm blanket, check BS, 1hr later if not 97.7 then radiant warmer if one hour still low call MD may want in incubator
If a newborn has hypoglycemia, what else do you want to check for CNS disease, sepsis (GBS+), metabolic aberrations, polycythemia, congenital heart disease, drug withdrawal, temp instability, hypocalcemia
S/S hypoglycemia lethargy, jitteriness, oor feeding, vomiting, pallor, apnea, irregular resp, resp distress, cyanosis, hypotonia, tremors, high pitched cry, exaggerated moro reflex,
At risk newborns for hypoglycemia AGA preterm, SGA, type 1 diabetic mothers
When to monitor for hypoglycemia 2 hours after birth(within 30 min of IDM), before feedings and whenever there are abnormal signs
T/F physiologic or neonatal jaundice is a normal process True
Physiologic or neonatal jaundice occures during transition from intrauterine to extrauterine life and appears after ____ hours of life 24
When is phototherapy reuired for tx of neonatal jaundice anything over 12
cause for physiologic or neonatal jaundice shortened RBC life span, slower uptake by liver and can't hand load, lack of intestinal bacteria breakdown, poorly established hydration
Unconjugated bilirubin average levels at birth, 3rd to 5th day and after 10 days At birth 2mg, 3rd to 5th day 5-6mg, usually not visible after 10 days
hyperbilirubinemia occures when and at what level per hour first 2 hours of life rising over 5mg/dl/hr
signs of hyperbilirubinemia vomiting, lethargy, poor feeding, wt loss, tachypnea, apnea, temp instability, jaundice after 6 days newborn and after 14 days premature newborn
causes of hyperbilirubinema Rh incompatibility, erythoblastosis fetalis, hydrops fetalis, diabetes, intrauterine infection, gram - bacilli, drug ingestion, too much oxytocin or pitocin, polycythemia, pyloric stenosis,obstruction of biliary duct, UTI, GBS, hypothyroidism, cephalohema
____ fetalis is Rh-negative mother pregnant with Rh+ fetus, transplacental passage of maternal antibodies takes place erythoblastosis fetalis
All Rh- mothers get RhoGam at ____ weeks 28 and after birth
ABO incompatibility is when mother is type ____ and baby is type ____ Mother O - baby A or B, may result in jaundice, need to give direct coombs if + keep eye on them
causes of neonatal anemia blood loss, hemolysis impaired RBC production
Cerebral bleeding may occure because of ____ hypoxia
____ anemia is a normal gradual dropin hemoglobin for the first 6-12 wks of life Physiologic Anemia
Signs of shock capillary filling time greater than 3 sec, decreased pulse, tachycardia, low blood pressure
Polycystemia - Venous hematocrit value is greater than ____% and venous hemoglobin level is greater than ___g/dl hematocrit over70%, hemoglobin over 22g/dl
Symptoms of polycythemia DECREASE in pulses, ruddy, tachycardia & congestive heart failure sx, respiratory distress, hyperbilirubinemia, discoloration of extremities seizures, jitteriness, hematuria, decreased urine output
sepsis neonatorum is from syphillis, gonorrhea, herpes type 2, or ____ left untreated before vaginal birth that baby aspirates Group B streptococcus
Signs and symptos of sepsis neonatorum pallor duskiness cyanosis, cool clammy, temp instability, lethargic, mottling
sepsis neonatorum is treated with ampicillin and gentamycin (do peaks and throughs, can affect hearing if long term) take VS hourly
____ protein - can tell if sepsis neonatorum is evident C-Reactive Protein
With ____ tachycardia initially, followed by apnea or bradycardis hyperbilirubinemia
hematologic signs and symptoms jaundice, petechial hemorrhages, heptaosplenomegaly
When does spirochetes cross the placenta with maternal syphili after 16th week
Infant assessment of maternal syphilis elevated cord serum IgM, rhinitis, fissures on mouth corners, rash mouth and anus, copper colord rash face and palms, edema joints, bone pain, cateracts, SGA
infant assessment of Gonorrhea conjunctivitis, corneal ulcerations, sepsis, temp instability, hypotonia, jaundice
Infant assessment of Herpes Type 2 births sm cluster vesicular skin lesions all over body, DIC, assess for fever, respiratory congestion, tachypnea and tachycardia
Nursing management of Herpes type 2 births careful handwashing, s/b in isolation, administer acyclovir
motehr with HPV, (genital warts) will have automatic CS
Infant assessment of chlamydia trachomatis birth perinatal hx of preterm birth, pneumonia, conjunctivitis, chronic follicular conjunctivitis
four physchologic tasks for coping anticipatory grief, acknowledgment of maternal failure, resumption of the process of relating to infant, understanding of special needs and growth patterns
T/F Research shows that there is NO safe amount to drink during pregnancy? True
What do you tell a breastfeeding mom if she wants to drink? That it does cross into the breast milk and to pump and dump.
