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OB Ch. 27
Infants w/ Gestational Age Probs
| Question | Answer |
|---|---|
| What is late preterm or near term infant | 34-36 1/2 wks |
| LBW wt? VLBW? ELBW? AGA? SGA? LGA? preterm? full? post? live birth? fetal death? neonatal death? | LBW:2500g, VLBW:1500g, ELBW:1000g(2.2lbs) AGA: 10-90th, SGA:<10th, LGA: >90th pre:<37, full:38-42, post: >42 fetal death: after 20wks, neonatal death: first 27 days |
| preterm infants are susceptible to? | necrotizing enterocolitis, growth failure, brochopulmonary dysplasia, intraventricular/peri hemorrhage, retinopathy |
| What three things are part of high risk infant classification | birth wt, gestational age, patho probs |
| What fx of infant renal system are immature? | adequately excrete metabolites/drugs, concentrate urine, maintain acid-base, fluid, electrolyte balance Assess I/O and specific gravity |
| Three options for O2 therapy for infant | O2 hood, nasal cannula, CPAP(most preferred for positive pressure) |
| Physical/emotional abuse is more common in which type of infant? | preterm birth |
| At what gestational age do infants need surfactant? | <32wks |
| what are additional therapies for resp distress | Inhaled nitric oxide, extracorporeal membrane exygenation |
| With nutrition, what is a major complication in feeding preterm infants | aspiration bc gag and swallow reflex is not formed |
| what is gavage feeding? | feed thru nasogastric or orogastric tube. Record hourly amts. |
| tube feeding must be assessed how often? | before each feeding |
| what is gastronomy feeding | thru stomach |
| when bathing preterm <32 wks, what should you bathe with? | warm sterile water for 1st week |
| what adhesives do you use for preterm? | semipermiable transparent adhesive dsg to secure lines, pectin barriers |
| what is polyethylene body bag is used when | after birth to xfer to neonatal unit for <30wks |
| at what decibel lvl can hurt infant's hearing? | constant 90db or frequent exposure of 110db |
| how long should sleep cycles go for complete sleep cycle to finish? | 50min. |
| what is containment/facilitated tucking/blanket swaddling mean? | infant limbs held flexed and close to body during turning or other position changes or heel stick |
| what nonpharmacological method acts as analgesic? | kangaroo care, skin to skin contact, helps maintain higher O2 sat |
| what are examples of approach behaviors of infant? avoidance? | approach: tongue ext, hand clasp, hand to mouth mvmts, sucking, looking, cooing avoid: flushed, dusky, pale, gray skin, tachypnea, gasping, sighing, tremors, startles, twitches, hiccups, grunting, spit up, yawning, coughing, arm/leg extensions |
| what are 4 central themes for NICU staff to use when caring for families? | 1.nurture parents 2.provide accurate/consistent info 3.clarify NICU policies 4.help parents connect with infant |
| what main criteria allow infant to go home? | physiologically stable, receive adequate nutrition, gain wt daily |
| NICU infants will die how much more than non NICU infants in 1st year. What must parents know before discharge? | Twice as likely CPR |
| Resp Distress Syndrome RDS is caused by | lack of sufactant Tx: O2, exogenous surfactant |
| Normal ABGs for neonates | pH: 7.35-7.45 PaO2: 60-80mmHg PaCO2: 35-45mmHg HCO3(bicarb): 22-26mEq/L Base excess: (-4) to (+4) O2 sat: 92%-94% |
| What does the ductus arteriosus connect? What occurs when fails to close? | left pulmonary aa and dorsal aorta PDA occurs |
| what is most common heurologic injury in neonates? | peri/intraventricular Hemorrhage in brain. Elevate HOB. Watch for pneumothorax |
| What is necrotizing Enterocolitis | acute inflammatory disease of GI mucosa from perforation. Preterms at most risk. Ileus forms. Tx: control infection |
| High arterial O2 saturations in ELBW/VLBW has been linked to what complication? | Retinopathy |
| Mechanical ventilation can lead to what complication | Bronchopulmonary Dysplasia(chronic lung disease) in infants <1000g or born <28wks. Listen for crackles, wheezing Tx: O2 therapy, nutrition, fluid restriction, meds. Key to preventing is prevent preterm births |
| What two problems come wtih post term infants? | Meconium aspiration syndrome and Persistent pulmonary HTN of newborn- baby does not change away from fetal O2 exchange like supposed to |
| Explain fetal blood flow from placenta to brain | O2 rich blood leaves placenta by umbilical v, thru ductus venosus, enter inf vena cava, empty in rt atrium, x foramen ovale to lft atrium(bypass lungs), leave thru aorta to heart adn brain. |
| Fetal blood flow from brain back to mom | Blood from brain to sup vena cava, to rt atrium, to rt ventricle, exit pulmonary art. |
| Where does the ductus arteriosus take blood | connect main pulmonary art and aorta leaving right side of fetal heart shunting to systemic system away from lungs. (right-to-left shunting) |
| Blood flow after birth | ductus arterosus and foramen ovale close allowing all CO to go to lungs |
| Common problems taht affect SGA | perinatal ssphyxia - prolonged hypoxia hypoglycemia- decr stores, Tx: IV dextrose, oral feedings hyperglycemia heat loss- decr brown fat, decr gycogen stores |
| Problems for LGA babies | morbidity birth trauma asphyxia congenital anomalies |
| IDM's(infants of Diabetic Mothers)have macrosomia, what's this? | excessive fetal growth due to incr insulin(growth hormone). Round, cherry red face, fat |
| In IDM's, mother's blood is more acidic than baby's, this causes what to happen | ketoacidosis and little CO2 or O2 exchange occurs with placenta. |
| what is single most important factor influencing fetal well being? | Mother's glycemic status. Keep 100-120. Anomalies occur b4 8th wk |
| Birth traumas include | cephalhematoma, Erb Palsy(rt arm), dystocia, phrenic nerve paralysis, brachial plexus paralysis, fracture clavical/humerus |
| Hypoglycemic most common in SGA and macrosomia, what r s/s | jitteriness, apnea, tachypnea, cyanosis, seizures. Glucose needs to be above 50 |
Created by:
palmerag
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