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RNSG 1251 UNIT 4 > ch. 34: nursing care of high risk newborn > Flashcards

ch. 34: nursing care of high risk newborn Flashcards

1
Q

What is considered preterm?

A

< 37 weeks

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2
Q

Should free flow oxygen in an incubator be used?

A

NO, because pressure fluctuates dramatically each time the doors are open

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3
Q

When is an O2 hood used?

A

when a baby can breathe on their own but needs extra O2

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4
Q

When does a baby need nasal cannula O2?

A

if they can breathe alone but need extra O2

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5
Q

When is a CPAP required?

A

-if O2 hood or nasal cannula not working
-the positive pressure keeps alveoli open and improves expansion of lungs

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6
Q

What is important to insert when a baby is receiving oxygen through CPAP?

A

an orogastric tube to decompress stomach and minimize air in GI tract

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7
Q

When is mechanical ventilation requited?

A
  • if CPAP and other methods not working
    -INDICATION: ABGs show hypoxia or hypercapnia
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8
Q

How is surfactant administered?

A

endotracheal tube

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9
Q

What does nitric oxide do?

A

provide pulmonary vasodilation

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10
Q

How do you preform suctioning on a baby?

A

for only 5-10 sec at a time w/ O2 before and after

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11
Q

What positions promote the drainage of secretions?

A

side-lying or prone

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12
Q

What is respiratory distress syndrome?

A

surfactant deficiency leads to alveolar collapse and noncompliant lungs

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13
Q

What can RDS cause?

A

hypoxia and acidosis

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14
Q

When do s/s or RDS appear?

A

immediately after birth or within 6 hrs of birth

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15
Q

What are the s/s of RDS?

A

-crackles
-poor gas exchange
-pallor
-retractions
-occasional apnea

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16
Q

How is RDS dx?

A

CXR reveals HYPOAERATED lungs and air filled bronchi

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17
Q

Why is a blood culture done while dx RDS?

A

to rule out pneumonia

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18
Q

What is the treatment of RDS?

A

-supportive
-NTE
-adequate ventilation & O2
-PPV, CPAP, O2 therapy
-surfactant admin
-axb may be started before blood culture results
-maintain proper fluids and nutrition

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19
Q

What is Bronchopulmonary Dysplasia (BPD)?

A

lung and airways are damaged causing tissue destruction (dysplasia) in alveoli

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20
Q

What is the cause of BPD?

A

-pulmonary immaturity
- ↓ surfactant
-lung injury and tretch
-barotrauma (injury by ↑ air pressure)
-inflammation by O2 exposure
-fluid overload

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21
Q

What are s/s of BPD?

A

-tachypnea
-retractions
-nasal flaring
-↑ respiratory effort
-activity intolerance
-tachycardia

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22
Q

How is BPD dx?

A

-CXR
-assessment: crackles in lungs, ↓ air movement, wheezing

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23
Q

What is the treatment for BPD?

A

-O2
-nutrition
-fluid restriction
-meds (diuretics, bronchodilators, corticosteroids)
-surfactant
-CPAP
-vit A (heal injuries)

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24
Q

What is retinopathy of prematurity (ROP)?

A

eye disease the can occur in premature babies:
-scarring & retinal attachment can occur
-mild to severe visual impairment

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25
Q

What is the cause of retinopathy of prematurity (ROP)?

A

O2 tensions that are too HIGH for the level of retinal maturity

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26
Q

What is the treatment of retinopathy of prematurity (ROP)?

A

-prevention of preterm birth and early detection
-closely monitor blood O2
-O2 and ventilator settings should be adjusted to keep SpO2 within 88-92%
-laser photocoagulation to stop blood vessel growth

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27
Q

What is meconium aspiration syndrome (MAS)?

A

there is meconium in the amniotic fluid which can lead to mechanical obstruction of airways and inflammation of lungs

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28
Q

What term babies are at risk for MAS?

A

postmature ≥ 42 weeks

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29
Q

Why are postmature babies are increased risk for MAS?

A

postmaturity can be associated w/ placental insufficiency not meeting O2 demand of fetus, and a hypoxic event in utero can lead to MAS

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30
Q

What are s/s of MAS?

