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Neonate

Health Deviations of the Neonate

QuestionAnswer
Disorders of Intrauterine Growth: Small for gestational age <10th percentile for weight; Causes: –1st trimester infection, teratogens, & chromosomal abnormalities; 2nd & 3rd trimester maternal & placental factors.
Small for gestational age: Risk to Infant Smaller head circumference and reduced brain capacity; Hypoglycemia; Polycythemia (RBC); Immunodeficiency; Perinatal asphyxia
Disorders of Intrauterine Growth: Large for gestational age Wt >4000 g or in 90th percentile despite gestational age; Risk to Infant: Birth trauma; Shoulder dystocia; Asphyxia; Hypoglycemia; Congenital anomalies
LGA & Diabetic Mother Enlarged Organs (Liver & Cardiac); Increased body fat; Placenta & umbilical cord are larger; At Risk For: Hypo & Hyperglycemia, Hyperviscosity & Hyperbilirubinemia.
Premature Born before 37 weeks; organs are immature; Lack physiologic reserves to function in an environment.
Factors Associated w/Preterm Birth Gestational hypertension; maternal infection; multifetal pregnancy; HELLP syndrome; premature dilation of cervix; pllacental or umbilical cord conditions that affect the fetus's reception of nutrients.
Late Preterm Infant Born between 34 and 36 6/7 weeks of gestation; referred to as "late preterm" rather than "near term"; Higher risk for: thermoregulation, hypoglycemia, hyperbilirubinemia, sepsis & respiratory function.
Later Preterm Infants At higher risk of mortality because they appear mature and as a result can be treated as term infants.
Premature Assessment: Respiratory Function Difficult pulmnary transition; low surfactant levels; period breathing & apnea; decreased functional aveoli.
Premature Assessment: Cardiovascular Function Hypotension; Hypovolemia
Premature Assessment: Body Tempurature Large surface area in relation to body weight; limited stores of subcutaneous & brown fat; poor muscle tone.
Premature Assessment: Central Nervous System Function Fluctuating systemic blood pressure which causes variation in cerebral blood flow and pressure; recurrent hypoxic and hyperoxic episodes; dependent on gestational age.
Premature Assessment: Nutritional Status Weak or absent suck, swallow and gag reflexes; small stomach capacity; immature digestive capacity; compromised metabolic functions (limited store of nutrients, decreased ability to digest proteins, immature enzyme systems).
Prenatal Adaptation: Parental Tasks Experiencing anticipatory grief over potential loss of infant; accepting failure to give birth to a healthy, full-term infant; resuming process of relating to infant &how they differ from other infants; adjusting home environment to meet needs of infant.
Parental Adapation: Parental Response Progressing through stages of behavior
Parental Adaptation: Parenting Maladaptation Rejection of infant; physical and/or emotional abuse
Parental Adaptation: Parental Support Nurturing parents; providing accurate and consistent information; clarifying nursery policies; help parents connect with other nursery parents.
Parental Adaptation: Parent Education CPR; community resources; lactation/feeding; home care (Oxygen, other equipment).
Prematurity Nursing Care: Oxygen Therapy Extracorporeal membrane oxygenation therapy (ECMO); high-frequency ventilation; mechanical ventilation (surfactant administration); continuouse distending pressure (CPAP); O2 Hood; Nasal Cannula; Weaning from O2.
Prematurity Nursing Care: Nutritional Care Types of nourishment;hydration;elimination patterns;oral feedings;gavage feeding;gastronomy feeding;advancing infant feedings; nonnutritive sucking.
Prematurity Nursing Care: Environmental Concerns Noise Level; Lighting
Prematurity Nursing Care: Developmental Outcome Inappropriate stimulation; containment or facilitated tucking; blanket swaddling or nesting; skin-to-skin (kangaroo care).
Post-Term Infant Born after 42 weeks; Dysmaturity may be evident upon birth: peeling skin, meconium stained skin & nails, loss of subcutaneous fat & muscle mass, no vernix, long hair & nails.
Post-Term Infant Risks Insufficient gas exchange in the post-term placenta puts infant at high risl of intrauterine hypoxia; meconium aspiration; persistent pulmonary hypertension.
