09/09/2015 Lecture Flashcards
What factos affect fetal growth?
1) maternal nutrition
2) genetics
3) placental function
4) environment
What are the different terms for birthweight variations?
1) AGA (appropriate) about 80%
2) SGA (small)
3) LGA (large)
What are the premature birthrrates?
1) LBW
2) VLBW
3) ELBW
What is an early and late insult?
Earl: less than 28 weeks, leads to overall growth restriction and never catch up, always smaller
Late insult: greater than 28 weeks, lag for a little bit but then catch up usually
what is IUGR? asymmetric vs symmetric?
intra-uterine growth retardation
asymmetric: head and long bones are growing normally/better compared to their abdomen and internal organs
symmetric: everything growing with a poor rate
Look up Placenta Previa
has something to do with placenta not rising/growing with uterus or something, causes SGA
Characteristics of SGA newborns
1) head disproportionately large
2) wasted appearance of extremities
3) low subq fat
4) scaphoid abdomen (sunken appeareance)
5) wide skull sutures
6) thin umbilical cord
If a baby has yellowy colored staining, what is it? is this a common problem with SGA newborns?
- meconium staining of vernix, yes
Problems of SGAs
1) perinatal asphyxia (can cause meconium staining)
2) thermoreg difficulty
3) hypoglycemia
4) polycythemia (hypercoag problems)
5) meconium aspiration
6) hyperbilirubinemia
7) birth trauma
- remember polycethemia = lots of RBCs and trauma releases heme group causing hyperbilirubinemia, opposite of hyper is hypo + glycemia (good way to remember a lot of this stuff)
Nursing Management of SGAs
1) measurements
2) BG/vitals monitoring
3) early feedings; IV dextrose 10%
4) monitor for s/s of polycthemia
5) MONITOR FOR TACHYPNEA
what should you always monitor for in newborns?
Tachypnea
If SGA baby is having problems coordinating sucking, breathing, swallowing, what should you need to administer?
IV dextrose 10% infusion
Do most SGA newborns experience IUGR?
no, some do but not all
What are the risk factors for LGAs?
1) maternal DM or glucose intolerance
2) prior history of a macrosomic infant
3) multiparity: as mom has more and more pregnancies, babies tend to get larger
4) post-dates gestation
5) maternal obesity
6) male fetus
7) genetics
so if mom’s obese with DM having a late-term male
Characteristics of LGAs?
1) large body, plump, full faced
2) proportional increase in body size
3) poor motor skills
4) difficulty regulating behavioral states
with an LGA, what should we check right away?
blood sugars, monitor for hypoglycemia (extra, another one::: look at Hct b/c of polycthemia)
Common Problems of LGAs?
1) Birth trauma: will have fractured clavicles on the baby
2) Hypoglycemia
3) Polycethemia (hydration, Hct)
4) Hyperbilirubinemia (phototherapy)
- just remember that hypoglyc,polyceth,and hyperbili go together
What are the signs of hypoglycemia in babies?
- jittering (later: seizures)
- poor at feedings
- irritable
- cold
when do we test BS of LGA?
30 min after delivery and then q1h
What are gestational ages for Preterm, early term, term, lat term
wrong in slide Term: 38-41 weeks (specific 38 week- 41, 6 days then starts late term) Early Term: 37-37, 6 days Preterm: before 36weeks and 6 days Late: 41 6days-42 week 6 days
(look this slide up)
After 42 weeks, what physiological deficiency occurs?
inability of placenta to provide adequate o2 and nutrients
postterm babies will look how?
- dry,c rack, wrinkled skin (possibly meconium stained)
- long-thin extremities, long naies
- creases cover entires soles of feet
- wide-eyed, aler
- abundant hair on scalp
- thin umbilical cord
Postterm newborn common problems
- perinatal asphyxia
- hypoglycemia
- polycythemia
- hypothermia
- meconium aspiration
What can lead to preterm birth?