A

-yellowish/pale green stained skin
-tachypnea
-retractions
-cyanosis
-nonresponsive

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31
Q

How is MAS dx?

A

presence of meconium on amniotic fluid
-CXR

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32
Q

What intervention is IMMEDIATELY performed on an infant with MAS who is NOT VIGOROUS?

A

endotracheal suctioning

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33
Q

What is the treatment of MAS?

A

-surfactant
-O2
-axb to prevent infection
-possible use of ventilator

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34
Q

What treatment is implemented if fetus is NOT responding to conventional ventilator therapy?

A

-high frequency ventilation
-nitric oxide
-ECMO

35
Q

What is the cause of persistent pulmonary htn of newborn (PPHN)?

A

events that ↑ pulm vascular resistance like HYPOXEMIA or ACIDOSIS which cause pulm vasoconstriction results in
-pulm HTN
-R to L shunting
-structurally normal heart

36
Q

What are s/s of PPHN?

A

tachycardia, cyanosis

37
Q

How is PPHN dx?

A

ABGs, pulse ox, ECHO

38
Q

What is the treatment of PPHN?

A

-HALT R to L shunting
#1: nitric oxide
2) surfactant
3) decrease stimuli
4) high frequency ventilation
5) ECMO

39
Q

What is the cause of patent ductus arteriosus (PDA)?

A

fetal ductus aretriosus fails to close after birth
-PDA ↑ BV to lungs: lung congestion

40
Q

What are s/s of PDA?

A

-cyanosis
-mottling
-murmur
-active pericardium
-BOUNDING pulses
-tachycardia
-tachypnea
-crackles

41
Q

How is PDA dx?

A

-CXR showing cardiac enlargement & pulm edema
-ABGs show hypercapnia
-ECHO visualizes PDA

42
Q

What is the treatment for PDA?

A

-ventilatory support
-fluid restrictions
-admin of INDOMETHACIN or IBUPROFEN which INHIBIT prostaglandin synthesis & cause PDA to constrict and close

43
Q

Why are infants prone to hypothermia?

A

-minimal subq fat
-limited brown fat
-fragile capillaries
-↓/ absent reflex control of capillaries
-low muscle mass
-poor muscle tone
-immature temp regulation system

44
Q

What are s/s of COLD STRESS (hypothermia)?

A

-pale, mottled skin
-skin cool to touch
-acrocyanosis
-resp distress
-hypoglycemia
-progresses to apnea
-bradycardia
-central cyanosis

45
Q

What is the treatment for COLD STRESS?

A

-SLOWLY rewarm infant w/ external heat source
-NTE
-prewarm incubator
-polyethylene bag
-heated water mattress
-skin to skin
-warm IV fluids

46
Q

What must be avoided for infants with cold stress?

A

exposure to cool air & drafts & cold scales, cold stethescopes, cold exam tables, prolonged baths

47
Q

What can temperature instability also be a sign of ?

A

SEPSIS

48
Q

What is GERMINAL MATRIX HEMORRHAGE (intraventricular hemorrhage)?

A

-bleeding around & into ventricles of brain
-most common injury in preterm
-bc germinal matrix area is rich in blood & has thin capillary walls

49
Q

What are s/s of GERMINAL MATRIX HEMORRHAGE ?

A

-hypoxia
-↓ HCT
-full anterior fonatnel
-changes in activity
-↓ muscle tone
-deteriorating resp status

50
Q

How is GERMINAL MATRIX HEMORRHAGE dx?

A

-CT
-H&H
-US

51
Q

What is the treatment for GERMINAL MATRIX HEMORRHAGE?

A

-maintain O2
-NTE
-head midline & HOB elevated
-correction of hemodynamic disturbances & coagulation abnormalities

52
Q

What is the treatment for GERMINAL MATRIX HEMORRHAGE if hydrocephalus develops?

A

surgery to place ventriculoperitoneal shunt

53
Q

What are possible outcomes of GERMINAL MATRIX HEMORRHAGE?

A

based on severity of hemorrhage:
-hydrocephalus
-cerebral palsy
-developmental delays
-learning disorders
-sensory & attention prblms

54
Q

What are signs that and infant is in PAIN?

A

-facial expressions
-crying
-body movements
-↑ BP
-↑HR
-eyes closed tight

55
Q

What is the treatment for pain?

