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NURS 4500: Final Material > Class 10: Neonatal Complications > Flashcards

Class 10: Neonatal Complications Flashcards

1
Q

how are high risk infants most often classified? (3)

A

according to:
- birth weight
- gestational age
- common pathophysiological problems

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2
Q

infants who are born considerably before term & survive are particularly susceptible to …

A
  • development of sequelae related to preterm birth
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3
Q

what is considered preterm

A
  • born before completion of 37 weeks of pregnancy (<= 36+6)
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4
Q

describe organ systems and physiological reserves w the preterm infant

A
  • organ systems are immature
  • & lack adequate physiological reserves to function in the extrauterine enviro
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5
Q

the lower the birth weight and gestational age, the ____ the chances of survival

A

the lower the chances of survival

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6
Q

what are causes of preterm birth (5)

A
  • infection
  • history of preterm birth
  • poor prenatal care
  • SDoH
  • bleeding
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7
Q

what is considered extremely low-birth-weight infants (ELBW)

A

<1000 g

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8
Q

what is used for classification of NB according to size

A
  • growth size
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9
Q

what is considered low birth weight

A

<2500 g

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10
Q

what is considered very low birth weight (VLBW)

A

<1500 g

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11
Q

what is considered extremely low birth weight (ELBW)

A

<1000 g

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12
Q

what is considered small for gestational age

A
  • BW < 10th percentile
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13
Q

what is considered average for gestational age (AGA)

A

BW between 10th-90th percentile

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14
Q

IUGR = usually < ___ percentile

A
  • usually <3rd percentile
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15
Q

what is considered large for gestational age (LGA)

A

> 90th percentile

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16
Q

what is considered late preterm

A

34+0 - 36+6 weeks gestation

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17
Q

what is considered term infants

A

38-42 weeks

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18
Q

what is considered postterm

A

> =42 weeks

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19
Q

define: live birth

A
  • born with signs of life
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20
Q

define: fetal death (aka still birth)

A
  • death of fetus prior to birth
  • 20+ weeks gestational age
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21
Q

define: neonatal death

A
  • death in 1st 28 days after birth
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22
Q

define: early neonatal death

A
  • within the first 7 days
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23
Q

define: late neonatal death

A
  • days 7-28
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24
Q

define: perinatal mortality

A
  • combined fetal & neonatal deaths / 1000 live births
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25
Q

what are some resp complications of prematurity (3)

A
  • resp distress
  • apnea of prematurity
  • bronchopulmonary dysplasia
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26
Q

what are some CVS complications of prematurity

A
  • patent ductus arteriosus
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27
Q

what are some CNS complications of prematurity

A
  • intracranial or intraventricular hemorrhage
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28
Q

what are some eye complications of prematurity

A
  • retinopathy of prematurity
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29
Q

what are some GI complications of prematurity (2)

A
  • feeding difficulties
  • necrotizing enterocolitis
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30
Q

what are some hematological complications of prematurity (2)

A
  • anemia
  • infection
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31
Q

what changes to BW can occur d/t complications of prematurity (3)

A
  • hypocalcemia
  • hypoglycemia
  • hypothermia
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32
Q

what are some hepatic complications of prematurity

A
  • jaundice
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33
Q

what is assessed r/t prenatal record & obstetrical history (5)

A
  • gestational age
  • type of delivery
  • trauma
  • maternal complications
  • risks for sepsis
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34
Q

what are risks for sepsis of the NB (9)

A
  • STIs
  • PROM
  • fever in birther
  • chorioamnionitis
  • prolonged labor
  • premature
  • UTI in birth
  • substance use in birth
  • inadequate prenatal care
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35
Q

what type of infant is more at risk in terms of stress during the physical exam? what do we do to combat this?

A
  • late preterm more at risk in terms of stress during the physical exam
    = may need to break the physical exam into smaller pieces at separate times
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36
Q

what should be done if there is resp distress during the physical exam?

