Ch23 Flashcards by Caroline Kurtz

Early insult

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Early insult

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Late insult

> 28 weeks. Results in intrauterine malnutrition. These kids have normal growth potential with optimal postnatal nutrition, & better prognosis than a fetus with an early insult

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Asymmetric

Infants whose head & long bones are spared compared to their abdomen & internal organs

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Symmetric

Fetuses with equally poor growth rates of the head, abdomen, & long bones

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SGA newborns typical characteristics

Head disproportionately large compared to rest of body
Wasted appearance of extremities; loose dry skin
Reduced subcutaneous fat stores
Decreased amount of breast tissue
Scaphoid abdomen (sunken appearance)
Wide skull sutures
Poor muscle tone over buttocks and cheeks
Thin umbilical cord

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SGA newborns: common probs

Perinatal asphyxia
Difficulty with thermoregulation
Hypoglycemia
Polycythemia 
Meconium aspiration 
Hyperbilirubinemia
Birth trauma

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Risk Factors Associated with Large-for-Gestational-Age Newborns

Maternal diabetes mellitus or glucose intolerance
Prior history of a macrosomic infant
Multiparity
Post-dates gestation
Maternal obesity
Male fetus 
Genetics

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LGA newborns: common characteristics

Large body, plump, full-faced
Proportional increase in body size
Poor motor skills
Difficulty regulating behavioral states

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LGA Newborns: Common Problems

Birth trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia

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Gestational age: Term

Born between 38 and 41 weeks

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Late insult

> 28 weeks. Results in intrauterine malnutrition. These kids have normal growth potential with optimal postnatal nutrition, & better prognosis than a fetus with an early insult

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Asymmetric

Infants whose head & long bones are spared compared to their abdomen & internal organs

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Symmetric

Fetuses with equally poor growth rates of the head, abdomen, & long bones

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SGA newborns typical characteristics

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SGA newborns: common probs

Perinatal asphyxia
Difficulty with thermoregulation
Hypoglycemia
Polycythemia 
Meconium aspiration 
Hyperbilirubinemia
Birth trauma

Risk Factors Associated with Large-for-Gestational-Age Newborns

Maternal diabetes mellitus or glucose intolerance
Prior history of a macrosomic infant
Multiparity
Post-dates gestation
Maternal obesity
Male fetus 
Genetics

LGA newborns: common characteristics

Large body, plump, full-faced
Proportional increase in body size
Poor motor skills
Difficulty regulating behavioral states

LGA Newborns: Common Problems

Birth trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia

Gestational age: Term

Born between 38 and 41 weeks

Postterm newborn: common characteristics

Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks
Nursing assessment: Typical characteristics
Dry, cracked, wrinkled skin; possibly meconium-stained
Long, thin extremities; long nails; creases cover entire soles of feet
Wide-eyed, alert expression
Abundant hair on scalp
Thin umbilical cord
Limited vernix and lanugo

Postterm Newborn: Common Problems

Perinatal Asphyxia
Hypoglycemia
Hypothermia
Polycythemia
Meconium Aspiration

Post-term Newborn: Nursing Management

Resuscitation
Blood glucose level monitoring
Initiation of feedings; IV dextrose 10%
Prevention of heat loss
Evaluation for polycythemia
Parental support

Etiology Leading to Preterm Birth

Infections/inflammation
Maternal or fetal distress
Bleeding
Stretching

Preterm Newborn: common characteristics

Weight

Preterm newborn: Respiratory system effects

Last body system to mature Surfactant deficiency, leads to Respiratory Distress Syndrome Unstable chest wall, leads to atelectasis Immature respiratory control center, leads to apnea Smaller respiratory passageways, increased risk for obstruction Inability to clear fluids, leads to transient tachypnea

Preterm newborn: GI System Effects

Small stomach capacity Weak or absent suck & gag reflexes Challenges with coordinating suck, swallow, & breathe regimen Limited ability to digest proteins & absorb nutrients Compromised metabolic function Minimal enteral feeding utilized to prepare gut for oral feedings Perinatal hypoxia can cause oxygen shunting to the heart & brain, resulting in GI ischemia & damage

Preterm newborn: Renal System Effects

Reduced ability to concentrate urine Reduced glomerular filtration rate Increased risk for fluid retention, fluid & electrolyte imbalances Increased risk for drug toxicity

Preterm newborn: Immune System Effects

Increased susceptibility to infections (Thin skin, Fragile blood vessels, Immaturity of immune system) Deficiency of IgG, as transplacental transfer occurs after 34 weeks gestation Impaired ability to manufacture antibodies

Preterm Newborn: Common Problems

Hypothermia Hypoglycemia Hyperbilirubinemia Problems related to immaturity of body systems

Promoting oxygenation

If the 1 or 5 minute Apgar score is 100bpm, a good cry, or good breathing efforts, and a pink tongue

If depression is due to narcotics...

give naloxone (narcan)

If metabolic acidosis is present...

give sodium bicarbonate

To improve heart rate ...

administer epinephrine (Adrenalin) via ET tube and repeat

S/S of cold stress

Respiratory distress, central cyanosis, hypoglycemia, lethargy, weak cry, abdominal distention, apnea, bradycardia, and acidosis

Asses fluid status by

Weight, urinary output, urine specific gravity, skin turgor, fontanels, temperature elevation, lethargy, & tachypnea Serum electrolyte levels, blood urea nitrogen, creatinine, & hematocrit

S/S of infection

Temperature instability, tachycardia, tachypnea, apnea, poor feeding, irritability, pallor, jaundice, hypotonia, hypoglycemia

Suspect pain if the newborn exhibits:

Sudden high-pitch cry Facial grimace (furrowed brow and quivering chin) Increased muscle tone Body posturing (arching/squirming, kicking/thrashing) Increase in heart rate, bp, & resp rate O2 desaturation