A

-nonpharm: reposition, swaddle, ↓ stimuli
-phram: morphine, fentanyl

56
Q

What are preterm complications of nutrition?

A

-weak/absent suck, swallow, & gag reflex
-difficulty coordinating breathing
-small stomach capacity & weak abd muscle
-limited stores of nutrients
- ↓ ability to digest proteins or absorb nutrients
-immature enzyme system

57
Q

What are examples of insensible water loss?

A

stooling, voiding, evaporation, incorrect fluid admin

58
Q

What is gavage feeding?

A

NG or orogastric tube

59
Q

What feeding method bypasses the GI system?

A

TPN

60
Q

What is necrotizing enterocolitis (NEC)?

A

an acute inflammatory disease of GI mucosa, commonly complicated by bowel necrosis & perforation

61
Q

What are the 3 components of NEC?

A

1)intestinal ischemia
2)bacterial colonization
3)enteral feeding

62
Q

What are s/s of NEC?

A

-↓ activity
-hypotonia
-pallor
-recurrent apnea
-bradycardia
-↓ SpO2
-cyanosis
-resp distress
-BLOODY STOOLS
-temp instability

63
Q

How is NEC dx?

A

radiographic exam that reveals BOWEL LOOP DISTENTION, pneumatosis, or air in wall of bowel
-cbc, coagulation studies, ABGs

64
Q

What is the management of NEC?

A

-based on degree of bowel involvement
-GOAL is to prevent progression of NEC
1) STOP ORAL OR TUBE FEEDINGS
2) place OG tube for gastric decompression
3) TPN
4) axb, bowel resection or transplant may be necessary

65
Q

What are s/s of ANEMIA?

A

-↓ H&H
-pale skin
-↑ apnea
-lethargy
-tachycardia
-poor weight gain

66
Q

What blood glucose level is considered HYPOGLYCEMIC for infants?

A

< 40-45

67
Q

What are s/s of HYPOGLYCEMIA?

A

-poor feeding
-hypothermia
-tremors
-jitteriness
-weak cry
-lethargy
-poor muscle tone
-seizures
-coma

68
Q

What are s/s of HYPERBILIRUBINEMIA?

A

-lethargy
-poor feeding
-YELLOW sclera and skin

69
Q

What is POLYCYTHEMIA?

A

hyper viscosity of blood

70
Q

What is the cause of POLYCYTHEMIA?

A

excess BV resulting from FETAL HYPOXIA & INTRAUTERINE STRESS forces body to ↑ RBC production

71
Q

What are infants w/ POLYCYTHEMIA at ↑ risk for?

A

STROKE

72
Q

What are s/s of POLYCYTHEMIA?

A

-cyanosis
-jitteriness
-seizures
-lethargy
-resp distress
-tachycardia
-CHF
-hypoglycemia

73
Q

How do you dx POLYCYTHEMIA?

A

HCT to determine blood viscosity

74
Q

What is the treatment for POLYCYTHEMIA?

A

partial exchange transfusion may be necessary (saline admin IV as blood removed from UVC)

75
Q

What are s/s of infection in infants?

A

-temp instability
-CNS changes
-color changes
-CV instability
-resp distress
-GI prblms
-metabolic acidosis
-lethargy
-irritability
-poor feeding
-vomiting

76
Q

How long are growth and development milestones corrected for gestational age?

A

until child reaches 2 1/2 years

77
Q

What are examples of developmental care?

A

-positioning (use rolls to keep AIRWAY OPEN), proper body alignment
-↓ unnecessary stimuli
-infant communication cues
-infant stimulation
-kangaroo care

78
Q

What are signs that an infant is overstimulated?

A

gaze, hiccups, gagging

79
Q

What soaps should be avoided?

A

alkaline based soaps

80
Q

What is the dosage of surfactant Beractant (survanta)

A

4ml/kg

81
Q

How do you measure the length of a gavage tube?

A

-from tip of nose
-to ear lobe
-to midpoint btwn the xiphoid process and umbilicus

82
Q

What size feeding tubes are for infants under 1kg?

A

4 Fr

83
Q

What size feeding tubes are for infants > 1kg?

A

5 to 6 Fr

RNSG 1251 UNIT 4 (6 decks)

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