A
  • assess this system and intervene as necessary to treate
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37
Q

what is an issue during physical assessment of the preterm infant? what do we do to combat this?

A
  • thermoregulation
    = consider the need to provide additional heat source, protect from cold stress during the exam
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38
Q

what is the New Ballard Score?

A
  • score that looks at the physical and neuromuscular signs to categorize maturity
  • estimates gestational age by maturity rating
  • higher score = higher GA
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39
Q

the New Ballard Score can be used as young as?

A
  • 20 weeks
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40
Q

what is the HR of premature infant

A

110-160

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41
Q

what is RR of a premature

A
  • 30-60 breaths/min
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42
Q

describe measurement of BP in newborns?

A
  • BP may be measured in preterm or sick newborns
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43
Q

describe findings in CVS assessment of premature infant

A
  • murmur more common
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44
Q

describe findings in resp assessment of premature infant (2)

A
  • apnea
  • resp distress symptoms more common
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45
Q

describe T in premature infants (2)

A
  • 36.5-37.5
  • more instability
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46
Q

what is assessed in the premature infant (5)

A
  • posture
  • activity
  • HC
  • length
  • weight
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47
Q

describe findings in the skin assessment of premature infant (5)

A
  • thinner
  • may be covered in vernix
  • lanugo
  • vessels may be easily seen over abdomen
  • lack of plantar creases
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48
Q

what should be assessed first w NB VS? last?

A
  • first = resps
  • last = temp
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49
Q

when assessing newborn VS, we want to assess the NB at ___

A

rest if possible

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50
Q

what is the method of assessment of NB temp? average findings? normal variation?

A
  • axillary
  • average finding: 37
  • normal variation: 36.5-37.5
51
Q

what is the normal variations of temp for preterm infants

A

36.3-37.5

52
Q

what is the method of assessment of NB HR

A
  • auscultation
  • palpation
53
Q

what are average findings for NB HR? normal variation?

A
  • average finding: 110-160
  • 80-100 bpm when asleep
  • up to 180 when crying
54
Q

what are normal variation for HR of preterm infants

A
  • 110-160 bpm
55
Q

what is the method of assessment of RR in NBs? (2)

A
  • observe effort
  • auscultate
56
Q

what are average findings for NB RR? normal variations?

A
  • average findings: 30-60 breaths/min
  • normal variations: short periodic breathing episodes (no apnea > 20 sec)
57
Q

stabilization of NB RR occurs when?

A
  • by day 1-2 —> usually then 30-40 breaths/min
58
Q

BP monitoring may be required for?

A
  • some preterm & other high risk NBs
59
Q

what is late preterm VS protocol at SBH

A
  • usually shortly after birth
  • then q30min x4 (2hrs)
  • then q4h x 24 h
60
Q

what is considered late preterm

A

34 to 36+6

61
Q

what is often the size & weight of a late preterm infant

A
  • often the size & weight of term infant
62
Q

late preterm infants have risk factors for: (7)

A
  • thermoregulation
  • hypoglycemia
  • hyperbilirubinemia
  • resp distress
  • poor feeding & discharge delays
  • neurodevelopmental problems
  • infection
63
Q

for late preterm infants, how often is T assessed?

A
  • q30 min in immediate PP until stable
  • then q1-4h
64
Q

what is the normal variation of temp in late preterm infants

A

36.5-37.5

65
Q

cold stress can lead to (3)

A
  • hypoxia
  • metabolic acidosis
  • hypoglycemia
66
Q

LBW increases..

A
  • vulnerability of neonates to cold stress
67
Q

LBW increases.. therefore preter, infants may require?

A
  • vulnerability of neonates to cold stress
  • may require additional heat source, try to minimize heat loss, maintain neutral thermal enviro
68
Q

late preterm infants have an increased risk for?

