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PNC 102 lecture > chapter 17: nursing care of the newborn at risk > Flashcards

chapter 17: nursing care of the newborn at risk Flashcards

1
Q

risk factors that affect the newborn

A
  • premature labor
  • diabetes
  • hypertension
  • placenta abnormalities
  • HIV infection
  • unhealthy lifestyle
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2
Q

identification of the at risk newborn

A
  • upon admission to labor and delivery, the nurse should review the pregnancy health of the woman
  • advanced planning and swift action may prevent long term complications for the high risk newborn
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3
Q

birth asphyxia

A
  • known as preinatal asphyxia, asphyxia neonatorum, or hypoxic ischemic encephalopathy
  • defined as acute brain injury caused by asphyxia when the baby did not get enough oxygen during the birth process
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4
Q

possible causes of birth asphyxia

A
  • mother does not get enough oxygen during labor
  • mother’s bp is too high or too low during labor
  • placenta separates from the uterus too quickly, resulting in loss of oxygen
  • the umbilical cord wrapped too tightly around the neck or body
  • fetus is anemic and does not have enough RBCs to tolerate labor contractions
  • newborn’s airway becomes blocked
  • delivery is too long or too difficult
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5
Q

pathophysiology of birth asphyxia

A
  • asphyxia slows or ceases breathing
  • lack of prefusion of blood to the brain and other organ systems
  • hypoxia forces cells to undergo anaerobic respiration
  • lactic acid forms and tissues become damaged
  • lack of oxygen affects the brain, muscles, and heart first
  • heart dysfunction causes hypotension
  • when adequate blood perfusion returns, the brain swells causing more neurological problems
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6
Q

signs and symptoms of birth asphyxia

A
  • cyanosis
  • difficulty breathing
  • gasping respiration
  • umbilical cord ph less than 7
  • Apgar score of less than 3 for more than 5 minutes
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7
Q

management of birth asphyxia

A
  • immediate neonatal resuscitation if needed
  • transfer to NICU if symptoms are severe or persistent
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8
Q

possible causes of respiratory distress of the neonate

A
  • asphyxia at birth
  • lack of surfacant in the lungs with a premature birth
  • fluid in lungs
  • meconium aspiration
  • pulmonary hypertension
  • cold stress
  • conditions affecting the newborn’s ability to breathe
  • nurse’s should identify early stages of respiratory distress and initiate care to provide oxygenation, improve gas exchange, and prevent more complications or death
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9
Q

respiratory distress syndrome (RDS) of teh nwborn

A
  • caused by a lack of surfacant in and immaturity of the fetal lungs
  • seen in premature infants, infants experiencing birth asphyxia, newborns of diabetic mothers, and those born by cesarean section
  • formerly known as “hyaline membrane syndrome” due to the formation of hyaline membranes that line the alveoli and impair ventilation
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10
Q

pathophysiology of respiratory distress syndrome of the newborn

A
  • absence of surfacant causes the alveoli not being able to stay open for oxygenation
  • hypoxemia and hypercapnia occur, leading to respiratory acidosis
  • acidosis causes vasoconstriction and damages the epithelium of the lungs, leading to hyaline membrane formation inside the alveoli
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11
Q

hypercapnia

A

elevated carbon dioxide

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12
Q

signs and symptoms of respiratory distress syndrome evident at birth or within 8 hours of life

A
  • tachypnea
  • dyspnea
  • grunting w/ expirations
  • nasal flaring
  • intercostal retractions
  • cyanosis
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13
Q

medical management of respiratory distress syndrome of the newborn

A
  • antenatal corticosteroids
  • transfer to NICU
  • surfacant therapy
  • oxygen therapy
  • continuous positive airway pressure
  • mechanical ventilation support, if needed
  • vapotherm
  • neonatal cpr, if indicated
  • administer ordered medications and fluids
  • monitor respiratory and oxygenation status
  • provide emotional support to the family
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14
Q

vapotherm

A

heated and humidified high flow oxygen through a nasal cannula

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15
Q

trasient tachypnea of the newborn (TTN)

