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OB Test 4 > Chapter 37 - Nursing Care of the High Risk Newborn > Flashcards

Chapter 37 - Nursing Care of the High Risk Newborn Flashcards

1
Q

High Risk Newborn

A

Infants born considerably before term who survive are particularly susceptible to development of sequelae related to their preterm birth

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2
Q

High risk infants are classified according to

A

birth weight, gestational age, and predominant physiologic problems s

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3
Q

Preterm Infants

A

Organ systems are immature and lack adequate reserves of bodily nutrients
Potential problems and care needs of preterm infant weighing 2000 g differ from those of term, postterm, or postmature infant of equal weight
Vast majority of high risk infants are those born less than 37 weeks
Preterm rate rose in US from 1980’s to 2006 then decreased

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4
Q

Extremely low birth weight

A

Birth weight is 1000 g or less

Practical and ethical dimensions of resuscitation

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5
Q

Late preterm infants

A

Previously referred to as near-term
Born between 34-0/7 and 36-6/7 weeks
Greater risk of complications or death prior to 1 year of age
More respiratory and neurological problems

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6
Q

Maintaining body temperature

A

Neutral thermal environment (environmental temp at which O2 consumption is minimal but adequate to maintain body temp)
(so can’t maintain a normal body temp)

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7
Q

Physiologic Functions

A

Maintaining adequate nutrition
Maintaining renal function
Maintaining hematologic status
Resisting infection

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8
Q

Respiratory Function

A 
Decreased # of alveoli
Deficient surfactant level
Smaller bronchus
Greater collapsibility
Weak/absent gag
S/S of respiratory distress
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9
Q

Cardiovascular Function

A 
Evaluate:
HR
BP
Color
Perfusion
O2 Sat
Pulses
Blood gas
Monitor
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10
Q

Body Temperature

A

Maintaining body temperature
Low body fat, decreased muscle mass, immature thermoregulation
High risk infant susceptible to heat loss
Unable to increase metabolic rate
Should be transferred from delivery in a prewarmed incubator, radiant warmer
Rapid changes in body temperature may cause apnea

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11
Q

CNS

A

Injury can occur with preterm delivery, gestational age, intrauterine asphyxia
Look for:
Seizures
CNS depression
Increased ICP (intracranial pressure - fontenelles bulge)
Hypo or Hyper tonia
Weak cry

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12
Q

Nutrition

A

May be IVF
TPN
NG/OG
Breast milk or formula

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13
Q

Growth and Developmental

A

Difficult to predict with accuracy
Corrected age
Milestones are corrected until age 2½
**Born at 28 weeks= 12 weeks early so at 12 months is actually 9 months
Usually D/C from NICU close to actual due date
High Risk Clinic
Risk of CP, Dev Delay

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14
Q

Corrected Age

A

baby born at 32 wks so 8 wks early so if 9 months old expect 7 months old stuff

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15
Q

Oxygen therapy (warmed and humidified)

A 
Hood therapy
Nasal cannula
Continuous positive airway pressure (CPAP)
Mechanical ventilation
Neonatal resuscitation
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16
Q

Oxygen therapy

A 
Surfactant administration
High-frequency ventilation
Nitric oxide therapy
Extracorporeal membrane oxygen therapy
Weaning from respiratory assistance
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17
Q

Surfactant

A

–>Reduces the surface tension of fluids that line the alveoli and passages= uniform expansion of lungs and maintenance of expansion at low intraalveolar pressures
**Prior to 34 weeks not enough surfactant is produced
Can give surfactant via ET tube

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18
Q

High Frequency Ventilation

A

Jet, oscillator, high frequency vents
Provide up to 300 breaths per minute
Smaller volume
Decreased the pressure needed to ventilate

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19
Q

Nitrous Oxide

A

Causes potent and sustained pulmonary vasodilation in the pulmonary circulation
Used in babies with persistent pulmonary hypertension
Viagra

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20
Q

ECMO

A 
Vandy - closet to us
Severe cardiac or respiratory failure
Modified heart lung machine
Oxygenates blood, allows lungs to rest
Use with anticoagulants
Cannot use in babies less than 34 weeks
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21
Q

