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Mgmt Test 3 - OB > Care of High-Risk Newborns > Flashcards

Care of High-Risk Newborns Flashcards

1
Q

Why are preemies more susceptible to hypothermia?

A

Lack of white fat to keep them insulated
Lack of brown fat, (develops at 28-30 weeks)
Babies don’t shiver (which normally produces heat)
Immature CNS, immature temp regulator in the brain (H1=hypothalamus)
Greater surface area (premature infants don’t flex)
Thin skin - blood vessels are closer to the surface of the skin (losing heat/vasoconstriction)

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2
Q

more than 1/3 of all infant deaths are related to preterm T or F

A

True

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3
Q

Causes related to high risk infants

A 
Substance abuse
Diabetes
Teen Moms
Illness (sepsis)
Multiple pregnancies
Unknown
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4
Q

What will we see in a baby experiencing hypothermia

A 
Changes in feeding behavior
lethargic or irritable (change from norm)
respiratory difficulty
hypoglycemia
mottled/pale appearance
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5
Q

what happens in cold stress

A

baby has decreased body temp
babies need to increase metabolic rate to produce heat; using up a lot of glucose and oxygen, resulting in hypoglycemia and resp. distress
babies are increasing their caloric & oxygen use - which they need just to sustain life
non-shivering thermogenesis
vasoconstriction

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6
Q

trt/prevention of hypothermia/thermo-regulation

A

kangaroo care (skin to skin)

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7
Q

signs of respiratory distress

A 
grunting
nasal flaring
retractions
cyanosis (lips)
see-saw respiration's (chest goes down, belly goes up)
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8
Q

A serious complication of hypothermia

A

cold stress

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9
Q

Respiratory Distress Syndrome (RDS) is a

A

lung disorder affecting preterm infants

insufficient surfactant production

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10
Q

RDS is found in this population more often

A 
big babies (born to diabetic moms) - insulin blocks cortisol, cortisol is involved in surfactant production
male babies - androgen's (male hormones) inhibit surfactant production
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11
Q

incidence and severity of RDS is reduced by giving

A

Maternal steroids - maternal betamethazone, acts as cortisol in the baby to get surfactant production going

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12
Q

S/S of RDS appear within

A

at birth or within the first 6 hours - quickly

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13
Q

treatment for AOP

A

caffeine - IV loading dose, then PO

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14
Q

Rate of death from RDS went from 100 - 10% of babies after surfactant trt was found T or F

A

true - considered golden treatment

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15
Q

ROP retinopathy of prematurity cause

A

Blood vessels in the eye become injured; still grow, abnormally, can rupture causing a leak and bleed, scar tissue forms which actually puts traction on retina, causing cause retinal detachment and blindness.
Don’t know the exact range; prolonged oxygen/ventilation support can put them at an increased risk and cause ROP

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16
Q

condition which inhibit/interferes with surfactant production

A

birth asphyxia

c-section

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17
Q

treatment of RDS

A

surfactant replacement therapy through ET tube, intubate them

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18
Q

two complications of oxygen therapy/ventilation support

A

retinopathy of prematurity

chronic lung disease

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19
Q

treatment of CLD (chronic lung disease)

A

supportive/palliative
antibiotics (prn)
broncho-dilators
provide support for parents as well

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20
Q

With IVH, patients are likely to develop

A

developmental delays

neurological abnormalities

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21
Q

Intraventricular (IVH) hemorrhage cause

A

because blood vessels are fragile they will rupture/burst; we will see bleeding in the brain
any hypoxic injury to the brain (systolic)
fluctuations in BP
fluctuations in cerebral blood flow

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22
Q

over the course of 2 years, having had CLD, what can you expect

A

chronic respiratory/lung infections

pneumonia’s

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23
Q

s/s of CLD (chronic lung disease)

A

tachycardia

resp acidosis

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24
Q

CLD prevention

A

maternal steroids -beta methadone
decreases inflammation in airways
minimize exposure to oxygen/ventilation

