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High Risk NB

Prematurity, Risks

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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