Alterations In The Newborn Flashcards
What qualifies a baby for SGA
Below 10th percentile or 5lb 8 oz
Factors that can affect fetal growth
Maternal nutrition
Genetics
Placental function
Environmental functions
What qualifies a baby for LGA
Above 90th percentile or 8lb 13oz
Typical characteriscs for a SGA newborn
Thin umbilical cord Head disproportionate large to body Sunken appearance to abdomen Loose dry skin Wide skull sutures
Common problems for SGA newborns
Hypoglycemia Difficulty regulating temperature Polycythemia Birth trauma Meconium aspiration Hyperbilirubinemia
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
Risk factors associated with LGA newborns
Maternal diabetes mellitus Prior history of a macroscomic infant Post dates gestation Male fetus Genetics Maternal obesity
Common characteristics of LGA newborns
Large body
Plump, full face
Poor motor skills
Difficulty regulating behavioral states
Common problems with LGA newborns
Birth trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia
What is the one nursing management that is different for LGA newborns than for SGA newborns
Hydration
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
Why are creases on the foot important
Can tell us more about gestational age
Why is a postterm baby at risk
Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks
Postterm newborn complications
Hypoglycemia
Hypothermia
Polycythemia
Meconium aspiration
Nursing management for postterm babies
Resuscitation Blood glucose monitoring Initiation if feedings Prevention of heat loss Evaluation for polycythemia Parental support
What are some etiologies leading to preterm birth
Infections/inflammation
Maternal or fetal distress
Bleeding
Stretching
What are issues with a preterm baby
Body system immaturity affecting transition to extra uterine life
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
Common problems for preterm newborns
Hypothermia
Hypoglycemia
Hyperbilirubenemia
Problems with immaturity of body systems
Nursing management for preterm newborn
Oxygenation Thermal regulation Nutrition and fluid balance Infection prevention Stimulation Parental support
Acquired disorders
Occur at or soon after birth
Possibly no identifiable cause
Congenital disorders
Present at birth
Typically some problem with inheritance
Happens during antepartal period
Majority with complex etiology
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