A
  • a common self limiting condition of infants in which tachypnea, increased oxygen needs, and mild respiratory distress occur
  • commonly occurs in infants sedated from maternal pain medications, prolonged labor, macrosomia, and babies born via cesarean section
  • caused by incomplete reabsorption of fluid in the lungs and usually resolves within 3-5 days
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16
Q

meconium aspiration syndrom

A
  • fetal distress may decrease oxygen and cause the fetus to pass meconium into the amniotic fluid
  • meconium can block the infant’s bronchioles, causing poor oxygenation, pneumonia, and pneumothorax
  • mainly affects term and postterm newborns
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17
Q

signs and symptoms of meconium aspiration syndrome

A
  • greenish yellow staining of the skin, nail beds, or umbilical cord
  • tachypnea
  • retractions, nasal flaring, grunting
  • decreased oxygen saturation levels
  • decreased breath sounds
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18
Q

management of meconium aspiration syndrome

A
  • thorough suctioning with the first breath
  • endotracheal intubation and mechanical ventilation, if indicated
  • transfer to NICU
  • medical and nursing care is the sam eas discussed for the newborn with respiratory distress
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19
Q

pathophysiology

A
  • fetal circulation persists, or remains, as it was in the uterus
  • ductus arteriosus and/or foramen ovale remain open
  • blood is shunted away from the lungs, the lungs have high pressure, and there is inadequate blood flow to the lungs for oxygenation
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20
Q

common causes of persistent pulmonary hypertension of the hypertension

A
  • perinatal asphyxia
  • RDS
  • neonatal sepsis
  • congenital defect of the heart or lungs
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21
Q

signs and symptoms of persistent pulmonary hypertension of the newborn

A
  • similar to RDS
  • cyanosis that does not improve with administration of oxygen
  • shock: low bp and tachycardia
  • possibility of a heart murmur caused by the open ducts arteriosus and/or foramen ovale
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22
Q

management of persistent pulmonary hypertension of the newborn

A
  • begins with transfer to the nicu
  • may resolve, or infant may have ongoing health problems
  • infant has a higher risk of neurosensory hearing loss and neurodevelopmental problems later
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23
Q

care of the newborn w/ cold stress

A
  • the risk of cold stress is highest during the immediate transitional period after birth
  • more likely to occur if born outside of the hospital environment
  • normal rectal temp for term and preterm infants: 97.7-98.6 F
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24
Q

neonatal hypoglycemia

A
  • plasma glucose level of less than 30 mg/dl in the first 24 hours of life and less than 45 mg/dL thereafter
  • the most common metabolic problem in newborns, affecting both healthy and ill appearing infants
  • 95% of the available glucose is used for brain function in newborns
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25
Q

long term complications from frequent or prolonged hypoglycemia are neurological damage such as

A
  • intellectual disability
  • development delays
  • personality disorders
  • decreased head size
  • seizures
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26
Q

check the blood sugar with a …

A

heel stick blood sample
- always check the blood sugar immediately after birth for any large or small birth weight newborn

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27
Q

a newborn’s blood glucose levels cacn drop if the newborn

A
  • has no glycogen sored in the liver
  • hased used up stored glucose for heat production or a birth stress
  • is an IDm and has hyperinsulinism
  • cannot feed enough to keep glucose level in an acceptable range
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28
Q

birth injuries

A
  • can occur as a result of traction and compression during the birthing process
  • also known as “birth trauma”
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29
Q

risk factors for birth injuries

A
  • fetal macrosomia
  • cephalopelvic disproportion
  • prolonged or very rapid delivery
  • use of forceps or vacuum extraction
  • abnormal presentation, such as breech
  • large fetal head
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30
Q

common soft tissue injuries…

A

resolve within days and cause no long term problems for the infant
- cephalohematoma, caput succedaneum, abrasion, or lacerations from instrumental deliveries

