ch. 34: nursing care of high risk newborn Flashcards
What is considered preterm?
< 37 weeks
Should free flow oxygen in an incubator be used?
NO, because pressure fluctuates dramatically each time the doors are open
When is an O2 hood used?
when a baby can breathe on their own but needs extra O2
When does a baby need nasal cannula O2?
if they can breathe alone but need extra O2
When is a CPAP required?
-if O2 hood or nasal cannula not working
-the positive pressure keeps alveoli open and improves expansion of lungs
What is important to insert when a baby is receiving oxygen through CPAP?
an orogastric tube to decompress stomach and minimize air in GI tract
When is mechanical ventilation requited?
- if CPAP and other methods not working
-INDICATION: ABGs show hypoxia or hypercapnia
How is surfactant administered?
endotracheal tube
What does nitric oxide do?
provide pulmonary vasodilation
How do you preform suctioning on a baby?
for only 5-10 sec at a time w/ O2 before and after
What positions promote the drainage of secretions?
side-lying or prone
What is respiratory distress syndrome?
surfactant deficiency leads to alveolar collapse and noncompliant lungs
What can RDS cause?
hypoxia and acidosis
When do s/s or RDS appear?
immediately after birth or within 6 hrs of birth
What are the s/s of RDS?
-crackles
-poor gas exchange
-pallor
-retractions
-occasional apnea
How is RDS dx?
CXR reveals HYPOAERATED lungs and air filled bronchi
Why is a blood culture done while dx RDS?
to rule out pneumonia
What is the treatment of RDS?
-supportive
-NTE
-adequate ventilation & O2
-PPV, CPAP, O2 therapy
-surfactant admin
-axb may be started before blood culture results
-maintain proper fluids and nutrition
What is Bronchopulmonary Dysplasia (BPD)?
lung and airways are damaged causing tissue destruction (dysplasia) in alveoli
What is the cause of BPD?
-pulmonary immaturity
- ↓ surfactant
-lung injury and tretch
-barotrauma (injury by ↑ air pressure)
-inflammation by O2 exposure
-fluid overload
What are s/s of BPD?
-tachypnea
-retractions
-nasal flaring
-↑ respiratory effort
-activity intolerance
-tachycardia
How is BPD dx?
-CXR
-assessment: crackles in lungs, ↓ air movement, wheezing
What is the treatment for BPD?
-O2
-nutrition
-fluid restriction
-meds (diuretics, bronchodilators, corticosteroids)
-surfactant
-CPAP
-vit A (heal injuries)
What is retinopathy of prematurity (ROP)?
eye disease the can occur in premature babies:
-scarring & retinal attachment can occur
-mild to severe visual impairment
What is the cause of retinopathy of prematurity (ROP)?
O2 tensions that are too HIGH for the level of retinal maturity
What is the treatment of retinopathy of prematurity (ROP)?
-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
What is meconium aspiration syndrome (MAS)?
there is meconium in the amniotic fluid which can lead to mechanical obstruction of airways and inflammation of lungs
What term babies are at risk for MAS?
postmature ≥ 42 weeks
Why are postmature babies are increased risk for MAS?
postmaturity can be associated w/ placental insufficiency not meeting O2 demand of fetus, and a hypoxic event in utero can lead to MAS
What are s/s of MAS?
-yellowish/pale green stained skin
-tachypnea
-retractions
-cyanosis
-nonresponsive
How is MAS dx?
presence of meconium on amniotic fluid
-CXR
What intervention is IMMEDIATELY performed on an infant with MAS who is NOT VIGOROUS?
endotracheal suctioning
What is the treatment of MAS?
-surfactant
-O2
-axb to prevent infection
-possible use of ventilator
What treatment is implemented if fetus is NOT responding to conventional ventilator therapy?
-high frequency ventilation
-nitric oxide
-ECMO
What is the cause of persistent pulmonary htn of newborn (PPHN)?
events that ↑ pulm vascular resistance like HYPOXEMIA or ACIDOSIS which cause pulm vasoconstriction results in
-pulm HTN
-R to L shunting
-structurally normal heart
What are s/s of PPHN?
tachycardia, cyanosis
How is PPHN dx?
ABGs, pulse ox, ECHO
What is the treatment of PPHN?
-HALT R to L shunting
#1: nitric oxide
2) surfactant
3) decrease stimuli
4) high frequency ventilation
5) ECMO
What is the cause of patent ductus arteriosus (PDA)?
fetal ductus aretriosus fails to close after birth
-PDA ↑ BV to lungs: lung congestion
What are s/s of PDA?
-cyanosis
-mottling
-murmur
-active pericardium
-BOUNDING pulses
-tachycardia
-tachypnea
-crackles
How is PDA dx?
-CXR showing cardiac enlargement & pulm edema
-ABGs show hypercapnia
-ECHO visualizes PDA
What is the treatment for PDA?
-ventilatory support
-fluid restrictions
-admin of INDOMETHACIN or IBUPROFEN which INHIBIT prostaglandin synthesis & cause PDA to constrict and close
Why are infants prone to hypothermia?
