CH 24 Congenital and Acquired Newborn Conditions Flashcards
congenital vs acuired disorders
congenital: PRESENT at birth due to some kind of malformation occuring during the antepartal period; problem with injeritance
acquired: occur AT or SOON AFTER birth; problems experienced by woman during her pregnancy or at birth; usually no cause
Neonatal asphyxia
- acquired
-lack of oxygen and blood flow to baby’s BRAIN - causes: excess fluid in lungs, umbilical chord arnd throat, baby is postterm and placents is starting to degrade
when is a newborn said to have asphyxia
when within 1 minute of age the newborn fails to establish adequate, sustained respiration on their own
Hypoxic- Ischemic Encephalopathy
1. what is it
2. nursing management
- acute or subacute brain injury due to systemic hypoxemia or reduced cerebral blood flow
- immediate resuscitation, monitor blood glucose levels
Transient Tachypnea
1. what is it
2. what babies do we commonly see it in
3. signs/symptoms
- Fast breathing (mild respiratory distress)
- C-section babies and late preterm
- RR 11-140, barrel shaped chest, mild cyanosis, nasal flaring, labored breathing
If not treated, what can transient tachypnea turn into
Respiratory Distress Syndrome
- What is Respiratory Distress Syndrome
- signs/symptoms
- result from lung immaturity and LACK OF ALVEOLAR SURFACTANT, which keeps the air sacs in the lungs from collapsing and allows them to inflate easily.
- expiratory grunting, HR >150, crackles, tachypnea >60, chest wall retractions, central cyanosis, nasal flaring
Nurse Management for child with Respiratory Distress Syndrome
- ventialtion, oxygen therapy
- antibiotics for positive cultures
- Fluids and vasopressors
- IV feedings
- Monitor blood glucose, O2, RR
most common risk for development of Respiratory Distress Syndrom (RSD)
premature birth
- also can be cesarean birth becuase they did not have vaginal and didn’t experience that thoracic squeezing
CPAP vs PEEP and what is their main purpose
PEEP
Positive end-expiratory pressure maintains positive airway pressure at the END of exhalation.
CPAP
Continuous positive airway pressure maintains positive airway pressure throughout the entire respiratory cycle, including during inspiration.
Treatment For RDS: This helps prevent volume loss during expiration
Meconium Aspiration Syndrome
- what is it
- s/s
- Inhalation of meconium with amniotic fluid into lungs; secondary to hypoxic stress
- prolonged tachypnea, barrel shaped chest, resp. distress, intercostal retractions
What procedure/test can conform meconium aspiration syndrome
If respiratory distress is present, a chest X-ray is usually performed: will show patchy fluffy infiltrates
What is Persisent Pulmonary Hypertension of the Newborn
pulmonary hypertension causing right-to-left extrapulmonary shunting and hypoxemia
Nursing assesment and s/s for Pulmonary Hypertension in newborn
- tachypnea within 12 hours after birth
- marked cyanosis, grunting retractions
- systolic ejection murmur
- echocardiogram: shows right-to-left shunting of blood
Periventricular- Intraventricular Hemorrhage (PVH/IVH)
- what is it
- who is at risk
- s/s
- what do we give moms to prevent this
- Bleeding in the brain due to fragility of cerebral vessels (intracranial bleed)
- at risk: SGA, preterm
- unexplained drop in hematocrit, pallor, poor perfusion, lethargic, weak suck, high pitched cry
- at delivery we give mag sulfate
Necrotizing Enterocolitis
- happens in the gut, part of gut is not working due to lack of blood supply and starts to die
what are the 3 patholic mechanisms that cause nechrotizing enterocolitis
bowel ischemia, bacterial flora, and effect of feeding
Risk factors for necrotizing enterocolitis
- premature before 37 weeks have immature bowels
- babies with diffiuclt deliveries with low oxygen levels
S/S of necrotizing entercolitis
and what diagnostic test would you do
- abdominal distention!!!! and tenderness
- blood stools, feeding intolerance (bilious vomiting), sepsis, lethargy - KUB: kidney/urinary/bladder x-ray: will show dilated bowel loops
Nursing management for Necrotizing Enterocolitis
- maintain fluid and nutritional staus
- bowel rest and Antibiotic therapy
What happens in Infants of Diabetic Mothers
High levels of maternal glucose crossed the placenta, stimulating increased insulin production leading to fetal growth
S/S of infant of diabetic mother
rosy cheeks, distended upper abdomen, excessive subQ fat, birth trauma
hypoglycemia, hypomagnesemia, hypocalcemia
how will you treat a baby that has effects from a diabetic mother
-prevent hypoglycemia (oral feedings, neutral thermal environment, rest periods)
- maintain fluid and electrolyte balance
- monitor bilirubin
Newborn of substance abusing moms
what are some types of Birth Trauma
forces of labor and delivery: fractures of the humerus, cranial nerve trauma, head trauma (cephalohematoma or caput succedaneum)
brachial plexus injury
shoulder dystocia= can cause brachial plexus to get injured
assessment of caput vs cephalohematoma
caput: swelling under head under the skin and CROSSES suture line
hematoma: does NOT CROSS
Hyperbilirubemia levels:
total serum bilirubin level >5 mg/dl
Physiologic vs Pathologic Jaundice
Physiological: 3rd-4th day of life; breastfeeding jaundice (not enough breast milk jaundice) so they can’t excrete enough of that bilirubin in their stools becuase they aren’t eating enough
Patholgic: within 24 hrs of life;
what are treatments for hyperbilirubineamia
supplement with bottle feeding, frequent feedings (more poop= more bili excreted), skin to skin, phototherapy
Patholigic jaundice babies
- causes
- what are they at risk for
Causes: ABO incompatibility and Rh incompatibility
Risk: Kernicterus (brain damage from extremely high bilirubin)
Neonatal Infections: s/s
- decreased temperature (because they don’t have metabolic capacity to produce heat)
- increased in WBC (neutrophils)
- elevated C-reactive protein
risk factors for neonatal sepsis
- premature rupture of membranes
- maternal fever
- prolonged labor
- rupture of membrane >12-18hrs
premature labor
Esophageal Atresia and Tracheoesophageal Fistula
lack of normal separation of esophagus and trachea during
S/S of esophageal atras. and trache. fist.
- hydramnios: excess amniotic fluid during pregnancy
- 3 C’s: coughing, choking, and cyanosis
- copious frothy bubbles of mucus and drooling
A baby with esoph atres/ trach will most likely
have to go into surgery as soon as they are properly diagnosed
What is Omphalocele and Gastroschisis
Omphalocele: defect of the umbilical ring that causes abdominal contents to eviscerate in an external peritoneal sac
GastroshisisL herniation of abdominal contents through ubilicus (no sac protecting the organs tho)
Imperforated Anus
rectum ending in a blind pouch or fistula (tubular connection between two internal organs)
Bladder Exstrophy
Protrusion of bladder onto abdominal wall
what does a Coombs test identify and what condition is it good for
hemolytic disease
+ results indicate newborns RBS are coated with antibodies
hyperbilirubinemia
what diagnostic procedure is used to verify the presence of jaundice
press newborn;s skin on the cheek or abdomen lightly with one finger; observe for a yellowish tint as the skin is blanched