The physician has diagnosed Jeremy with postmaturity syndrome. What characteristics support this diagnosis? What are the nursing interventions for each? Hypoglycemia, Cold stress/thermoregulation Monitor temperature; Seizures-Prevent cold stress. Polycythemia-Obtain a central line to determine accurately the presence of polycythemia. Pneumonia-Keep lungs clear of fluid.
The Dr has Dx Jeremy w/ postmaturity syndrome. What complications is Jeremy at risk for? What would be the appropriate nursing interventions to prevent these complications? Expected nursing outcomes include that Jeremy establishes effective respiratory function. Jeremy is free of metabolic alterations such as hypoglycemia and maintains a stable temperature.
Give 3 nursing Dx that may apply to Jeremy w/ postmaturity syndrome. (i.e. Impaired gas exchange related to airway obstruction from meconium aspiration.)Risk for altered tissue perfusion related to increased blood viscosity. Hypothermia related to decreased liver glycogen. Altered nutrition\: less than body requirements related to increased use of glucose secondary to stress in utero and decreased placental perfusion.
The Dr has Dx Jeremy w/ postmaturity syndrome. What are the expected outcomes when providing nursing care to Jeremy? There could have been an inaccurate determination of the estimated date of birth. However, this is unlikely as Jeremy presents with many characteristics of a postterm baby. Many babies born at postdate are of average size.
Jeremy very alert during the 1st assesment, 7 lbs 5-oz BB at 42 wks, skin is dry & cracking w/ little vernix/lanugo, fingernails are long w/ greenish discolor. 23 inches long w/ little subcutaneous fat. Interpret & analyze Jeremy's birth. Jeremy is 42 weeks' gestation and very alert. His skin is dry and cracking with little vernix or lanugo. His fingernails are long with greenish discoloration, which suggests meconium staining. He is also long for his weight with little subcutaneous fat.
You are caring for a newborn infant of a diabetic mom (IDM). The infant was born 4 hrs ago & wts 4000 g. The infant's mom notes that the infant is receiving frequent blood glucose checks & asks the nurse if the baby is a diabetic. How would you respond? The nurse would explain that the infant is not a diabetic, but is at risk for hypoglycemia. That while the fetus is in the uterus, he receives the high maternal BS. At birth baby insulin still produce but there is no longer high BS levels. Risk for ~24hrs
What is the most common problem of an IDM? After birth, the most common problem of an IDM is hypoglycemia. The nurse monitors the infant's blood glucose closely, per agency protocol.
The nurse is caring for a newborn infant of a diabetic mother (IDM). The infant was born 4 hours ago and weighs 4000 g. The nurse is determining expected outcomes of nursing care for the IDM. List three expected outcomes. (a) The IDM's respiratory and metabolic alteration problems are minimized. (b) pts understand the etiology of the baby's health problems & preventative steps pt can initiate to decrease the impact of IDM on future babies. (c) The parents express concerns
The nurse is caring for a newborn infant of IDM. The infant was born 4 hours ago and weighs 4000 g. The infant is macrosomic, is ruddy in color, and has excess adipose tissue. The nurse recalls the cause of excessive fetal growth of the IDM as what? The excessive fetal growth of the IDM is caused by exposure to high levels of maternal glucose, which readily crosses the placenta. Fetus responds to these high glucose levels with increased insulin production & hyperplasia of the pancreatic beta cells.