A
  • resp distress
69
Q

describe the presence of surfactant & functional alveoli in late preterm infants

A
  • decreased amt of surfactant
  • decreased # of functional alveoli
70
Q

what RR at rest is considered abnormal in late preterm infants

A

<30 or >60 breaths/min

71
Q

what are early signs of resp distress (3)

A
  • nasal flaring
  • tachypnea
  • and/or frunting w expiration
72
Q

what are signs of an airway obstruction in the late preterm infant (3)

A
  • stridor
  • gasping
  • with or without suprasternal or subclavicular indrawings
73
Q

central cyanosis?

A

…

74
Q

seesaw breathing?

A

…

75
Q

apnea >20 secs is considered..

A
  • abnormal
76
Q

what are signs of resp distress syndrome (2)

A
  • tachypnea >= 60 breaths/min
  • central cyanosis lasting beyond the 1st hour or 2 after birth
77
Q

what are some causes of apnea in the late preterm infant? (5)

A
  • hypo or hyperthermia
  • resp distress
  • fever
  • hypoglycemia
  • infection
78
Q

apnea is considered.. what does it require?

A
  • abnormal
  • requires further investigation
79
Q

what should be assessed r/t the CVS system of the late preterm infant (6)

A
  • skin color
  • BP (if required)
  • cap refill
  • peripheral pulses
  • O2 sat
  • HR & rhythm
80
Q

what is normal HR variation in late preterm infant

A

110-160

81
Q

what cap refill is considered normal in the late preterm infant

A

<= 3 secs

82
Q

what should be assessed r/t cap refill in the late preterm infant (3)

A
  • central vs peripheral
  • bilat
  • upper vs lower body
83
Q

what are signs of hypovolemia in the late preterm infant (6)

A
  • cap refill >3 secs
  • pale
  • hypotonia
  • lethargy
  • tachycardia or bradycardia
  • signs of resp distress
84
Q

describe the ductus arteriosis in the preterm infant

A
  • may not close right after birth
85
Q

describe murmurs in the preterm infant

A
  • a murmur may be heard at the Left upper sternal border
  • should be documented & communicated to provider
86
Q

in the preterm infant, assess for… (5)

A
  • difficulty feeding
  • apnea
  • cyanosis
  • pallor
  • dyspnea
87
Q

late preterm infants may be challenged in…

A
  • may be challenged in coordinating the suck-swallow-breathe reflex
88
Q

what is the best source of nutrition for the late preterm infant

A
  • breastmilk
89
Q

describe how breastmilk should be given to late preterm infants

A
  • indiv should be encouraged to continue to pump & provide breastmilk until infant is able to feed at the breast
90
Q

breast fed infants tend to have… (3) than their bottle-fed counterparts

A
  • fewer desaturations
  • warmer skin temp
  • better coordination of breathing, sucking, and swallowing
91
Q

hyperbilirubinemia occurs in ___% of preterm infants

A

80%

92
Q

what should be assessed d/t the increased risk of hyperbilirubinemia in the preterm infant (4)

A
  • assess for signs of jaundice
  • close monitoring of weights
  • ins & outs closely monitored
  • support w breast feeding
93
Q

there is an increased risk of hypoglycemia if.. (5)

A
  • born premature (<37 weeks)
  • small for gestational age infants
  • infants of diabetic mothers (IDM)
  • large for gestational age
  • infants at risk of having carnitine palmitoyl transferase -1 (CPT-1), including those w known family history & all neonataes of Inuit familie
94
Q

what is the goal for late preterm infants glucose

A

> = 2.6 mmol/L pre-feeds

95
Q

who should be assessed for S*S of hypoglycemia ? when?

A

all newborns –> immediately and ongoing

96
Q

what are mild symptoms of hypoglycemia (60

A
  • jitteriness or tremulousness @ rest (may notice as they get ready to feed)
  • limpness
  • mild lethargy
  • difficulty feeding
  • eye rolling
  • weak or high-pitched cry
97
Q

what are severe symptoms of hypoglycemia in newborns (7)

A
  • apnea or tachypnea
  • seizures
  • cyanosis
  • cardiac failure/arrest
  • episodes of sweating
  • pallor
  • hypothermia
98
Q

if any symptoms of hypoglycemia are noted in the preterm infant, what should be done?