Thermoregulation: Four Mechanisms of Heat Transfer Convection:Heat loss through air currents (avoid drafts);Conduction:heat loss through direct contract (avoid cold objects); Radiation:heat loss without direct contact (keep away from cold sources); Evaporation: heat loss by conversion of liquid into vapor
Clinical Manifestations of Cold Stress Respiratory distress, central cyanosis, hypoglycemia, lethargy, poor feeding, weak cry, abdominal distention, apnea and bradycardia.
Complications of Cold Stress Metabolic acidosis, hypoglycemia, pulmonary hypertension, sepsis.
Intraventricular Hemorrhage Bleeding from the brain due to fragility of cerebral vessels; most common in the first 72 hours after birth; grades I to V
Clinical Manifestations of Intraventricular Hemorrhage Possibly no symptoms, risk factors, unexplained drop in hematocrit, pallor, poor perfusion, seizures, lethargy, weak suck, high pitched cry, hypotonia, cranial ultrasonography.
Birth Injuries IInjuries due to the forces of labor and birth; types: fractures, brachial plexus, injury, cranial nerve trauma, head trauma.
Birth Injuries: Nursing Assessment Risk Factors; physical & neurologic assessment: bruising, bumps, swelling, paralysis, symmetry of structure and function.
Birth Injuries: Nursing Management Supportive; assessment for resolution or complications; support and education: realistic appraisal of situation; community referral for ongoing follow-up and care.
Polycythemia Venous hematocrit about 65%; >65% hematocrit results in increased viscosity of blood (increased resistance of blood flow, decreased O2 delivery, abnormalities in CNS function, hypoglycemia, decreased renal function & coagulation disorders.
Treatment of Polycythemia Asymptomatic hematocrit 65%-72%: fluids, close observation and repeat hematocrit Q12hrs; Symptomatic: partial exchange transfusion.
Hyperbilirubinemia: Bilirubin: Unconjugated Product of RBC breakdown; unconjugated (indirect) (initially released by RBC breakdown, can leave vascular space & permate other extravascular tissue such as skin, sclera & oral membranes, and manifests as jaundice.
Bilirubin: Conjugated (direct) Done by liver with glucuronide, excreted into the bilary tract which excretes it to the GI system and then it is excreted in urine/feces.
Hyperbilirubinemia Assessment Transcutaneous Bilirubinometry (TcB): cannot be used if infant is under phototherapy; Serum Bilirubin; Skin Assessment for jaundice: apply pressure to boney area (nose, forehead or chest), assess color of blanched skin, use natural lighting.
Manifestations of Hyperbilirubinemia Jaundice, lethargy, poor feeding, kernicterus (yellow staining on brain cells), high bilirubin levels in relation to hours old.
Treatment of Hyperbilirubinemia Phototherapy (maintain temp carefully, eye protection); Bilibed; Encourage feedings; Exchange transfusion.
Respiratory Distress Syndrome: Risks & Cause Risks:Prematurity, maternal diabetes, maternal hypotension, hydrops fetalis. Cause: Lack of pulmonary surfactant, muscle weakness, overly compliant chest wall.
RDS Clinical Manifestations Tachypnea, grunting, nasal flaring, intercostal or subcostal retraction, hypercapnia, respiratory acidosis, hypotension, shock.
RDS Treatment Self-limiting disease:Will begin to resolve in 72 hours w/production of surfactant; Supportive: ventilation, O2, surfactant supplementation, positive pressure ventilation (CPAP), monitor (arterial blood gases (ABGs), pulse oximetry, neutral thermal envir.
Meconium Aspiration Syndrome: Cause Fetus passes meconium in utero: occurs in 10-15% of all births, occurs most commonly with term and post-term births.
Meconium Aspiration Syndrome: Manifestations Meconium staining is noted in amniotic fluid and once baby is born on nails & skin; If meconiium is aspirated in lungs either in itero or at birth infant may develop chemical pneumonitis (persistent pulmonary hypertension of newborn (PPHN), sepsis, RD
Meconium Aspiration Syndrome: Treatment Endotracheal suctioning at birth; ECMO (extracorporeal membrane oxygenation); Routine assessments and monitoring for complications.
Transient Tachypnea of the Newborn Mild respiratory distress, pulmonary liquid removed slowly of incompletly, resolution by 72 hours of age; Risk Factors: maternal sedation, cesarean birth.
Transient Tachypnea Manifestations Tachypnea (100-140); expiratory grunting; retractions; labored breathing; nasal flaring; mild cyanosis respiratory; slightly decreased breath sounds.