-minimal subq fat
-limited brown fat
-fragile capillaries
-↓/ absent reflex control of capillaries
-low muscle mass
-poor muscle tone
-immature temp regulation system
What are s/s of COLD STRESS (hypothermia)?
-pale, mottled skin
-skin cool to touch
-acrocyanosis
-resp distress
-hypoglycemia
-progresses to apnea
-bradycardia
-central cyanosis
What is the treatment for COLD STRESS?
-SLOWLY rewarm infant w/ external heat source
-NTE
-prewarm incubator
-polyethylene bag
-heated water mattress
-skin to skin
-warm IV fluids
What must be avoided for infants with cold stress?
exposure to cool air & drafts & cold scales, cold stethescopes, cold exam tables, prolonged baths
What can temperature instability also be a sign of ?
SEPSIS
What is GERMINAL MATRIX HEMORRHAGE (intraventricular hemorrhage)?
-bleeding around & into ventricles of brain
-most common injury in preterm
-bc germinal matrix area is rich in blood & has thin capillary walls
What are s/s of GERMINAL MATRIX HEMORRHAGE ?
-hypoxia
-↓ HCT
-full anterior fonatnel
-changes in activity
-↓ muscle tone
-deteriorating resp status
How is GERMINAL MATRIX HEMORRHAGE dx?
-CT
-H&H
-US
What is the treatment for GERMINAL MATRIX HEMORRHAGE?
-maintain O2
-NTE
-head midline & HOB elevated
-correction of hemodynamic disturbances & coagulation abnormalities
What is the treatment for GERMINAL MATRIX HEMORRHAGE if hydrocephalus develops?
surgery to place ventriculoperitoneal shunt
What are possible outcomes of GERMINAL MATRIX HEMORRHAGE?
based on severity of hemorrhage:
-hydrocephalus
-cerebral palsy
-developmental delays
-learning disorders
-sensory & attention prblms
What are signs that and infant is in PAIN?
-facial expressions
-crying
-body movements
-↑ BP
-↑HR
-eyes closed tight
What is the treatment for pain?
-nonpharm: reposition, swaddle, ↓ stimuli
-phram: morphine, fentanyl
What are preterm complications of nutrition?
-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
What are examples of insensible water loss?
stooling, voiding, evaporation, incorrect fluid admin
What is gavage feeding?
NG or orogastric tube
What feeding method bypasses the GI system?
TPN
What is necrotizing enterocolitis (NEC)?
an acute inflammatory disease of GI mucosa, commonly complicated by bowel necrosis & perforation
What are the 3 components of NEC?
1)intestinal ischemia
2)bacterial colonization
3)enteral feeding
What are s/s of NEC?
-↓ activity
-hypotonia
-pallor
-recurrent apnea
-bradycardia
-↓ SpO2
-cyanosis
-resp distress
-BLOODY STOOLS
-temp instability
How is NEC dx?
radiographic exam that reveals BOWEL LOOP DISTENTION, pneumatosis, or air in wall of bowel
-cbc, coagulation studies, ABGs
What is the management of NEC?
-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
What are s/s of ANEMIA?
-↓ H&H
-pale skin
-↑ apnea
-lethargy
-tachycardia
-poor weight gain
What blood glucose level is considered HYPOGLYCEMIC for infants?
< 40-45
What are s/s of HYPOGLYCEMIA?
-poor feeding
-hypothermia
-tremors
-jitteriness
-weak cry
-lethargy
-poor muscle tone
-seizures
-coma
What are s/s of HYPERBILIRUBINEMIA?
-lethargy
-poor feeding
-YELLOW sclera and skin
What is POLYCYTHEMIA?
hyper viscosity of blood
What is the cause of POLYCYTHEMIA?
excess BV resulting from FETAL HYPOXIA & INTRAUTERINE STRESS forces body to ↑ RBC production
What are infants w/ POLYCYTHEMIA at ↑ risk for?
STROKE
What are s/s of POLYCYTHEMIA?
-cyanosis
-jitteriness
-seizures
-lethargy
-resp distress
-tachycardia
-CHF
-hypoglycemia
How do you dx POLYCYTHEMIA?
HCT to determine blood viscosity
What is the treatment for POLYCYTHEMIA?
partial exchange transfusion may be necessary (saline admin IV as blood removed from UVC)
What are s/s of infection in infants?
-temp instability
-CNS changes
-color changes
-CV instability
-resp distress
-GI prblms
-metabolic acidosis
-lethargy
-irritability
-poor feeding
-vomiting
How long are growth and development milestones corrected for gestational age?
until child reaches 2 1/2 years
What are examples of developmental care?
-positioning (use rolls to keep AIRWAY OPEN), proper body alignment
-↓ unnecessary stimuli
-infant communication cues
-infant stimulation
-kangaroo care
What are signs that an infant is overstimulated?
gaze, hiccups, gagging
What soaps should be avoided?
alkaline based soaps
What is the dosage of surfactant Beractant (survanta)
4ml/kg
How do you measure the length of a gavage tube?
-from tip of nose
-to ear lobe
-to midpoint btwn the xiphoid process and umbilicus
What size feeding tubes are for infants under 1kg?
4 Fr
What size feeding tubes are for infants > 1kg?
5 to 6 Fr
