Acute Conditions of the Newborn Flashcards
This means severe and sudden onset; duration is also shorter
Acute
Acute Conditions of the Newborn
- RDS
- Transient Tachpnea of the Newborn (TTN)
- Apnea
- Meconium Aspiration Syndrome (MAS)
- Hyperbilirubinemia
- Rh Incompatibility
- ABO Incompatibility
- Sudden Infant Death Syndrome (SIDS)
- Fetal Alcohol Syndrome (FAS)
- Newborn at Risk because of Maternal Infection
Is the most comman cause of neonatal and infant mortality
* - Occurs in premature babies whose lungs are not fully developed
- Happens due to insufficient lung surfactant
RDS
Other causes of RDS
- Slow transition to extrauterine life
- Pneumonia
- MAS
- Sepsis
A systemic inflammatory response to infection leading to organ dysfunction
Sepsis
How does pneumonia cause RDS?
Alveoli are filled with pus & fluid, causes surfactant dysfunction / deficiency.
How does sepsis cause RDS?
Sepsis can trigger RDS due to lung inflammation & impaired gas exchange
Universal sign of RDS
Tachypnea (> 60 breaths/min)
Assessment findings of RDS aside from tachypnea
- Nasal flaring
- Chest retractions
- Grunting
- Seesaw breathing
- Head bobbing
- Stress response
- Respiratory failure - Late sign
What does seesaw breathing mean?
Excessive use of abdominal muscles ; rocking motion of the chest & abdomen.
Why does RDS rarely occure in NSD & Mature Infants?
- Mature infants have fully developed lungs & adequate surfactant levels
How is RDS prevented?
- Dating Pregnancy via Sonogram ( determine AOG/FLM)
- Determining Lecithin-Sphingomyelin Ratio
- Corticosteroids administration in preterm labor
How to check for fetal lung maturity?
Amniocentesis
At what level of L/S ratio indicates mature lungs w/ enough surfactant.
Greater than or equal to 2:1
Use of administering corticosteroids in preterm labor?
To hasten/accelerate FLM by accelerating formation of lung surfactant
Nursing Care Management for RDS
- Promote adequate oxygenation & normal breathing pattern
- Prevent secondary infections
3.Promote desired fluid & nutritional intake
Proper positioning to improve bronchial drainage & ventilation to all lung fields?
- Head elevated & turn to sides
This uses specific positions to help drain secretions and excess fluids from different lung segments using gravity & prevent aspiration
Postural drainage
Necessary to maintain O2 level
Oxygen administration
This helps to loosen mucus secretions
CPT
When is the best time to suction
- Before feeding
- Before bedtime
Aids in breathin since sick or premature babies are often not able to breathe well enough on their own. May need help from this machine to deliver O2 into the lungs & remove CO2
Mechanical Ventilator
RDS
How to prevent secondary infections?
BY:
- Maintaining aseptic technique & observe isolation precautions
- Minimizing child contact with infected persons
- Admnister medications as ordered
This medication relaxes muscles of the airways, causing widening of the airways resulting in easier breathing.
Terbutaline (bronchodilator)
Synthetic surfactant is sprayed into the lungs using syringe or catheter through an endotracheal tube (ETT)
Surfactant replacement
This occurs shortly after birth & fades by 72 hrs of age when the lung fluid is absorbed & respiratory activity becomes effective
Transient
Rapid respiration that remains between 80-120 breaths per min due to retained lung fluids
Tachypnea
Why does TTN more often happen to newborns delivered via C/S?
Since lung fluid absorption during labor & delivery did not normally take place
- thoracic cavity was not compressed, thus less lung fluid is expelled
Why should fetal lung fluids be cleared at birth?
To allow entry of O2 and the onset of effective pulmonary gas exchange
Assessment findings of TTN
- Tachypnea
- Grunting
- Nasal flaring
- Mild retractions
- Slightly labored breating
- Mild hypoxia
- Oral feeding difficult
- Retained lung fluids - revealed thru Chest x-ray
How long does TTN usually resolve with supportive care?
24-72 hrs
Primary goal for management of TTN
Ensure adequate oxygenation & prevent complications while the newborn gradually clears retained lung fluid
Signs of respiratory distress
- Grunting
- Nasal flaring
- Retractios
O2 sat of 90-95% do you treat immediately with O2?
No it is usually monitored, not treated immediately with oxygen unless baby has + signs of RDS
At what level of oxygen saturation is considered a moderate case for O2 therapy?
Less than 90%
Management for TTN
- Monitor Respiratory Rate & Oxygenation
- Avoid Oral Feeding until Tachypnea resolves
- Maintain a neutral thermal environment
Why is NB on NPO status if they are experiencing tachypnea?
Increased risk for aspiration
How to maintain hydration & electrolye balance if NB is on NPO
IV fluids (D52 or D10W) as ordered
Why must hypothermia be prevented if NB has TTN
Worsen respiratory status
How to maintain a neutral thermal environment for NB?
- Use warmers
- Skin-to-skin contact
A condition when infant** pauses breathing** for more than 15-20 seconds accompanied by bradycardia & cyanosis
Apnea
Why is apnea more common in preterm infants?
Due to fatigue to immaturity of respiratory mechanisms
Causes / Triggers for Apnea
- Prematurity (AOP) - immature brainstem fails to regulate breathing properly.
- Infection - airway inflammation & apnea
- Hypothermia - slow brain activity, reducing signals for breathing
- Hypoglycemia - brainstem suppression ; decrease glucose in the brain causes cannot regulate breathing properly
- Hyperbilirubinemia - can lead to apnea if it progresses to kernicterus
Kernicterus - condition where bilirubin crosses BBB & damages brain.
Nursing Management of Apnea
- Stimulate baby to breathe again by gently shaking or flicking soles of the feet or rubbing baby’s back
- If baby is unresponsive - ventilation & resuscitation may be necessary.
- Use apnea monitor - warn nurses for succeeding episodes
- Protect baby from undergoing conditions which triggers them to cause apnea.
- Observe infant after feeding since a full stomach can put pressure on the diaphragm. Burp infant every after feeding
- Do not take rectal temp - to prevent vagal stimulation
It is caused by the presence of meconium in the tracheobronchial airwary. Infant with hypoxia in utero experiences vagal reflex relaxation of the rectal sphincter which releases meconium into the amniotic fluid - baby is under stress meaning not receiving enough oxygen
MAS
Why do babies who are stressed in utero possible get MAS?
Baby gasping for O2 causing meconium to be aspirated into the lungs.
Main Causes of increased stress for the baby causing MAS
- Placental insufficiency - aging / abruption
- Issues involving the umbilical cord - prolapse
Meconium Aspiration induces hypoxia via 4 major pulmonary effects:
- Obstruction of the airway
- Surfactant dysfunction
- Chemical pneumonitis
- Pulmonary hypertension
Complications of MAS
- Aspiration Pneumonia
- Brain damage - due to hypoxia from airway obstruction & ineffective gas exchange
- Lung collapse (Atelectasis)
How does MAS complicate to lung collapse?
Sometimes airways can be partially blocked, allowing air to reach parts of the lung beyond the blockage but prevent it from being breathed out
- Involved lung may become over-expanded
- Over-expansion can then rupture and collapse the lung
Assessment for MAS
- Meconium-stained nails & umbilicus
- Chest retractions w/ tachypnea
- Barrel chest
- Blood gas reveals Low PO2 (Partial pressure of O2)
- Chest xray reveals bilateral lung fields are hyperinflated w/ non-symmetrical air space opacities, with areas of atelectasis & flattening of the diaphragm