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25
Screening/mgmt of IVH
day 7 ultrasound oxygen/ventilation therapy
26
stage 4 IVH will present with
neurological abnormalities
27
what causes fluctuation in blood flow in IVH patients
crying diaper changing oxygen/ventilation support
28
prevention of IVH
maternal steroids - beta methazone
29
when will we s/s of IVH
within 72 hours birth; otherwise no evidence of a problem
30
Nursing interventions for IVH
``` cluster care minimum to care for these patients measure head circumference observe for chg in neurological status elevate head 30* - decreasing intracranial pressure parental support ```
31
if a baby has symptoms with IVH what would they be
``` lethargy poor muscle tone respiratory deterioration w/apnea or cyanosis(hypo glycemia/thermia) seizures (last sign) decreased reflexes tenting/bulging fontanel ```
32
***complication of IVH***
hydrocephalus (water on the brain); requires a shunt
33
what is NEC
infection of the intestines - gas forming bacteria invade intestinal wall; pockets form in intestine as well as food those areas of intestine begin to die sepsis/systemic infection can occur
34
what causes nec
unknown - immature GI system? hypoxia - lack of air to the belly? feeding too much, to soon?
35
prevention of NEC
breast-milk (formula w/probiotics) | maternal betamethazone
36
s/s of nec
abdominal distention- loops of bowel can be seen respiratory distress - diaphragm pushing against lungs spitting up feedings
37
NEC mgmt
``` stop feedings immed - call physician (iv nutrition) antibiotics decompress belly surgery may be necessary - ostomy? long-term gi problems ```
38
birth asphyxia - what is it
lack of oxygen/increased carbon dioxide in blood
39
hypoxia vs asphyxia
hypoxia - lack/decreased amt of oxygen | asphyxia - increased carbon dioxide (acidosis)
40
what does asphyxia cause
ischemia to organs
41
possible causes of asphyxia
insufficient surfactant maternal fxrs (htn, infection) placental fxrs (insufficient, abruption, previa) fetal fxrs (congenital anomalies, cord problems, prematurity) Stress puts baby at risk for asphyxia
42
birth asphyxia manifestations
rapid breaths then nothing (resuscitating when nothing is happening) rapid fall in HR gasping loss of consciousness
43
what do we want to prevent (goal) for birth asphyxia
prevent further brain damage - secondary cell death
44
intervention to prevent secondary cell death to the brain in birth asphyxia
therapeutic hypothermia - controlled cooling w/cap or blanket decreasing biological processes - metabolism must be done within 6hrs of birth must be 36 weeks in utero cooled for 72hours must slowly increase their temperatures (seizures if done too fast) 34-35*C babies are monitored w/EEG, iv fluids, sedation helps mild to moderate cases, not much improvement for significantly impaired cases
45
other complications w/birth asphyxia
hypo-thermia/tension/glycemia feeding problems seizures fluid/electrolyte imbalances
46
nursing care for birth asphyxia
sedation ventilation parental support
47
difference between transient tachypnea and respiratory distress syndrome is
TTN - really called wet lung amniotic fluid leftover in lungs (wet lung), usually resolves on its own in 12-72 hrs RDS - surfactant problem
48
transient tachypnea of the newborn (TTN) cause
amniotic fluid leftover in lungs (wet lung), resolves on its own in 12-72 hs
49
risk fxrs for TTN
male babies c-section w/o labor (labor process pushes fluid along) maternal diabetes/asthma
50
most common respiratory problem seen in NICU
TTN - transient tachypnea of the newborn
51
population affected w/TTN
term | late pre-term
52
if a babies respiratory rate is greater than 60 will we feed them?
NO. IV fluids/continue checking xrays
53
Meconium Aspiration Syndrome MAS is caused by a stress event such as asphyxia/hypoxia - anal sphincter relaxes causing release of stool, baby aspirates meconium in utero or at birth. t or f
true
54
what is MAS
meconium fluid enters lungs during fetal life or at birth
55
what does MAS result in
obstruction of airway (meconium is thick/tarry) | infection/inflammation of the airway
56
nursing intervention for MAS
gives lung rest/support (oxygen/ventilation) npo Viagra (helps w/vaso-dilation of lungs)-off label use
57
last resort trt for MAS
extra corpral membrane oxygenation (ecmo) heart/lung bypass machine
58
hyperbillirubinemia can cause
brain damage
59
positive direct coombs test
monitors bilirubin levels direct = babies test - not moms (+) = maternal antibodies were found on babies RBCs; moms blood cells were attacking babies antigens (rh incompatibility/hemolytic disorders)
60
1 cause of hyperbilirubinemia
HEMOLYTIC FXRS - Rh incompatibility; sometimes ABO
61
causes of hyperbilirubinemia
hemolytic fxrs (#1 cause) infection hypoxia diabetic mom
62
pathological vs physiologic hyperbilirubinemia