Nutritional care

A 
Weight and fluid loss or gain
Insensible water loss
Elimination patterns
Oral feeding
Gavage feeding
Gastronomy feedings
Parenteral fluids—TPN
Advancing feedings
Nonnutritive sucking
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22
Q

Nutrition

A

Suck-swallow-breathe reflex
Inability to suck due to congenital anomaly
Intubation
Potential for NEC
Anomaly such as gastroschisis or omphalocele
Renal function

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23
Q

Breast Feeding Nutrition

A

Breast milk-babies who are 28-36 weeks may breast feed if can suck and swallow and tolerate
Preterm babies that are breastfed have fewer desats and decels (A’s and B’s), better thermoregulation,improved suck-swallow reflex
Human milk fortifier
Pump if unable to breastfeed
Human milk bank
(nook nipple)

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24
Q

For NG tube confirm placement with

A

ph testing or xray

25
Q

Formula feeding Nutrition

A

Mix to 22-24 cal per oz (mix per instructions 20 cal per oz)
Different types of nipples: premmie (red), nuk(orthodontic) regular
Stimulate sucking-nonnutritive sucking
Speech therapy
Oral aversions
(have red nipple for premies)

26
Q

Insensible water loss (IWL)-

A

evaporative loss primarily through skin 70% and through respiratory tract 30%

Basal IWL in term infants is ***20ml/kg/24hr-increased is preterm based on skin, RR, humidified O2, radiant warmers, bili lights

(how intact skin?, how fast breathing?, warmer/billi lights)

27
Q

Gavage feeding NG or OG

A

Bolus or continuous
Minimal enteral nutrition (MEN)-small amount continuous to stimulate gut
Residual volume-aspirate Q 2-4 hours, if < 1 hour residual refeed on cont, if < 50% on bolus refeed. If more than stop feed
(usually want bolus feeding)

28
Q

Residual volume-***

A

aspirate Q 2-4 hours, if < 1 hour residual refeed on cont, if < 50% on bolus refeed. If more than stop feed

29
Q

GT feeds

A

Long term need for feeds
Mic-key , Bard
Fundoplication - (should not be able to vomit)

30
Q

Skin Care

A

Increased sensitivity and fragility
Braden Q or Neonatal Skin Condition Scoring (NSCS) should be used daily
Avoid the use of soap

31
Q

Environmental Concerns

A

NICU infants are exposed to high levels of auditory input

Days/nights

32
Q

Developmental Care

A

Positioning
Reducing inappropriate stimuli-cluster care
Infant communication-increased HR, averting gaze, flailing limbs
Environment
Kangaroo care

33
Q

Parental adaptation to the preterm infant

A

Parental tasks - Anticipatory grief-potential loss of infant
Parental responses
Parental support
Maladaptation-physical and emotional abuse/neglect
Parent education

34
Q

Complications in High Risk Infants

A

Respiratory distress syndrome (RDS)
Complications associated with oxygen therapy - Retinopathy of prematurity (ROP), Bronchopulmonary dysplasia (BPD), Patent ductus arteriosus (PDA)

35
Q

Patent ductus arteriosus (PDA)

A

normal in fetal circulation-left pulmonary artery connects to the distal aorta, diverts blood to placenta for gas exchange
Constricts after birth
Can stay open or reopen with stress-mottling cyanosis
Small PDA can be asymptomatic
Can administer ibuprofen and indomethacin to inhibit prostaglandin production that caused the PDA to constrict

36
Q

Respiratory distress syndrome (RDS)

A

Increased risk for : male, caucasian, second born twin, maternal diabetes
Caused by lack of pulmonary surfactant
S/S usually within 6 hrs after birth, crackles, poor air exchange, pallor, retractions, apnea
Usually resolves within 72 hours-surfactant starts being produced in alveoli

37
Q

Retinopathy of prematurity (ROP)

A

retinal vessels are damaged
Too high O2 causes vasoconstriction of vessels
Opthalmology
Varying degrees of visual impairment (can be blind)

38
Q

Bronchopulmonary dysplasia (BPD)