1) infections/inflammation in mom: can even be things like gingavitis or a lot of times UTI
2) maternal or fetal distress
3) bleeding (ex placenta previa)
4) stretching (ex: extra amniotic fluid or triplets)
So a preterm newborn is born before when?
born before end of 37th weeks
What is the second cause of infant deaths?
preterm birth (look up)
Preterm characteristics
1) weight less than 5.5lbs
2) plentiful lanugo
3) lack of plantar creases
4) poorly formed ear pinna
5) fused eyelids
What is the last system to develop?
respiratory
surfactant deficiency leads to ____
respiratory distress synbdrome
unstable chest wall leads to __________
atelectasis
immature respiratory control center leads to _______
apnea
smaller respiratory passageways leads to ___________
respiratory obstruction
there may be increased BP in a premie, what complication can occur?
intracranial hemmorhage
preniatal hypoxia in a premie can cause what?
oxygen shunting to heart and brain resulting in GI ischemia damage
lots of premies have infection and what do we treat with? what can be a complication with a premia?
1) gentomyacin/IV antibiotics
- impaired renal function increases risk of drug toxicity
When does IgG transplacental tansfaer mostly occur for fetus? what does this mean if born before?
after 34 weeks, weakened immune system
When a newborn fails to establish adequate resp after birth, what is this called? What does this chain effects
asphyxia -> hypoxia -> acidosis/hypercarbia -> inhibition of the transition to extrauterine circulation -> cyanosis -> hypotonic and unresponsive
We give resusitation to babies with an Apgar score of what?
less than 7
What do we do to minimize oxygen consumption in premies?
1) maintain neutral thermal environment
2) decrease stimulation: turn lights down, swaddle, limit visitors, cluster care
If we need to resusciatte what are the 4 things we might do?
1) stabilization
2) ventilation
3) Chest compression
4) admin of epi and or volume expansion
We continue to resuscitate until what happens?
HR is greater than 100bpm, vigorous cry, pink tongue
If depression of airway is due to narcotics what do we giv (what if metabolic acidosis?)
narcotics - give naloxone (Narcan)
- if metab acidosis: give sodium bicarbonate
to increase HR in baby, what should w administer?
-admin epi (Adrenalin) via ET tube and repeat
look up ABCDs of Newborn Resuscitation
…..
When administer oxygen to premies, to what factors do we need to adjust the levels we admin>
1) condition
2) gestational age
3) postnatal age of newborn
What can too much o2 admin cause in a premie?
Retinopathy of Prematurity
for short-term resp distress or cyanosis what should we treat baby with?
oxygen hood or blow-by oxygen, o2 should always be humidified
What is used to prevent alveoli collapse in babies?
CPAP
If NG tube is bloody what could be happening?
necrotizing bowel
Do we need to do daily weights on a premie?
yes and plot on growth curve chart
What is the most common cause of morbidity and mortality in NICU population? what factors contribute?
INFECTION!
- lack of antibodies from breast milk and transplacenta
Infectio PRevention in NICU
- remove jewelry and srub prior to entering NICU
- wash hands between babies
- no ill persons
- avoid tape on newborns
- monitor for s/s
what are the s/s of infection in newborn?
- elevated temp, cool extremities
- tachycardia
- TACHYPNEA
- pallor
- jaundice
- poor feeding
- hypotonia
- hypoglycemia
What are some sensory interventions that encourage normal development?
- kangaroo care
- rocking
- singing/music
- gentle massage/touch
- waterbed mattress (like feeling of in-utero)
- non-nutritive sucking
(remember to reduce stimulation)
Should pain in newborn be considered same sort of things as those that cause pain in the adult?
yes!
non-pharm methods for pain management? pharm?
- swaddling
- sucrose and non-nutritive sucking
- kangaroo care
- gentle massage
pharm
- morphine, fentanyl, acetaminophin, ECLA
What’s the tool used to assess newborn pain?