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31
Q

_________ are less common, but have potential for more complications

A

brachial plexus injuries, cranial nerve injuries, and fractures

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32
Q

brachial plexus injuries

A
  • occur from an increase in the infant’s neck shoulder angle resulting in a traction force to the brachial plexus
  • occur in 0.5 to 1,00 live births and associated w/ large birth weight, long labors, vaginal breech delivery, and shoulder dystocia
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33
Q

brachial plexus

A

a network of nerves originating in the neck area that branch off to form the nerves that control movement and sensation in the shoulders, arms, and hands

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34
Q

symptoms of brachial plexus injuries

A
  • limited movement on one side of the body
  • no Moro reflex on the affected side
  • claw like appearance of the hand on the affected side
  • abnormal muscle contractions on the affected side
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35
Q

definitive diagnosis of brachial plex injuries may include…

A

x rays to determine a fracture of the clavicle, shoulder, or arm; imaging studies; and nerve conduction studies

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36
Q

medical management of brachial plexus injuries

A
  • physical therapy (ROM activities, massage, stretching)
  • surgical treatment (nerve graft)
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37
Q

nursing care of the brachial plexus injuries

A
  • report symptoms of brachial plexus injury immediately
  • protect the affected arm from dangling when held or moved
  • do not lift the infant under the axillae
  • teach parents how to support the affected arm with rolled blankets when infant is in the car seat and crib
  • monitor for signs of pain and report to the provider
  • position the infant w/ a good body alignment
  • provide emotional support to the family
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38
Q

fractures

A
  • the clavicle is the most frequently fractured bone
  • associated w/ macrosomic infants and infants w/ large shoulders, making vaginal delivery difficult
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39
Q

signs and symptoms of fractures

A
  • newborn does not move the affected arm
  • a plapable bone irregularity may be noted during physical assessment
  • diagnosis is made w/ an x ray of the clavicle and affected arm
  • heals in 7 to 10 days
  • care includes immobilizing the arm and observing for possible brachial plexus injury
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40
Q

hyperbilirubinemia

A
  • the most common condition that requires medical attention in newborns; also known as “jaundice”
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41
Q

types of jaundice

A

physiologic jaundice
pathological jaundice

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42
Q

pathological jaundice

A
  • the serum bilirubin levels rises excessively and requires treatment to accelerate removal from the blood before complications can occur
  • the serum bilirubin is excessively elevated; the skin becomes saturated w/ bilirubin, causing the yellow coloration; the bilirubin begins to deposit in the brain and can cause neurotoxcity (kiernickterus)
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43
Q

risk factors of hyperbilirubinemia

A
  • prematurity
  • blood type incompatability with the mother
  • lack of effective breastfeeding
  • excessive bruising from an extended labor or a malpresentation in labor, such as face presentation
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44
Q

signs and symptoms of hyperbilirubinemia

A
  • visually detected when level reaches 5-6 mg/dL, first appears on the face; sclera may be tinted yellow also
  • yellow color spreads down the body as bilirubin level rises
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45
Q

transcutaneous bilirubinometer is a…

A

noninvasive instrument that gives an estimate of the total bilirubin before a serum bilirubin test is performed
- definitive diagnosis is made through laboratory testing