What is the main action of insulin? The main action of insulin is to facilitate the entry of glucose into muscle & fat cells in a function similar to a cellular GH.
A nurse is bottle-feeding a 34-week-gestation neonate. How long should the feeding last? 15-20 minutes
A nurse is caring for a 2-hour-old infant of a diabetic mother. How frequently should the nurse monitor the infant's blood glucose level? every hr
A nurse is caring for an infant who was exposed to alcohol in utero. What s/s might this baby exhibit? A. rhinorrhea and genital candidiasis B. irritability and muscular rigidity C. hypertonicity and jitteriness D. sleeplessness & inconsolable crying sleeplessness & inconsolable crying
A nurse is caring for an infant who was exposed to HIV/AIDS. What s/s might this baby exhibit? A. rhinorrhea and genital candidiasis B. irritability and muscular rigidity C. hypertonicity and jitteriness D. sleeplessness & inconsolable crying A. rhinorrhea and genital candidiasis
A nurse is caring for an infant who was exposed to cocaine in utero. What s/s might this baby exhibit? A. rhinorrhea and genital candidiasis B. irritability and muscular rigidity C. hypertonicity and jitteriness D. sleeplessness & inconsolable crying B. irritability and muscular rigidity
A nurse is caring for an infant who was exposed to heroin in utero. What s/s might this baby exhibit? A. rhinorrhea and genital candidiasis B. irritability and muscular rigidity C. hypertonicity and jitteriness D. sleeplessness & inconsolable crying C. hypertonicity and jitteriness
A 32-week-gestation neonate in the neonatal intensive care unit is being fed intravenously. How often should the nurse change the IV solutions and tubing? every 24 hrs
You are caring for 37-wk-gestation neonate who frequently spitting up, has watery stools 2-3x/day, has mild tremors when stimulated w/ 70 breaths per min. What stage of withdrawal does this infant appear to be in? A. none B. mild C. moderate D. severe B. Mild
___withdrawal is characterized by excessive vomiting, 6 watery stools per day, marked irritability, and tremors with 80-100 breaths per minute. Moderate withdrawal is characterized by excessive vomiting, 6 watery stools per day, marked irritability, and tremors with 80-100 breaths per minute.
____withdrawal is characterized by vomiting and diarrhea with electrolyte imbalance, unrelieved irritability, and convulsions with 100 plus breaths per minute. Severe withdrawal is characterized by vomiting and diarrhea with electrolyte imbalance, unrelieved irritability, and convulsions with 100 plus breaths per minute.
An HIV positive mother asks the nurse, "When will I know if my baby has HIV?" What is the correct response by the nurse? "Current tests cannot differentiate between your blood and your baby's blood for 15 months
A nurse is teaching new parents about the recommended screening tests available for babies prior to discharge. These screening programs test for disorders associated w/ which of the following? A. mental retardation B. cardiac anomalies A. mental retardation is correct answer the others cardiac anomalies, neural tube defects & congenital anomalies are all testable in utero
A nurse is caring for a small-for-gestational-age (SGA) neonate. What complication is this baby at risk for? polycythemia
A nurse is teaching a class on the prevention of preterm births. What is the most important point to emphasize? A. obtaining early prenatal care B. avoiding drugs and alcohol C. getting adequate exercise D. eating a nutritious diet Obtaining early prenatal care
A nurse is caring for a high-risk 4-hour-old neonate. The neonate was born at 36 weeks' gestation. What is the newborn's classification? A. postterm newborn B. preterm newborn C. term newborn D. SGA newborn Preterm newborn anything prior to 38 weeks
Andrea Johnson, G3P2 birth a 6-lbs 3-oz BB @ approx 38 wks labor lasted 2 hrs. hx no prenatal care. Labs mom has UTI & a + culture for (CMV) & group B strep. What are the advantages of treating the baby w/ antibiotics in his home vs a hosp setting? Home treatment of the Johnson baby facilitates infant-parent bonding and is a more cost-effective method of treatment. Home therapy also reduces the incidence of nosocomial infection.
