Ch 21-24 objectives Flashcards
Vitamin K administration
Admin within 1 hour of birth
.5-1mg IM 25g needle
90 degrees vastus lateralis
Eye treatment post birth
Prophylaxis for opthalmia neonatorum
Erythromycin ointment or tetracycline topical
Remove drainage w/ sterile saline and cotton
Baby temp checks
Shortly after birth
Q30min til stable, more freq. if abnormal
When should Hep B globulin be given
Within 12 hours birth
Congenital heart screening
Pulse ox should be 95%+
Newborn and calories
Need more cals from formula than breastmilk
May lose up to 10% birth weight- should be evaluated after 7%
Regain weight after two weeks
Breast milk pros
Infection preventing, stimulates leukocytes, immunoglobulins
Lowers risks of
- SIDS
- Asthma
- Diabetes
Improve cog development
Breastfeeding hormones
Suckling causes prolactin and oxytocin release
Breastfeeding positions
Across chest
Football
Laying next to mom
Breast engorgement interventions
Proper fitting bra
Massage breasts
Cold between feedings
Heat just before feedings
Try to release milk frequently
Preterm gestational age
before 37 weeks
Late preterm gestational age
34-36 weeks
Term gestational age
38-41 weeks
Post term gestational age
Over 42 weeks
Preterm concerns
Resp Fluids Skin Infection Pain Nutrition Temp
Preterm respiratory
Low surfactant until 34 weeks
Poor cough reflex
Apneic spells, periodic breathing
Side lying or prone position helpful (while being watched)
need suction
Preterm thermoregulation
rapid heat loss
Immature temp regulation in brain
Maintain neutral thermal environment
Preterm skin
Very fragile skin, prone to infection (NO IgG!!)
Watch for diaper rash
avoid iodine, alcohol wipes
Avoiding overstimulation in pre term infants
Cluster care: multiple tasks performed at once
Rest periods for baby
Reduce stimuli: Noise, lights
Motor development pre term baby
Reposition every 2-3hr gently and slowly. Hands midline
Acrocynosis
Blue lips, fingers, feet
NORMAL
Periodic breathing vs apneic spells
Periodic breathing: cessation for 5-10sec w/o other changes–followed by 10-15sec rapid respirations. NORMAL
Apneic spells: Cessation for over 20 seconds or less but w/bradycarida, cyanosis, pallor.
Signs of overstimulation in pre term
BP, HR, RR instability
Cyanosis, pallor
Flaring nares, low O2 sats, apnea
Coughing
Stiff extended arms and legs Arching Worried look Turning away from eye contact Regurgitation, hiccuping Fatigued
signs of maternal drug exposure
Irritable, jittery, restless seizures Rigid muscles Excess suckling Diarrhea/weight loss/Vomiting
Tachypnea
Retractions, apnea
HTN, Diaphoresis
Risks for post term infants
Decreased placental functioning
Meconium aspiration (from amniotic fluid)
Low amniotic fluid
Labor intolerance
Decreased oxygen
Hypoxia, malnourishment
Intraventricular hemorrhage
Bleeding into/around ventricles of brain
Rupture of blood vessels, can cause IICP
S&S: Determined by severity
- Low muscle tone/lethargy
- Bradycardia
- Poor respiratory status
- Hct drop
- Tense fontanelle
- Seizures
Interventions:
- Ultrasound at 7 days old
- Maintain respiratory function
- Watch for hydrocephele
- May need shunt to drain fluid
Retinopathy of Prematurity
Blood vessel injury in eye
Visual impairment
LASER SURGERY
Broncho-pulmonary dysplasia
Damage to lungs, need to be on vent for long time
S&S:
- inability for vent weaning
- Tachycardia/pnea
- Retractions, wheezing, crackles
- Resp acidosis, cyanosis
Interventions;
-Maternal steroids to reduce prematurity
Supportive antibiotics, bronchodilators, diuretics (pulmonary edema)
HIGH cals
Necrotizing enterocolitis
Intestinal inflammation
S&S:
- Inc abd girth/tenderness
- Low to no bowel sounds
- Loops of bowel seen through abd wall
- Vomiting, vomiting bile
- Occult blood
AIR IN INTESTINAL WALL
Management (preventative)
- Probiotics, preventing NEC
- Breastfeeding
Management (treatment)
- Antibiotics
- NPO
- Gastric suction
- surgery maybe
Ostomy may be indicated, can lead to SBS
Short Bowel Syndrome
S&S:
- Malabsorption
- Diarrhea
- Failure to thrive
Interventions:
Short Bowel Syndrome
S&S:
- Malabsorption
- Diarrhea
- Failure to thrive
Interventions:
- Surgery
- TPN primary source
- Restore fluids/electrolytes post surgery
Begin enteral nutrition asap
Transient tachypnea of Newborn
Resolves in 24-48hr
Inadequate absorption of lung fluid
Normal bilirubin range
Under 5 first 24 hrs.
Early onset sepsis
Acquired during birth
Prolonged rupture of membranes/prolonged labor
Chorioamnionitis
Symptomatic within 72hr
RAPID PROGRESSION
Late onset sepsis
During or after birth, before or after discharge
Sx 8-90days after birth
Newborn signs of sepsis
Temp instability
Resp problems
Odd feeding habits