``` TIMING Pathological (disease process going on) - appears in 1st 24 hrs - acidosis seen a lot (interferes w/ blood/brain barrier) - picks up albumin - no albumin to conjugate the bilirubin Physiologic - after 24hrs of birth - norm RBC process (breaking down) fetus has to make more RBC then is needed extrautero - babies breaking down its fetal hemoglobin the byproduct is bilirubin ```
63
conjugated vs un-conjuguated bilirubin
``` Conjugated = good - liver makes bilirubin water soluble, excrete through urine/stool Un-conjugated = bad - toxic - bilirubin builds up - give albumin (trt) ```
64
kernicteris
chronic brain damage from hyperbilirubinemia (jaundice on the brain)
65
byproduct of RBC is
bilirubin
66
hyperbilirubinemia can lead to what acute and chronic conditions?
Acute - Billirubin Encephalopathy (jaundice of the brain) Chronic - Kernicterus - neurological abnormalities/developmental delays This can be prevented
67
trt for bilirubin
``` photo-therapy (protect babies eyes/groin) increased feeds (urine and stool excretion) in extreme cases exchange transfusions (remove babies unconguated blood, & replace it, along with albumin) ```
68
most common bacterial causing infection in the newborn
group B strep
69
Sepsis onset
early - s/s within the first 24 hrs of life - worse prognosis late - after 1st week of life
70
risk fxr for sepsis (infection)
>18hr ruptured membranes foul smelling fluid preemies maternal infection (group B)
71
sepsis (infection) characteristics
hypothermia (early sign) resp problems seizures (late sign) - shock
72
trt for sepsis (infection)
``` iv antibiotics supportive care (ventilated) ```
73
hypoglycemia classification
40
74
hypoglycemia can cause
brain damage; brain uses glucose for fuel
75
hypoglycemia risk fxrs
prematurity/late preterm/postmaturity prematurity - don't have glycogen stores post-maturity -they had to use glycogen due to placental insufficiency
76
normal blood glucose for a term baby
50-90; less than 40 classify hypoglycemia
77
early s/s of hypoglycemia
jittery/tremors (most common) resp. difficulty low temp
78
late s/s of hypoglycemia
seizures coma resp. distress
79
most common early sign of hypoglycemia
jittery/tremors
80
prevention of hypoglycemia
monitor (glucose) | early feeds
81
if s/s of hypoglycemia continue, treat with
IV glucose (dextrose)
82
risk fxrs for infants of diabetic mothers
prematurity hypoglycemia asphyxia resp distress
83
mgmt of hypoglycemia
on moms end - control diabetes so baby isn't affected monitor glucose feed early monitor complications
84
neonatal abstinence syndrome (NAS) is
drug exposed babies showing signs of withdrawal
85
method to score babies (around feeding times)
Finnegan Score Sheet for NAS (tool to determine if treatment is needed for withdraw)
86
characteristics of NAS
``` resp problems irritable - inconsolable hyperthermia sneezing (3x's in a row) diaper rash (constant stools) ```
87
medications for withdrawal (babies)
oral morphine | phenobarbital (due to poly drug use)
88
nursing care for NAS
``` cluster care encourage feedings once they sleep - try to allow them to get an hours rest injury prevention involve parents (non judgmental) ```
89
what is Gastroschisis***
abdomen doesn't fully close/fuse organs are outside the abdomen this does NOT involve the cord congenital abdominal anomaly
90
Gastroschisis can be dx when
in utero
91
Gastroschisis begins/happens when
at the 6th week gestation
92
Gastroschisis nursing mgmt
prevent infection/injury to organs apply warm sterile dressings wrap in plastic for protection
93
trt for gastroschisis
silo - gravity pulls organs into stomach area slowly (can take days for this to happen)
94
what is omphalocele ***
pt with omphalocele have other anomalies (trisomy...) | intestines/organs are housed IN the umbilical cord
95
omphalocele trt
same as gastroschisis (silo)
96
congenital diaphragmatic hernia (cdh) where would you hear bowel sounds
chest
97
congenital diaphragmatic hernia (cdh) where would you hear heart sounds
shifted over - more left
98
congenital diaphragmatic hernia (cdh) occurs when
there is an opening in the diaphragm, the intestines travel into the chest cavity left lung doesn't grow to the optimal level
99
s/s of cdh
``` respiratory distress (only 1 lung is functioning properly) barrel chest (aveoli hyper-stimulated) ```
100
s/s of MAS
barrel chest (aveoli hyper-stimulated)
101
mgmt of cdh
oxygen/ventilator ecmo (extracorporeal membrane oxygenation) surgery (when stable)
102
best position for cdh baby
affected side - left side
103
babies are at risk for what later in life if on ecmo
stroke
104
treatment on ecmo is usually no longer than
2 weeks | gives lungs a rest to allow the other lung to grow
105
Glucose protocol
usually every hr/1st 4 hrs; every 4hrs/x's 2

Mgmt Test 3 - OB (7 decks)

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