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46
Q

medical management of hyperbilirubinemia

A
  • breastfeeding or bottle feeding
  • breastfeeding at least 8-12 times or bottle feeding 8 -10 times a day
  • 6 wet diapers and three stools per day is most favorable to eliminate bilirubin through the GI tract and kidneys
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47
Q

phototherapy

A
  • used when total serum bilirubin level is at or above 15 mg/dL in infants 25 to 48 hours old, 18 mg/dL in infants 49 to 72 hours old; 20 mg/dL in infants older than 72
  • uses a “blue light” through overhead lights, pads, or blankets to convert bilirubin molecules into water soluble compounds that can be excreted by the body
  • infant’s eyes must be covered to prevent damage tro the retina from the bright light
48
Q

exchange transfusions

A
  • a blood exchange transfusion in the NICU may be required if kernickterus occurs
  • serious neurological damage may result if the bilirubin levels do not drops w/ feedings and phototherapy
49
Q

nursing interventions for hyperbilirubinemia

A
  • encourage breastfeeding 8 to 12 times a day, or bottle feeding 8 to 10 times a day
  • monitor the number of stools
  • weigh diapers for accurate urine output information
  • place eye patches to protect newborn’s eyes during phototherapy
  • expose the maximum amount of skin to the light, except for the genital area
  • monitor newborn’s behavior; irritability or lethargy could indicate that the bilirubin level is irritating the brain
  • monitor body temp for hypothermia from being undressed
50
Q

care of the newborn w/ an infection

A
  • newborns can be exposed to infection from the mother from organisms that enter teh vagina during labor, from contaminated hospital personnel and equipment, and from family and visitors
  • a newborn’s immune system is immature and unable to fight against severe infection before it becomes systemic
51
Q

neonatal sepsis

A
  • blood infecion that presents within the first 28 days of life; chemical released into the blood to help fight the infection cause inflammation over the entire body
52
Q

most common causes of neonatal sepsis

A
  • group B strep
  • e. coli
  • herpes
53
Q

herpes as a cause for infant sepsis

A
  • virus may infect the newborn during pregnancy, labor, or delivery
54
Q

types of herpes

A
  • herpes virus type (oral)
  • herpes virus type 2 (genital) the most common for newborns
  • the fetus can be exposed while passing through the birth canal if the mother has an active case of herpes type 2 at the time of delivery; a scheduled cesarean birth should be done
55
Q

signs of herpes

A
  • includes skin infection that blisters, crusts over, then heals
  • can become systemic and life threatening
  • symptoms of a systemic neonatal herpes infection are identical to the manifestations of neonatal sepsis
  • management is also the same except for antibiotics; the newborn will receive antiviral medications instead
56
Q

preterm birth

A

les than 37 weeks, 6 days

57
Q

early term birth

A

from 37 week 6 days through 38 weeks, 6 days

58
Q

full term birth

A

from 39 weeks through 40 weeks, 6 days

59
Q

late term birth

A

from 41 weeks through 41 weeks, 6 days

60
Q

post term birth

A

42 weeks and beyond

61
Q

SGA/intrauterine growth restriction (IUGR) newborn

A
  • an SGA newborn is an infant whose weight is les than the 10th percentile for his or her gestational age
  • the SGA newborn may have been affected by intrauterine growth restriction (IUGR), limited fetal growth caused by a decrease in placenta perfusion during gestation
62
Q

possible causes of SGA

A
  • abnormalities of the placenta or vessels restricting nutrients and oxygen to the developing fetus
  • maternal hypertension
  • uncontrolled, severe maternal diabetes
  • poor maternal nutrition
  • maternal drug use or heavy smoking
  • exposure to teratogenic substances
  • maternal alcohol consumption
  • multigestation
  • parents of small stature
63
Q

SGA/Intrauterine Growth Restriction (IUGR) Newborn diagnosed during…

A

pregnancy at route visits upon measurement of fundal height and through ultrasound examination

64
Q

physical findings of infants w/ IUGR

A
  • weight, length, and head circumference all below the 10th percentile for gestational age
  • large head in relationship to the rest of the body
  • thin extremities and trunk
  • loose skin
  • thin umbilical cord
65
Q

risks for term SGA infants

A
  • perinatal asphyxia during labor, if SGA was due to placental insufficiency
  • meconium aspiration
  • hypoglycemia
  • hypothermia
66
Q

nursing interventions for SGA newborns

A
  • perform a gestational age assessment
  • observe for respiratory distress
  • detect tremors or jitteriness, which are early signs of hypoglycemia
  • institute early feeding to prevent hypoglycemia
  • monitor for hypothermia
  • monitor for vital signs and daily weight
  • teach parents on keeping the infant warm and to provide frequent feedings
67
Q

the large for gestational age (LGA) newborn is an…

A

infant whose weight is greater than the 90th percentile for gestational age
- predominant cause is maternal diabetes