Transient Tachypnea Management Oxygenation, supportive care, IV fluids or gavage feedings, supplemental O2, neutral thermal environment.
Bronchopulmonary Dysplasia: Causes Chronic lung disease acquired as a result of mechanical ventilation and supplemental oxygenation. (Highest risk is infants weighing <1000 G and < 28 weeks gestation.
BPD Manifestations Tachypnea, retractions, nasal flaring, increased work of breathing, exercise intolerance, feeding and handling intolerance, tachycardia, lund sounds: crackles, decreased air movement and occasional expiratory wheezes.
BPD Treatment O2 Therapy, nutrition, fluid restriction, medications (diuretics, corticosteroids and bronchodialators).
Retinopathy of Prematurity: Causes Mechanism is unclear, but seems to be related to high O2 concentrations; retinal vessel formation starts at week 16 and they mature until 42-42 weeks
Retinopathy Clinical Manifestations Visual Impairment (mild to severe); scar tissue formation
Retinopathy Prevention It is recommended to not keep premature infants at 100% O2 saturation with O2 therapy, but rather keep their levels above 90% but below 100%.
Neonatal Infection Classifications Congenital (Intrauterine), Early-onset (perinatal), Late-onset (after perinatal period)
Neonatal Infections: Common Types Group B Strep, Sepsis, Herpes Simplex Virus
Neonatal Infection Manifestation (Respiratory) Apnea, bradycardia, tachypnea, grunting, nasal flaring, retractions, decreased O2 sat, metabolic acidosis.
Neonatal Infection Manifestation (Cardiovascular) Decreased cardiac output, tachycardia, hypotension, decreased perfusion.
Neonatal Infection Manifestation (Central Nervous) Temperature instability, lethargy, hypotonic, irritability, seizures
Neonatal Infection Manifestation (GI) Feeding intolerance, abdominal distention, vomiting, diarrhea
Neonatal Infection Manifestation (Integumentary) Jaundice, pallor, petechia, mottling.
Prevention of Neonatal Infection Hand washing, standard precautions, frequent replacement of equipment (IV tubing, NG/OG tubes), keeping environment and equipment free of contamination, breastfeeding.
Treatment of Neonatal Infection Medication therapy: antibiotic agents, antifungal agents, antiviral agents; supporting compromised body systems.
Necrotizing Entercolitis: Cause Acute inflammation of the GI mucose complicated by perforations; exact cause is unknown, but the following has been associated with the development of NEC (intestinal ischemia, colonization, substrate in intestinal lumen.
Necrotizing Entercolitis: Manifestations Lethargy, hypotonia, pallor, recurrent apnea/bradycardia, decreased oxygen saturation, respiratory distress, temperature instability, metabolic acidosis, cyanosis, GI s/s (abdominal distention, increasing or bile stained gastric aspiration, bloody stools)
Necrotizing Entercolitis: Treatments Supportive in regards to compromised body systems; prevention in regards to bowel perforation (NPO, NG to low suction, antibiotic therapy, prevention of further infection, parental nutrition); surgical intervention
(PPHN) Persistent Pulmonary Hypertension: Cause Unknown; heart is structurally normal however the right-to-left shunt that was present in fetal circulation persists into extrauterine life; most common in tern & post-term infants.
PPHN Manifestations Cyanosis & tachycardia at birth; progresses into respiratory distress and severe pulmonary hypertension.
PPHN Treatment ECMO; high frequency ventilation, nitric oxide therapy.
SIDS Death of an infant <1 year that is unexplained after a complete investigation and post-mortem exam. (Attributed to back sleep).
SIDS Prevention Back to sleep until 6 months; appropriate bedding; maternal smoking risk; dangers of co-sleeping on non-infant surfaces.
Substance Exposed Newborns: Most Common Tobacco, Alcohol, Marijuana
Fetal Alcohol Syndrome Physical and mental disorders that appear at birth; long term
Neonatal Abstinence Syndrome Drug dependency aquired in utero manifested by neurological behaviors and physical behaviors.
Nursing Assessment for Substance Exposed Newborns Maternal history, risk behaviors, toxicology, newborn behaviors.
Nursing Management of Substance Exposed Newborns Comfort promotion, stimuli reduction, nutrition, prevention of complications, parent-newborn interactions.
Created by: nglidden