Alterations In The Newborn Flashcards by Bailey Pontius

What qualifies a baby for SGA

Below 10th percentile or 5lb 8 oz

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Factors that can affect fetal growth

Maternal nutrition
Genetics
Placental function
Environmental functions

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What qualifies a baby for LGA

Above 90th percentile or 8lb 13oz

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Typical characteriscs for a SGA newborn

Thin umbilical cord
Head disproportionate large to body 
Sunken appearance to abdomen
Loose dry skin
Wide skull sutures

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Common problems for SGA newborns

Hypoglycemia 
Difficulty regulating temperature 
Polycythemia
Birth trauma 
Meconium aspiration 
Hyperbilirubinemia

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Nursing management for SGA newborns

Weight, length, and head circumference measurements
Serial blood glucose monitoring
Monitor vital signs
Early and frequent oral feedings
Anticipatory guidance

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Risk factors associated with LGA newborns

Maternal diabetes mellitus
Prior history of a macroscomic infant 
Post dates gestation
Male fetus 
Genetics
Maternal obesity

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Common characteristics of LGA newborns

Large body
Plump, full face
Poor motor skills
Difficulty regulating behavioral states

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Common problems with LGA newborns

Birth trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia

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What is the one nursing management that is different for LGA newborns than for SGA newborns

Hydration

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If a baby is full term, at what weeks are they born?
Preterm?
Late preterm?
Post term?

38-42
Before 37 weeks
34- end of 36
After 42

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Why are creases on the foot important

Can tell us more about gestational age

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Why is a postterm baby at risk

Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks

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Postterm newborn complications

Hypoglycemia
Hypothermia
Polycythemia
Meconium aspiration

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Nursing management for postterm babies

Resuscitation 
Blood glucose monitoring
Initiation if feedings
Prevention of heat loss
Evaluation for polycythemia
Parental support

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What are some etiologies leading to preterm birth

Infections/inflammation
Maternal or fetal distress
Bleeding
Stretching

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What are issues with a preterm baby

Body system immaturity affecting transition to extra uterine life

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Common characteristics for preterm newborn

Weight less than 5.5
Scrawny, poor muscle tone
Undescended testes
Lots of lanugo
Fused eyelids
Soft, spongy skull bones
Thin transparent skin

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Common problems for preterm newborns

Hypothermia
Hypoglycemia
Hyperbilirubenemia
Problems with immaturity of body systems

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Nursing management for preterm newborn

Oxygenation
Thermal regulation
Nutrition and fluid balance
Infection prevention
Stimulation
Parental support

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Acquired disorders

Occur at or soon after birth

Possibly no identifiable cause

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Congenital disorders

Present at birth
Typically some problem with inheritance
Happens during antepartal period
Majority with complex etiology

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Examples of acquired conditions for newborns

Transient tachypnea
Respiratory distress syndrome
Meconium aspiration
Birth trauma
Hyperbilirubinemia

Neonatal asphyxia

Failure to establish sustained respirations after birth
Asses: color, work of breathing, heart rate, temp, and apgar
Management: immediate resuscitation, neutral thermal environment, blood glucose, parental support and education

Transient tachypnea of newborn

Mild respiratory distress Pulmonary liquid removed slowly or incompletely Usually resides in 72 hours of age

Respiratory distress syndrome

Lung immaturity and lack of alveolar surfactant

Meconium aspiration syndrome

Inhalation of particulate Meconium with amniotic fluid into lungs Secondary to hypoxic stress

Persistent pulmonary hypertension of the newborn (PPHN)

Marked pulmonary hypertension causing right to left extrapulmonary shunting and hypoxemia

Nursing assessment for PPHN

Tachypnea within 12 hours after birth Marked cyanosis, grunting, and retractions Systolic ejection murmur Echocardiogram (to see right to left shunting)

Bronchopulmonary dysplasia

Chronic lung disease Associated with newborns who have lung injury Need continued oxygen after initial 28 days of life

Possible causes for bronchopulmonary dysplasia

``` Surfactant deficiency Pulmonary edema Lung immaturity Barotrauma Fluid overload ```

Therapeutic management for bronchopulmonary dysplasia

Administer steroids to mother during antepartal period and exogenous surfactant to newborn

Retinopathy of prematurity

Developmental abnormality affecting immature blood vessels of the retina 5 different stages If newborn is premature vessels may not develop

Does retinopathy of prematurity develop in one or both eyes

Both due to hyperoxemia acidosis, or shock

What is one thing you must be careful doing to a patient with retinopathy of prematurity

Administer oxygen carefully Ensure lowest concentration and shortest duration

Preventricular-intraventricular hemorrhage

Bleeding in the brain due to fragility or cerebral vessels Most common in first 72 hours of life Grades 1-5 May be no symptoms

Necrotizing enterocolitis

3 pathological mechanisms: bowel ischemia, bacterial flora, and effect of feeding

Signs and symptoms of necrotizing enterocolitis

``` Abdominal distention and tenderness Bloody stools Feeding intolerance Sepsis Lethargy Apnea Shock ```

Infants with diabetic mothers

High levels of maternal glucose pass through placenta, stimulating fetal insulin production leading to somatic fetal growth

What must you watch in a newborn of a diabetic mother

Prevention of hypoglycemia

Newborns of substance abusing mothers

Fetal alcohol syndrome Birth defects Drug dependency Mental disorders

Most common substances for substance abusing mothers

Tobacco Alcohol Marijuana

Types of birth trauma

Fractures Cranial nerve trauma Head trauma

Hyperbilirubinemia

Imbalance in rate of bilirubin production and elimination | Total serum bilirubin level greater than 5mg/dL

Physiologic signs of hyperbilirubinemia

Jaundice

What does bilirubin do in the body

It is produced when the liver breaks down red blood cells

Neonatal sepsis

Bacterial, fungal, or viral microorganism or their toxins in blood or other tissues Can be congenital, early onset (perinatal period) or late onset Antibiotic therapy

Congenital conditions

``` Neural tube defect Micro/hydrocephalus Cleft lip and palate Congenital club foot Development of dysplasia of the hip ```

Neural tube defects

Occur when the neural tube fails to close properly Normally between 17 and 30 days of gestation

Difference between cleft lip and cleft palate

Cleft lip- involves fissure or opening in lip | Cleft palate- involves roof of mouth

Esophageal atresia

Congenitally interrupted esophagus

Tracheoesophageal fistula

Abnormal communication between trachea and esophagus

Omphalocele

Umbilical ring defect with evisceration of abdominal contents into external peritoneal sac

Gastroschisis

Herniation of abdominal contents through abdominal wall defect

Imperforate anus

No opening in anus Prepare newborn for surgery

Club foot

Tendons of foot are shorter May be associated with Edwards syndrome Surgical intervention with complete recovery

Skin rashes

``` Stork bites Mongolian spots Hemangiomas Port-wine stains Jaundice ```