NIPS: Neonatal Infant Pain Scale
What sort of position do we want to put a baby in when possible?
flexed positioning (simulates in utero position)
Acquired vs Congenital Disorders?
- occur at or soon after birth are acquired
- congenital are present at birth (usually inheritance, genetic factors)
when baby still has fluid in lungs what occurs? what majorly assists with removal of fluid?
transient tachypnea, usually resulves by 72 hours of age
- passage through vaginal canal removes a lot of the fluid (so look out with a C-section)
(look up s/s of transient tachypenia)
What is respiratory distress syndrome?
breathing disorder resulting from lung immaturity and lack of alveolar surfactant; have “stiff lungs”
what does x-ray of RDS baby look like? s/s?
- looks like ground glass
- HR >150 to 180,
- tachypnea (rates over 60)
- crackles
- Silverman index score > 7
what tool is used to assess RDS?
Silverman Index
What is MAS?
Meconium aspiration syndrome
- meconium released into amniotic fluid and then aspirated, can block resp passageways -> causes overexpansion of lung and then eventual rupture then collapse
What are some treatments for MAS?
1) antibiotics
2) chest physiotherapy
3) mechanical ventilation
what is PPHTN? what does it cause
persistent pulmonary HTN
- R-L extrapulmonary shunting of blood which leads to hypoxia
S/s of PPHTN
- tachypnea w/in 12 hours after birth
- marked cyanosis, grunting, retrations
- systolic ejection murmur
- ECG shows R->L shunting of blood
what is BD?
bronchopulmonary dysplasia
- a chronic lung disease in newborns who have lung injur, , need continued o2 after initial 28 days of life
what’s treatment of BD?
-admin of steroids in mother (antepartal period)
do males or females have BD more?
males
What is ROP
Retinopathy of PRematurity
- developmental abnormality affecting immature blood vessels of the retina
( five stage from mild to severe)
0 usually develops in both eyes due to hyperoxemia, acidosis or shock
– look up on slides
ok having trouble concentrating….notes might end soon
………..
PVH/IVH is most common in what infants? when does it usually occur?
it is bleeding in brain due to fragility of cerebral vessels, most commin in infants born under 30 weeks, within first 72 hours after birth
-grades I-v
What’s nursing assessment of PVH/IVH
look up
What is necrotizing enterocolitis? 3 patho mechanisms that can lead to NEC?
- occurs typically in babies that are formula-fed, serious GI disease marked by distended abdomen, have air in bowel walls
3
1) Bowel Ischemia
2) Bacterial Flora (from formula)
3) Effect of feeding
what’s the most common anomaly in an infant born to a diabetic mother?
cardiovascular anomalies
be familiar with substance abuse of 3 susbstance that are asterisked in slides
………..
What are the three specific findings associated with FAS
Fetal Alcohol Syndrome
1) Growth restriction
2) Craniofacial structural (wide set eyes, epicanthal folds, thin upper lip, flatter face
3) CNS dysfunction
- lots of times on a spectrum so fetal alcohol syndrome are at the severe end of the fetal alcohol spectrum disorder
UUUUUGGGHHH
gggggghhh
How do we monitor bilirubin levels?
Can rise 5 mg/dL/day up to 15, then we treat
so 1st day: 5 and less is ok
2nd day: 10 and less is ok
3rd: less than 15 is ok but greater than or equal to we treat (but on slide says something about 17 mg/dL)
what is conicterus (sp?)?
result from Rh incompatbility
where do you want to take the measurement with the bilirubinmeter?
on forehead b/c jaundice moves from forehead to toe
horizontal vs vertical transmission of infections in infants
vertical: from one generation to another (mom gives baby something say via breastmilk or during birth)
horizontal: from one person to another (usually through contact with body fluids)
What are primary organisms causing infection in infants?
GBS, E. Coli, Staphylococcus
