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High Risk NB
Prematurity, Risks
| Term | Definition |
|---|---|
| List the 5 primary variables for high risk | 1) Age, 2) size, 3) genetics, 4) maternal/environmental variables, 5) labor variables |
| List the sx cluster that emerges regardless of etiology (8) | 1) temp instability, 2) resp ineffectiveness, 3) cardiac instability, 4) glucose instability, 5) muscle tone variations, 6) ineffective feeding, 7) altered LOC, 8) ineffective interaction |
| A baby with nonreducible nuchal cord will show this pattern on fetal heart monitor | Deep variables (cord issue) |
| For majority of premature babies, they will have ______ throughout life | Lasting complications |
| ______ is the leading cause of infant mortality morbidity | Prematurity |
| The mothers at highest risk for preemies are | Teenage moms |
| 80% of prematurity between ___ weeks is due to ________ _______ | 24-28 wks; intrauterine infection |
| What sort of special needs may a preemie need? | PT/OT, sensory deficits, learning deficits |
| Our primary nursing role re: prematurity is ___ | Prevention! (Prevent teen birth, contraception planning, teaching/health promotion in pg, universal teaching of signs of preterm labor) |
| ______ is paramount in a premature infant | Thermoregulation |
| What respiratory concerns do we expect with premature babies? | Uterine hypoxemia/asphyxia, respiratory distress syndrome, transient tachypnea of NB (C/S), apenea, meconium aspiration syndrome |
| What treatment can be given to prevent RDS? (think specific prevention strategies) | Reduce # of elective inductions, use of pit. Increase health status of mom, decrease fetal stress, identify high risk concerns, and respond quickly/appropriately |
| What O2 treatments do we give for an infant in RDS | Bi-PAP, C-PAP |
| We give ____ to a baby with apnea | Caffeine |
| With LBW babies, we introduce ____ to help maintain surface tension of ____ | Surfactant; alveoli |
| Mild signs of respiratory distress | Pale, flaring of nares |
| Moderate signs of respiratory distress | Poor feeding, subcostal retractions, restlessness, weak/kitten cry, pale + pale mucous membranes |
| Severe signs of respiratory distress | Intercostal/sternal/nuchal retractions, end expiratory grunting, stridor, hypotonia, poor response to pain, "asleep", cyanosis of peripheral (limbs) and/or central (mucous membranes/trunk) |
| True or false: acrocyanosis is a sign of respiratory distress | False. Normal finding in NB |
| What is a pre/post-ductal test? | A screening test that looks for duct dependent congenital heart disease. A pulse ox placed on R hand (pre-ductal) and foot (post ductal) to determine sat levels |
| If saturation differences between pre/post is >= __% then there is a problem and cardiology consult needed | 5% |
| We look at above and below _____ during pre/post-ductal | Umbilicus |
| When administering O2 via NC, we consider two things: | 1) baby's skin, 2) humidifying O2 to not dry out mucous membranes |
| If a baby is not able to tolerate NC, we can use a _____ @ 2-5L/min which can be blended with room air | Oxygen hood |
| CPAP stands for | Continuous positive airway pressure |
| What key assessments are needed in care of NB on CPAP? | O2 sat, chest rise/fall, overall color, lung sounds, skin condition |
| Endotracheal tubes and mechanical ventilation have potential for _____ and cause also cause the lungs to ______ | Infection; blow out |
| What is the difference between an ambu bag and a T-piece resuscitator (neopuff)? | Neopuff allows more control so you're less likely to blow lungs out |
| With intubation we can also cause ______ issues | Trauma; pressure sores on trachea |
| How is O2 therapy and psych/social impairment related? | If over-oxygenated baby, result in oxygen toxicity, which causes brain damages, which results in learning difficulties/impairment |
| What is the rebound effect? How does it relate to eyes? | When remove/reduce O2, create rebound from constriction to vasodilation --> leaky vessels --> hemorrhage --> retinal detachment/myopia |
| ROP stands for _____ | Retinopathy of prematurity |
| O2 toxicity causing vasoconstriction of vessels in retina and is not ________ | dose dependent |
| ____________ is one of the most common lung injuries as result of prematurity and extended O2 therapy | Bronchopulmonary dysplasia |
| What is bronchopulmonary dysplasia? | An injury to small airways, interfering with alveolar development, which reduces overall surface area for gas exchange |
| Bronchopulmonary dyplasia results in _____ hunger | Chronic oxygen hunger |
| How can we avoid bronchopulmonary dysplasia? | Give mom betamethasone in 2 doses 24h apart |
| How we care for baby with bronchopulmonary dysplasia? (O2 specific) | Give preemies surfactant, lower O2 levels, correct PDA, minimize tidal volumes |