68
Q

most common complications for LGA newborn

A
  • shoulder dystocia
  • fracture of the clavicle or limbs
  • perinatal asphyxia
  • meconium aspiration
  • respiratory distress
  • hypoglycemia
69
Q

assessment findings for LGA newborns

A
  • large, obese baby
  • listless, apathetic bab
70
Q

nursing interventions for LGA newborns

A
  • perform a gestational age assessment
  • assess respiratory status
  • assess and report for signs of birth injuries
  • monitor for tremors
  • provide frequent feedings
71
Q

preterm newborn

A

infants born before 37 weeks’ gestation and have an increased risk of complications and mortality

72
Q

risk factors for preterm birth

A
  • low socioeconomic status
  • cigarette smoking
  • prior premature births
  • multiple prior therapeutic or spontaneous abortions
  • little or no prenatal care
  • poor nutrition
  • untreated infections
  • pre eclampsia
  • multiple gestation
73
Q

physical assessment of preterm newborn findings

A
  • skin is thin, and arteries and veins are visible
  • skin is fragile, and looks smooth and shiny
  • a moderately premature infant will have abundant lanugo
  • partially formed fingernails and toenails
  • ears may fold
  • very preterm infants have less muscle tone
  • the premature baby does not lie in a “fetal position” until 35 weeks
74
Q

potential complications of prematurity

A
  • respiratory distress
  • hypothermia
  • heart problems: patent ductus arteriosus and hypotension
  • intraventricular hemorrhage in the brain
  • anemia
  • infection
  • fluid and electrolyte imbalances
  • apnea of prematurity
75
Q

necrotizing entertocolitis (NEC)

A
  • the damage to the intestinal tract that may have occurred from abnormal intestinal flora, immaturity of the intestinal mucosa, intestinal ischemia, and a genetic predisposition
  • may effect only the mucosal lining, or may be full thickness necrosis and bowel perforation
76
Q

signs and symptoms of necrotizing enterocolitis

A
  • vomiting
  • diarrhea
  • delayed gastric emptying
  • decreased bowel sounds
  • lethargy
  • increased abdominal girth
  • visible intestinal loops
  • palpable abdominal mass
  • hematochezia (bright red blood in the stool)
77
Q

medical management of preterm newborns includes

A

stopping formula feedings, insertion of a nasogastric tube, feeding with breastmilk, and administration of antibiotics
- surgical intervention may be required to remove perforated or necrotic intestinal tissue

78
Q

retinopathy of prematurity (ROP)

A
  • visual impairment and blindness
  • early surgical laser treatment is the treatment of choice
79
Q

delayed development and preterm newborns

A
  • most babies catch up by 12-18 months and meet developmental milestones of their crrected ages
  • corrected age - baby’s actual age in weeks or months minus the number of weeks or months of prematurity
  • premature infants are at risk for learning disabilities and neurological problems such as ADHD
80
Q

long term complications of prematurity

A
  • retinopathy of prematurity
  • cerebral palsy
  • delayed development
81
Q

post term newborn

A
  • infants born after 42 weeks’ gestation
  • unknown cause
  • in some cases, the placenta begins to detach and break down leading to placental insufficiency syndrome; the lack of adequate nutrition and oxygen results in an SGA infant
82
Q

characteristics of post term newborns

A
  • more alert than a term infant
  • decreased subcutaneous fat, loose skin
  • dry, peeling skin
  • lack of vernix and lanugo
  • long fingernails and toenails
  • meconium staining on the umbilical cord
83
Q