Andrea Johnson, G3P2 birth a 6-lbs 3-oz BB @ approx 38 wks labor lasted 2 hrs. hx no prenatal care. Labs mom has UTI & a + culture for (CMV) & group B strep. What risk factors does Ms. Johnson present w/ that predispose her baby to sepsis or infection? Ms. Johnson received no prenatal care and had a precipitous labor lasting 2 hours. She also has been diagnosed with several infections\: urinary, CMV, and group B strep, exposing her newborn to infection. Septicemia is also more common in male babies.
Andrea Johnson, G3P2 birth a 6-lbs 3-oz BB @ approx 38 wks labor lasted 2 hrs. hx no prenatal care. Labs mom has UTI & a + culture for (CMV) & group B strep. What baby lab tests should the nurse expect the Dr to order that would confirm the dx sepsis? blood cultures from 2 diff peripheral sites, a spinal fluid culture, urine culture, & skin cultures if there are any lesions/drainage. CBC including WBC w/ differential, chest x-ray, serology, & gram stains of spinal fluid may be ordered.
Andrea Johnson, G3P2 birth a 6-lbs 3-oz BB @ approx 38 wks labor lasted 2 hrs. hx no prenatal care. Labs mom has UTI & a + culture for (CMV) & group B strep.What lab values should the nurse anticipate that would support a positive diagnosis of sepsis? A low white blood count may indicate the diagnosis of sepsis. A low neutrophil count and high bands (immature white cells) could indicate that an infection is present. A newborn may normally have a level of 30,000 in the first 24 hours.
The nurse is caring for an infant with hyperbilirubinemia. The infant is receiving phototherapy. The infant is now 5 days old. The total serum bilirubin level on admission was 24 mg/dL and now is 21 mg/dL. What nursing action is indicated? This is an improvement. Current phototherapy is usually continued until the total serum bilirubin is less than 18 mg/dL. The nurse should share the infant's progress with the parents.
The nurse is caring for an infant with hyperbilirubinemia. The infant is receiving phototherapy. The mother begins to cry as the nurse shares the bilirubin results with her. How should the nurse respond? The nurse should stay with the mother, allowing her to cry. Some parents may feel guilty about their baby's condition and think they have caused the problem. After a period of silence, the nurse encourages the mother to express her feelings
The nurse is caring for an infant with hyperbilirubinemia. The infant is receiving phototherapy. How is the effectiveness of phototherapy determined? Phototherapy success is measured by monitoring the serum bilirubin levels.
The nurse is caring for an infant with hyperbilirubinemia. The infant is receiving phototherapy. The nurse teaches the parents how to assess for jaundice. What does the teaching include? lighter-skinned babies, blanch the skin over a bony prominence by pressing firmly w/ thumb release pressure if jaundice the area appears yellow before normal color returns. darker-skinned babies check gums for yellow pigmentation.
The nurse is caring for an infant with hyperbilirubinemia. The infant is receiving phototherapy. What is the nursing care associated with phototherapy? Ideally, the entire skin surface of the newborn is exposed to the light. monitor serum bilirubin levels (The lights must be turned off while drawing blood). applies eyepatches over the newborn's closed eyes during exposure to the phototherapy lights.
