Ch 23: Newborn Special Needs

Question 1

Factors affecting fetal growth

Answer 1

• maternal nutrition
• genetics
• placental function
  -environmental factors

Question 2

what is AGA

Answer 2

appropriate for gestational age

Question 3

what is SGA and the parameters

Answer 3

Small for Gestational Age
- <2500g (5 lb 8oz)
- below the 10 percentile

Question 4

what is LGA and the pareameters

Answer 4

Large for Gestational Age
>4000g or 8lb 13oz

Question 5

what is IUGR

Answer 5

Intrauterine Growth Restriction
- head and brain are normal but the rest is small

Question 6

What uterine and placental factors could contribute to SGA

Answer 6

• decreased blood flow in the uterus and placenta
• placental abruption
• placenta previa
• infection in tissues around the fetus

Question 7

how would the head, skin, and muscle present in a SGA newborn

Answer 7

head disproportionately large compared to the rest of the body, skin is loose and dry along with reduced subcutaneous fat stores, poor muscle tone

Question 8

what is birth asphyxia

Answer 8

DECREASE in blood flow to the baby’s tissue or a decrease in oxygen in the baby’s blood around delivery time

Question 9

what is meconium aspiration

Answer 9

a growth restricted fetus may pass meconium in the amniotic fluid and may aspirate this into their lungs

Question 10

common problem in SGA newborns: hypoglycemia

Answer 10

occurs in the early hours of life because the small newborn does not have enough stored carbs to use for energy and is unable to adequately process the carbohydrates it does have

Question 11

common SGA newborn problem: polycythemia

Answer 11

“Excess red blood cells”
- blood becomes too thick
- puts them at risk for hypoglycemia
- hyperbilirubinemia (jaundice)

Question 12

why do SGA babies have difficulty regulating body temperature

Answer 12

SGA babies have less fat and body weight to keep them warm and don’t have enough carbohydrates to use for energy

Question 13

why are SGA babies at risk for infection

Answer 13

becuase they have an impaired immune system

Question 14

what are some maternal factors that may cause a LGA baby

Answer 14

diabetes!!! is the biggest cause )can be gestational, insulin-dependent, drug induced)

• weight gain
• previous LGA babies
• overdue pregnanyc

Question 15

what are some common assessment findings you would see in a LGA baby

Answer 15

• large body, plump, full faced
• proportional increase in body sice
• poor motor skills
• difficulty regulating behavioral states (poor feeding ability)

Question 16

Are LGA babies also at risk for hyperbilirubinemia

Answer 16

YES, they are also at risk for polycythemia which can overwhelm the liver and cause jaundice

Question 17

gestational age ranges

Answer 17

Term: 38-42 weeks
Preterm: before the completion of 37
Late Preterm 34-36 and 6 days
Postterm: born after 42 completed weeks

Question 18

what risks does the post-term newborn face

Answer 18

• inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks
• dry crackled skin
• long nails
• creaces over feet
• limited vernix and lanugo

Question 19

what is the most important thing to monitor for a post-term baby

Answer 19

whether the placenta is providing enough nutrition and adequate oxygen to the baby

Question 20

how can maternal or fetal distress cuase preterm labor

Answer 20

preeclampsia (because body knows that getting that placenta out will fix all the problems)

Question 21

Preterm baby skin characteristics

Answer 21

very thin skin, plentiful lanugo, absence of creases and folds, abundant vernix

Question 22

how much does a preterm baby weigh

Answer 22

less than 5.5 lb

Question 23

do preterm babies have breathing issues

Answer 23

may need oxygen or ventilator until lungs are fully developed, may have respiratory distress, or apnea

Question 24

do preterm babies have feeding issues

Answer 24

may have trouble sucking and swallowing and it exhausts them to breast feed so they might need feeding tube

Question 25

blood issues in preterm babies

Answer 25

low blood pressure and anemia (low red blood cell count)

Question 26

The nurse documents that a newborn is postterm based on the understanding that he was born after
38 weeks’ gestation.
40 weeks’ gestation.
42 weeks’ gestation.
44 weeks’ gestation.

Answer 26

42 weeks

Question 27

SGA and LGA newborns have an excessive number of red blood cells related to
hypoxia.
hypoglycemia.
hypocalcemia.
hypothermia.

Answer 27

hypoxia
- The fetus’s body, in an attempt to compensate for
the low oxygen level, produces more red blood cells to carry the limited
amount of oxygen available. Thus, polycythemia will be present at birth in a
fetus experiencing hypoxia in utero.

Question 28

Because subcutaneous and brown fat stores were used for survival in utero, the nurse would assess an SGA newborn for which of the following?
Hyperbilirubinemia
Hypothermia
Polycythemia
Hypoglycemia

Answer 28

hypothermia
- Subcutaneous and brown fat stores may be used by the stressed fetus to survive in utero and thus will not be available to
provide extrauterine warmth.

Question 29

When assessing a preterm newborn, which of the following findings would be of greatest concern?
Milia over the bridge of the nose
Thin transparent skin
Poor muscle tone
Heart murmur

Answer 29

heart murmur
- When a newborn is born too soon, fetal circulation may persist into extrauterine life. The ductus arteriosus and foramen ovale
may remain open if pulmonary vascular resistance remains high and oxygen
levels remain low. This would be manifested by a heart murmur

Question 30

When caring for parents experiencing a perinatal loss, which of the following nursing interventions would be most appropriate?
A.Sheltering the parents from the bad news
B. Making all the decisions regarding care
C. Encouraging them to participate in the newborn’s care
D. Leaving them by themselves to allow time to grieve

Answer 30

C. Encouraging them to participate in the newborn’s care
so that the grieving process can take place. Avoiding the
experience of loss inhibits the grieving process. Avoidance prolongs the
experience of loss and does not allow the parents to vent their feelings so
that they can progress through their grief.

Question 31

The nurse focuses on energy conservation to promote growth and development. Which measures would the nurse include in the nursing plans of care? Select all that apply.
a. Keeping the handling of the newborn to a minimum
b. Maintaining a neutral thermal environment
c. Decreasing environmental stimuli
d. Initiating early oral feedings
e. Using thermal warmers in all cribs

Answer 31

a, b, c,
- not e why? Thermal warmers may produce hypothermia and thus increase
energy demands.

Question 32

Which of the following concepts would the nurse incorporate into the plan of care when assessing pain in a newborn with special needs?
a. Newborns experience pain primarily with surgical procedures.
b. Preterm newborns in the NICU are at least risk for pain.
c. Pain assessment needs to be comprehensive and frequent.
d. A newborn’s facial expression is the primary indicator of pain.

Answer 32

C. Pain assessment, which is
comprehensive, involves observations of changes in vital signs, behavior,
facial expression, and body movement. It is considered the “fifth vital sign”
and should be checked as frequently as the other four signs. All newborns
experience pain, not just newborns undergoing surgical procedures.