3340: PEDS PRETERM Flashcards
LBW Infant
less than 2500g (5lb 8oz) regardless of gestational age
VLBW
less than 1500g (3lb 5oz) regardless of gestational age
ELBW
less than 1000g (2lb 3oz) regardless of gestational age
Preterm
before 37 weeks
Full term
39-40 6/7 weeks
Post term
later than 42 weeks
SGA
below 10th percentile
LGA
above 90th percentile
AGA
between 10th and 90th percentile
Biggest problems with preterm infants
respiratory
thermoregulation
nutrition
Babies born before __ weeks have minimal to absent reflexes (sucking and swallowing included)
32
What position should you place an infant in to facilitate drainage of mucous, regurgitated feedings:
side-lying or prone position
To promote drainage of lung secretions in the preterm infant, the nurse should:
frequently change the infant’s position
The most common mode of O2 deliver in a newborn
hood therapy
Least invasive way to deliver O2
nasal cannula
Inhaled Nitric Oxide
gas used inboxed babies with pulmonary hypertension; relaxes blood vessels in the lungs without having any effect on vessels of the rest of the body
ECMO
the use of a bypass machine to oxygenated the infant’s blood while the infant’s lungs heal
requires anticoagulation
T or F: Premature baby’s blood oxygen can drop fast when agitated
True
Pulse Oximetry
percentage of hemoglobin that is bound by oxygen
simple, non-invasive, continuous monitoring of oxygen saturation by sensors attached to the skin
NTE
environment in which the infant can maintain stable body temperature without an increase in O2 consumption or an increase in metabolic rate
goal: infant maintains temperatures and growth using the least amount of energy
4 methods of heat loss
Evaporation
Conduction
Convection
Radiation
Conduction
loss of heat from direct contact with cold objects
Evaporation
loss of heat from drying the skin or insensible water loss
Convection
Loss of heat from air movement surrounding the infant
Radiation
Loss of heat from being near cold surfaces (not touching)
Placing the newborn on cold, unpadded scale
Conduction
Using a cold stethoscope to listen to breath sounds
Conduction
Placing the infant’s crib by the window on a snowy day
Radiation
Partially drying the infant’s hair after a bath
Evaporation
Placing the infant’s crib near an AC vent
Convection
Brown Fat Oxidation
Non-shivering Thermogenesis Maintains Temperature Increases Metabolism Increased O2 and glucose consumption May cause respiratory distress, hypoglycemia, acidosis, and jaundice
Cold Stress
Excessive loss of heat that results in increased respirations and non shivering thermogenesis to maintain core body temperature
Nursing Intervention : Cold Stress
Warm the baby and seek to identify causes
Indications of Inadequate Thermoregulation
Hypoglycemia and Respiratory Distress may be the 1st signs to show that the infant’s temp is low
Metabolic acidoses r/t anaerobic metabolism is a major hazard of ______
Cold Stress
4 Consequences of Cold Stress
Respiratory Distress
Acidosis
Hypoglycemia
Hyperbilirubinemia
Becoming cold can lead to respiratory distress primarily because the infant:
Needs more oxygen than he or she can supply to generate heat
75-80% of the nutrient stores in a newborn term infant are accumulated during the ___ trimester of pregnancy
3rd
The neonatal nurse should regularly assess the premature infant’s ability to metabolize the TPN solution adequately by monitoring the infant for which of the following clinical manifestations?
Hyperglycemia
Normal Blood Glucose in an Infant
70-100
What is the preferred way of giving gavage feeding to an infant?
orogastric because they are obligated nose breathers
Signs of being ready to Nipple Feed
Strong sucking, Swallowing, Gag Reflexes present
@ least 32 weeks
Steady weight gain in an infant
20-30g/day
RDS
Neonatal Respiratory Distress Syndrome
Insufficient production of surfactant, atelectasis, hypoxemia, hypercarbia, acidemia
Incidence INCREASES as gestational age DECREASES
Manifestations of RDS
crackles, poor air exchange, pallor, retractions, apnea, grunting while breathing
What is the most common problem in premature infants?
RDS
LS Ratio 2:1
The baby’s lungs are mature and the baby is ready to be born
How would the chest X ray of an infant with RDS appear
“ground glass” - reticulogranular appearance
RDS ABG
respiratory acidosis
Decreased pH
Decreased PaO2
Increased PaCO2
RDS Tx
Surfactant Replacement Therapy
Supportive Tx: Mechanical Ventilation, Correction of acidosis, Parenteral Feedings
ROP
Retinopathy of Prematruity
Developing blood vessels in a premature infant’s retina constrict and become permanently occluded in response to high oxygen concentrations; damages retina and may cause decreased vision, myopia, or blindness
What should be avoided in babies that weigh less than 1500gm
SpO2 > 95%
BPD
Bronchopulmonary Dysplasia
Lower airway: inflamed and scarred lungs
How is BPD defined and classified?
Gestational Age and O2 requirement: mild, moderate, severe
Most Common Chronic Lung Disease of Infancy
BPD
Clinical Manifestations of BPD
Irritability Tachypnea, Retractions, Coughing Failure to thrive Barrel Chest Pulmonary HTN
BPD Tx
Supplemental O2 Planned Rest Periods Small frequent meals to prevent overdistension Diuretics Bronchodilators Chest Percussion
IVH
Intraventricular Hemorrhage
Immature, fragile blood vessels within the brain burst and bleed into the hollow chambers (ventricles) normally reserved for cerebrospinal fluid
IVH Dx
Ultrasound
IVH Grade 1-2
Usually no symptoms or long term damage
IVH Grade 3-4
Symptoms and Long term problems
IVH Grade 4
Extension into brains issue
50% mortality rate
90% neurologic disabilities
IVH Clinical Manifestation
Rising ICP: lethargy, poor muscle tone, decreased reflexes, irregular respirations, bradycardia, bulging fontanels
Seizures if bleeding is severe
Hydrocephalus
Tx for persistent Hydrocephalus
Ventriculoperintoneal Shunt (VP Shunt)
How to avoid increasing ICP
Keep infant calm Minimum stimulation Head elevated 15 degrees Avoid trendelenberg measure head circumference daily Be alert for subtle neurologic changes
NEC
Necrotizing Enterocolitis
Life threatening inflammatory disease of intestinal tract
Immature bowel damaged when blood supply decreased, bacteria then invaded damaged area
When does NEC usually occur
first 7-14 days
NEC Clinical Manifestations
Nonspecific: lack of energy, unstable body temp, apnea, bradycardia, hypotension, low urinary output
GI symptoms: increased abdominal girth, bile colored vomiting, decreased or absent bowel sounds, loops of bowel seen through the abdominal wall
Dx of NEC
X-ray and clinical findings
NEC tx
STOP oral/tube feedings Relieve Gas Antibiotic Therapy Surgery if there is a hole Colostomy if full thickness dies
SBS
Decreased ability to digest and absorb a regular diet because of shortened small intestine
Diarrhea, Dehydration, Malnutrition, FTT
Tx of NEC
STEP
LILT