T/F The phototherapy is discontinued and the eyepatches are removed at least once per shift to assess the eyes and establish eye contact. The newborn's temperature is maintained. Maintain adequate fluid intake. True
A widely used cutoff point or threshold for intervention in newborn hypoglycemia is a plasma glucose concentration of 40 mg/dL. It is important to use proper technique when performing a heel stick on a newborn. What are the nursing actions & rationale? The infant's lateral heel is the site of choice. Grasp the infant's lower leg & foot to impede venous return slightly. This will facilitate extraction of blood. puncture the lateral heel with a microlancet. Be careful not to puncture too deeply.
What is the optimal penetration for a heel stick on a baby? Optimal penetration is 4 mm.
A widely used cutoff point or threshold for intervention in newborn hypoglycemia is a plasma glucose concentration of 40 mg/dL. It is important to use proper technique when performing a heel stick on a newborn. What equipment and preparation are needed? Equipment\: microlancet, alcohol swabs, 2 X 2 sterile gauze squares, small bandage, transfer pipette, glucose meter, gloves. Preparation\: Use a warm wet wrap or specially designed chemical heat pad to warm the infant's heel for 5-10 seconds.
A nurse is administering epinephrine to a compromised newborn. What is the most accessible vein for administering this medication? A. femoral site B. brachial site C. scalp site D. umbilical Umbilical
A nurse is reading a journal article about the increase in babies w/ kernicterus. What is the most likely contributing factor? A. decrease in access to prenatal care B. increase in adolescent pregnancy C. decrease in length of hospital stay decrease in length of hospital stay
A nurse is caring for a newborn receiving phototherapy. What is an appropriate nursing action? A. Remove newborn from the light when drawing bilirubin levels B. Increase amount of formula to replace fluid loss C. Keep eyepatches in place @ all times A. Remove newborn from the light when drawing bilirubin levels
A nurse is assisting with the birth of a compromised newborn. What should be the initial nursing action? A. Place the newborn under a radiant warmer B. Suction the nasal & oral passages C. Stimulate the newborn by rubbing feet D. Perform CPR. B. Suction the nasal & oral passages
The nurse is caring for a newborn whose mother was diagnosed with group B streptococcus. Which antibiotic should the nurse anticipate the physician or nurse-midwife to order for the newborn? A. ampicillin B. acyclovir C. nafcillin D. vancomycin A. ampicillin
What is acyclovir used for? acyclovir is used in the treatment of herpes.
What is nafcillin used for? nafcillin is used in the treatment of penicillin-resistant staphylococci.
What is vancomycin used for? vancomycin is used in the treatment of methicillin-resistant strains.
After resuscitation, the nurse is caring for the neonate born at 39 wks' gestation w/ dx of meconium aspiration syndrome. When should the nurse expect to perform glucose testing? A. 4 hours of age B. 8 hours of age C. 2 hours of age D. 24 hours of age C. 2 hrs of age
Your assessment of 4-hr-old baby: skin cool to touch w/ increased movements & BS of 40 mg/mL. What should be the initial nursing action? A. Increase IV fluids B. Obtain an order for antibiotics C. Start O2 at 4 L per minute D. Warm the newborn slowly. warm the baby slowly then increase IV fluids are correct.antibiotics and O2 are appropriate for cold stress
A nurse is assigned to care for four newborns. The newborn most likely to develop physiologic jaundice is the one whose mother\: A. has diabetes B. received heparin C. has cardiac problems D. received sulfa. D. received sulfa
A nurse is assisting with the birth of a compromised baby. What position should the nurse place the baby in prior to the first breath? A. head-down B. side-lying C. head-elevated D. prone head down- This position will prevent aspiration of the oropharynx secretions.
A neonate has a respiratory rate of 48 beats per minute after 30 minutes of cardiac compression. Which medication would the nurse anticipate giving? A. Narcan (naloxone) B. Intropin (dopamine) C. Apresoline (hydralazine) D. epinephrine D. epinephrine
____ is a form of brain damage caused by excessive jaundice? Kernicterus is a form of brain damage caused by excessive jaundice
Created by: cgwayland on 2008-06-17



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