A

barotrauma from pressure ventilation and oxygen toxicity
Chronic lung disease
Not seen as much due to surfactant and steroids antepartum
May d/c’d home on O2
(from mechanical ventilation)

39
Q

Germinal matrix hemorrhage-intraventricular hemorrhage IVH

A

Risk increased with decreased gestational age
Germinal matrix-lies beneath the lining of the lateral ventricles
Especially vulnerable to alterations in cerebral blood flow and blood pressure changes
Usually occurs in infants < 34 wks, hx of hypoxia, birth asphyxia,
(graded I - V) ( younger you are the more at risk you are)

40
Q

Necrotizing Enterocolitis (NEC)

A

acute inflammatory disease of the GI mucosa, commonly complicated by bowel necrosis and performation
10% of all NICU admits
90% preterm infants
Mortality rates 9-50%

41
Q

Risk Factors of NEC ***

A

1.Intestinal ischemia from asphyxia, hypoxia, or events that cause redistribution of blood away from GI tract (hypotension, hypovolemia, severe stress)
2. Bacterial colonization of GUT with harmful organisms prior to establishment of normal flora. Klebsiella, E. Coli, Clostridium
3. Enteral feeding
Breast milk protective against NEC, rare in infants exclusively breastfed

Occurs 1-3 days after birth, but can occur up to 1 month

42
Q

Pain

A 
Do they feel pain-yes
Pain is fifth vital sign
Crying
Facial expressions
Non-pharmocological measures
(sweeties)
43
Q

Late preterm infants

A

34-36 weeks gestation
At risk for: thermoregulation, hypoglycemia, hyperbilirubinemia, poor feeding, sepsis, respiratory distress
Should not go home before 48 hours

44
Q

Post mature infants

A 
> 42 weeks
Risk for placental insufficiency
Dry,cracked skin
Long nails
Profuse scalp  hair
Absent vernix
Depleted SQ fat
Risk of meconium
45
Q

Meconium

A

Indicative of fetal distress
Aspiration (can intabate and suction out to see if get meconium past vocal cord) vs.staining (come out with meconium on it but not in airway)

46
Q

Small for gestational age (SGA) and intrauterine growth restriction (IUGR)

A

Risk factors: smoking, preeclampsia, low socioeconomic status, multiples,infections

47
Q

Large for gestational age (LGA)

A

Weighing 4000 g or more at birth
LGA despite gestation when the weight is greater than the 90th percentile
Can be preterm, postterm, or infants of diabetic mothers

48
Q

Discharge Planning

A

Home care needs of infant’s parents are assessed
Information provided about infant care
Referrals for appropriate resources
Referrals for home health assistance
Appropriate immunizations, metabolic screening, and hearing evaluation
Transport to and from regional centers
(have to go through car seat test)

49
Q

Key Points

A

Preterm infants are at risk for problems stemming from the immaturity of their organ systems

50
Q

Key Points

A

Nurses who work with preterm and other high risk infants observe them for respiratory distress and other early symptoms of physiologic disorders

51
Q

Key Points

A

Adaptation of parents to preterm or high risk infants differs from that of parents to normal term infants

52
Q

Key Points

A

Nurses can facilitate the development of a positive parent-child relationship

53
Q

Key Points

A

Nurses’ skills in interpreting data, making decisions, and initiating therapy in newborn intensive care units are crucial to ensuring infants’ survival

54
Q

Key Points

A

Pain management requires vigilant ongoing assessment, anticipation of painful events, and early interventions to prevent and diminish such a response

55
Q

Key Points

A

Nurses must assess macroenvironments and microenvironments of infant and family to create a developmentally positive atmosphere

Parents need special instruction before they take home a high risk infant 
CPR 
Oxygen therapy 
Suctioning
Developmental care
56
Q

Key Points

A

SGA infants considered at risk because of fetal growth restriction

57
Q

Key Points

A

High incidence of nonreassuring fetal status among postmature infants is related to progressive placental insufficiency that can occur in a postterm pregnancy

58
Q

Key Points

A

Specially trained nurses may transport high risk infants to and from special care units

59
Q

Key Points

A

Parents need assistance coping with anticipatory loss and grief

OB Test 4 (9 decks)

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