potential complications in post term newborns

A
  • stillbirth or neonatal death
  • prolonged labor and birth trauma due to larger body size
  • hypoglycemia
  • increased risk of meconium aspiration
84
Q

neonatal complications are directly related to…

A

inadeqte glucose control in pregnancy

85
Q

congenital malformations

A
  • high blood sugar concentrations are toxic to cell growth in the first trimester
  • may cause cardiac and CNS abnormalities of the fetus
  • cardiomegaly
  • spina bifida
86
Q

nursing interventions for congenital malformations

A
  • promptly identify congenital abnormality, if obvious
  • notify the provider of physical abnormalities or abnormal vital signs
87
Q

fetal macrosomia

A
  • an infant weighing more than 4000g at birth
  • occurs in 15% to 45% of diabetic pregnancies
  • high levels of maternal glucose lead to fetal hyperglycemia and hyperinsulinemia, which causes increased growth in the fetus
88
Q

vaginal birth increases risk for birth injuries caused by….

A

shoulder dystocia

89
Q

the macrosomic IDM is typically delivered via

A

cesarean birth

90
Q

the macrosomic IDM appears…

A

ruddy, fat, puffy, and may have decreased muscle tone at birth

91
Q

nursing interventions for fetal macrosomia

A
  • notify the provider of birth weight and signs of macrosomia
  • perform a gestational age assessment
  • observe for signs of birth injuries
  • observe for signs of hypoglycemia
92
Q

hypoglycemia

A
  • due to a rapid fall in glucose within an hour of birth
  • linked to fetal hyperinsulinism
93
Q

fetal hyperinsulinism

A
  • the fetus produces high levels of insulin in response to the maternal glucose
  • when the cord is cut, the glucose influx is over, and fetus is left with high levels of circulating insulin leading to hypoglycemia
94
Q

fetal hypoxia

A
  • poorly controlled maternal diabetes can lead to a decreased supply of oxygen (hypoxia) to the fetal tissues and decreased blood flow to the placenta
  • chronic fetal hypoxia can lead to intrauterine death or to respiratory depression at birth
  • the fetus attempts to compensate for the decreased oxygen by producing extra red blood cells, a condition called polycythemia
95
Q

polychythemia

A
  • diagnosed when the hematocrit is greater than 65%
  • increases the risk of strokes, seizures, and hyperbilirubinemia
96
Q

characteristics of polycythemia

A
  • ruddy skin
  • sluggish capillary refill time
  • respiratory distress, apnea, cyanosis
  • poor feeding
  • lethargy
  • seizures
  • hematuria
97
Q

medical management of polycythemia

A
  • frequent monitoring of the vital signs, hematocrit, and blood glucose
  • some physicians will perform a partial blood exchange transfusion w/ saline to decrease the hematocrit quickly in symptomatic infants
  • in asymptomatic infants, observe for the onset of any symptoms and t the body adjust to the hematocrit; some physicians will hydrate the newborn with IV fluids
98
Q

nursing interventions for polycythemia

A
  • notify the provider immediately of any signs and symptoms
  • infuse IV fluids, if ordered, and observe closely for signs of fluid overload
99
Q

hypocalcemia

A

calcium level less than 8 mg/dL

100
Q

hypomagnesemia

A

magnesium level less than 1.7 mg/dL can occur in IDM

101
Q

pathophysiology of mineral/electrolyte metabolism

A
  • poor control of maternal glucose leads to maternal glycosuria, which is accompanied by magnesium loss, which causes fetal deficiency
  • insufficient magnesium level causes loss of calcium
  • severe hypomagnesemia causes a secondary hypocalcemia and hypoparathyroidism
102
Q

hypoparathyroidism

A

decreased secretion or activity of the parathyroid hormone, because magnesium is needed for the appropriate secretion of the PTH