| Long-term oxygen therapy should be weaned ______ and monitored ______ | Slowly; well after discontinuation |
| What is intraventricular hemorrhage? | Bleeding originates from brain w/extension from ventricular system |
| Intraventricular hemorrhage is a common problem, especially in infants born before _____ weeks | 32 |
| Most hemorrhages occur within ______ after birth | 72 hours |
| What can increase risk of hemorrhage? | Seizure activity, respiratory distress, caffeine |
| Assessment for hemorrhage includes (labs, resp, behavior, tone) | Monitor unexplained Hct, drop, paleness/pallor, sx of respiratory distress or desat, seizures, lethargy, babies w/ weak suck and high pitched cry, hypotonia |
| How can you avoid hemorrhage complications in baby? | Cluster care and be very gentle with baby |
| Myocardial dysfunction is often due to _________ | Congenital defects (shunting, conduction issues) |
| Suck-swallow-gag is not safe until at least ____ weeks | 34 weeks |
| Babies born early will have prolonged _____ | IV access |
| Parenting role r/t feeding preemies | Want mothers to pump + store milk, fortify milk with calories, kangaroo care as much as possible, NG tube feed until suck/swallow good, may initially give all nutrition IV (TPN/lipids) |
| Prematurity affects CNS through | Ineffective themoregulation, intraventricular hemorrhage, seizures, disorganized feeding/attachment/cueing |
| Renal issues r/t prematurity include | Tubular necrosis |
| NEC stands for | Necrotizing enterocolitis |
| How do we reduce risk of NEC? | Thoughtfully use antibiotics, careful use of parenteral nutrition, SLOW feedings, corticosteroids, probiotics, breastmilk |
| What is NEC? | Bowel has ischemic events r/t immature intestinal barrier, improper gut flora, stress. Too much/too soon enteral feedings. Compromised gastric circulation. Infection |
| Assessment of NEC | Feeding intolerance, distended bellies, bloody stools, septic shock, DIC, bilious vomiting |
| S/sx of septic shock | Resp distress, temp instability, hypotension, lethargy, decreased UO |
| With NEC you may see these labs | Increased/decreased WBC, thrombocytopenia, neutropenia, metabolic acidosis, CRP levels up |
| If we suspect NEC, our actions should be | FIRST STOP FEEDINGS, place baby on IV fluids, consider TPN, IV antibiotics |
| 80% of preemies have _____ | Jaundice |
| Preemie skin issues include | Paper thin skin, poor flora, easily disrupted, infection, pain |
| Preemie issues with interaction | Habituates (shuts down), ineffective cues with caregivers, pain, air hunger, med effects |
| We should ____ care because preemie babies can't handle ______ stimulation | Cluster; constant |
| 17P refers to _____ given between _________ to decrease risk of premature delivery | Progesterone given between 16-25 weeks to decrease risk of premature delivery |
| 17P does what? | Prevents contractions by suppressing cytokines, prostaglandins and response to oxytocin |
| Near term/late preterm newborns may look _____ on the outside but they are ______ not normal | Normal; neurologically |
| Late preterm NB will have these issues | Poor feeding, sleepiness, transient tachypnea, poor temp/glucose control, jaundice and infection |
| Late preterm NBs will work very hard and then crash, often after _____ hours | 24 |
| Late preterm NBs are considered deliveries between ______ and ___ weeks | 35 - 38 6/7 |
| Late preterm NBs account for >70% of _____ | NICU admissions |
| To prevent late preterm deliveries, we encourage mothers to ______ | Stay pregnant til 39 weeks |
| Rates of late preterms have doubled d/t increased ______ and _______ | C/S, inductions, and older mothers |
| What is the car seat test? | How does baby tolerate being in car seat? Late preterms may asphyxia in seat d/t poor tone |
| How can we keep women pregnant til 39 weeks? | Rest, stress reduction, take care of selves, HYDRATE, avoid doing elective inductions/C-S until 39 wks |
| Babies with bronchopulmonary dyplasia may have _______ delays | Psycho/physical delay |
| Bronchopulmonary dysplasia is treated with these meds | Steroids, Vit A, diuretics, bronchodilators |
| Bronchopulmonary dysplasia is associated with | Lack of surfactant, pulmonary edema, immature, lungs, too much fluid, mech ventilation trauma |
| Teach parents that complications such as ______, _______ and _______ r/t nutrition and hydration may arise for BD babies | Altered nutrition, reflux, fluid restrictions |
| True or false: circumoral cyanosis is a sign of concern | True |
| What reasons are there to induce a woman (medical necessity)? | Abruption, cord prolapse, LGA, IUGR, previa, worsening preeclampsia |
Created by:
lapio-obgyn
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