A
  • check BG
  • use algorithm to determine next steps in care based on BG result
99
Q

if the infant is at risk for hypoglycemia, >= 35 weeks gestation at birth, what should we ensure is done?

A
  • ensure infant is put skin to skin & feed (breast or formula [5-10 ml/kg] or expressed human milk)
100
Q

for NB >= 35 weeks, when is BG checked?

A

~2h after birth, after first feed

101
Q

what is done if the NB BG is >= 2.6 mmol/L, and no symptoms of hypoglycemia, what is done?

A
  • monitor BG q3-6h before feeds
102
Q

if BG is 1.8-2.5 or mild symptoms of hypoglycemia present in the NB, what is done? (2)

A
  • glucose gel AND feed infant
  • repeat BG 1 hr after feed
103
Q

what is done if the NB BG is <1.8 (2)

A
  • call to neonatology
  • treat based on symptoms
104
Q

what concern is there r/t the renal system in the late preterm infant

A
  • immature renal system
105
Q

due to the concern of immature renal system in late preterm infants, what needs careful attention?

A
  • strict I&Os
106
Q

NB should have at least __ void(s) in the first 24 hrs of life

A

1

107
Q

meconium stool should be passed within ?

A
  • 24 hrs of life
108
Q

how often should weights be done on the late preterm infant

A
  • OD weight at minimum, q24 h
109
Q

what is imp to note r/t the signs of electrolyte imbalance & hypoglycemia in late preterm infants

A

signs can overlap

110
Q

abdomen of the late preterm infant should be…(3)

A
  • soft
  • round
  • no masses
111
Q

describe neuro assessment in the late preterm infant (7)

A
  • observe muscle tone ( should be equal)
  • flexion
  • symmetry of mvmts
  • reflexes
  • cry (should not be high pitched)
  • check fontanelles
  • signs of seizures
112
Q

which reflex is not well coordinated in the late preterm infant

A

suck-swallow-breathe reflex

113
Q

what neuro concerns are there in the late preterm infant (2)

A
  • potential trauma
  • immature development & functioning
114
Q

what is imp to assess for r/t fontanelles of the late preterm infant ? why?

A
  • bulging –> can indicate increased ICP
115
Q

what are signs of seizures in the late preterm infant (3)

A
  • nystagmus
  • repetitive chewing motions
  • twitching at corner of mouth
116
Q

what type of tremors are abnormal in the late preterm infant

A
  • tremors at rest or when calm
117
Q

what is included in nursing care for the late preterm infant (5)

A
  • hydration
  • hematological support
  • infection prevention (immunity)
  • skin care (more thin & fragile)
  • enviro concerns
118
Q

what is included in hydration for the late preterm infant (3)

A
  • calculate weight loss/gain
  • review feeding
  • signs of hydration
119
Q

what is included in hematological support for the late preterm infant (2)

A
  • signs of bleeding
  • anemia
120
Q

what is included in caring for enviro concerns w the late preterm infant (2)

A
  • maintain neutral thermal enviro
  • reduce stimuli
121
Q

what nursing care plays a role in developmental care for late preterm infants (5)

A
  • skin-to-skin contact
  • minimal stimuli in enviro
  • slow, gentle mvmts
  • consider swadlling for physical exam
  • take breaks
122
Q

what is included in family support & involvement for late preterm infant (4)

A
  • psychological tasks of parents of a high-risk infant
  • facilitate parent-infant relationships
  • encourage & reinforce parents during caregiving activities
  • get parents to demonstrate back how to care for infant
123
Q

what is included in nursing care r/t growth & developmental potential in late preterm infants (2)

A
  • corrected age
  • signs of stress or fatigue in newborn
124
Q

parent education for late preterm infants should be given regarding (3)

A
  • SIDS
  • CPR
  • proper position of infant when put to sleep

NURS 4500: Final Material (16 decks)

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