103
Q

medical management of mineral/electrolyte metabolism

A
  • screening for hypocalcemia and hypomagnesemia
  • administering calcium and magnesium to obtain normal levels
104
Q

signs and symptoms of mineral/electrolyte metabolism

A
  • poor feeding
  • lethargy
  • tremors, seizures
  • cardiac arrhythmias
  • respiratory distress
105
Q

nursing interventions for mineral/electrolyte metabolism

A
  • report abnormal signs and symptoms immediately to the provider
  • maintain close observation to detect deterioration
  • administer calcium and/or magnesium as ordered
  • provide education and emotional support to the family
106
Q

neonatal abstinence syndrome

A

a group of similar behavioral and physiological signs and symptoms in the neonate caused by withdrawal from various pharmacologic agents

107
Q

withdrawal symptoms of chemically exposed infants depends on

A
  • age of the neonate
  • drug
  • drug’s half like
  • time of the mother’s last use
108
Q

neonatal abstinence scales are tools used to evaluate newborn…

A

reflexes and behavioral that indicate the severity of withdrawal symptoms and plan for medical interventions

109
Q

medical interventions for neonatal abstinence

A
  • transfer to NICU
  • intravenous fluids as ordered
  • provide medications to reduce symptoms and gradually wean from the substance (morphine is most frequently used medication for opioid addicted newborns)
  • administer phenobarbital as ordered to control seizures
  • avoid administering naloxone to the mother at the time of delivery; it causes abrupt withdrawal and seizures for the neonate
110
Q

nursing interventions for chemically exposed infants

A
  • assess for signs of withdrawal and report any signs and symptoms immediately
  • administer and monitor pharmacological treatment
  • protect the skin from diarrhea
  • bottle feed with high calorie formula
  • encourage breastfeeding if not contraindicated
  • provide parenting education to the caretakers
  • communicate w/ and provide a referral to a social worker for post discharge care and follow up
111
Q

long terms effects for chemically exposed infants

A
  • poor growth throughout childhood
  • hyperactivity and add
  • impaired cognition
  • poor language development
  • higher rated of criminal behavior and substance use disorder
112
Q

perinatal transmission

A
  • transmission of HIV from mother to child during pregnancy, labor and delivery, or breastfeeding
  • the risk of perinatal acquisition is 25% to 40% without interventions such as antiviral therapy
  • CDC recommends that infants born to mothers with unknown HIV status should receive rapid HIV testing
113
Q

medical management of the HIV exposed newborn

A
  • if the mother received antiretroviral medications during pregnancy: Zidovudin (ZDV) 4mg/kg twice a day through 6 weeks of age
  • if the mother did not receive prenatal antiretroviral medications: ZDV 4mg/kg twice a day through 6 weeks of age
  • Nevirapine (NVP) 3 doses in the first week of life; 12 mg PO per dose if birth weight is greater than 2 kg, and 8 mg per dose if birth is 1.5-2kg
114
Q

nursing interventions for newborn exposed to HIV

A
  • maintain strict standard precautions
  • anyone handling the newborn, including family members, must wear gloves until the first bath
  • assess and notify hcp of any abnormalities
  • administer medications as ordered
  • pt teaching on the importance of following the drug prophylaxis plan after discharge
  • advise the mother not to breastfeed
115
Q

care of the family of an at risk newborn

A
  • fear of the unknown and the NICU environment
  • anger
  • gueilt, because the mother often blames herself
  • loss of bonding and attachment time
  • loss of control
  • frustration
  • anxiety about the baby’s health
  • helplessness because the parent’s cannot provide the high skilled level of care needed by the infant
116
Q

family centered nursing interventions for at risk newborns

A
  • provide opportunity for parents to hold and bond w/ newborn
  • develop a therapeutic relationship with the parents
  • provide positive reinforcement for their concerns
  • encourage parents to talk about their NICU experience
  • never behave as if the parents are in the way or interrupting
117
Q
A

PNC 102 lecture (42 decks)

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