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Module 5 (Pediatrics) > Complications of Newborns > Flashcards

Complications of Newborns Flashcards

1
Q

Nonmodifiable Risk Factors for At-Risk Newborns
not tested

A

Previous preterm delivery
Multiple abortions
Race/Ethnic Group
Uterine/Cervical Anomaly
Multiple Gestation (twins, triples, quadruples)
Pregnancy Induced HTN (STRESS)
The short interval between pregnancies
Bleeding in the first trimester

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2
Q

The rule of thumb is having a pregnancy after another pregnancy is

A

wait at least a year or longer to have another baby
- Antepartum causes HTN and they are too stressed to deliver and will usually deliver earlier

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3
Q

Modifiable Risk Factors for At-Risk Newborns

A

Age at pregnancy <17 or >34 years of age (chromosome)
Unplanned pregnancy
Domestic violence – stress with trauma
Low pre-pregnancy weight - malnutrition
Obesity – T2DM
Infection – connection between baby
Substance abuse/Alcohol abuse – connection and no prenatal care
Cigarette Smoking – smaller without blood flow to the baby
Late or no prenatal care

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4
Q

Why do young and unplanned pregnancies cause risk for prematurity?

A

no prenatal care
hide or don’t know about it

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5
Q

Very premature

A

Neonates born at less than 32 weeks’ gestation

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6
Q

Premature

A

Neonates born between 32 and 34 weeks’ gestation

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7
Q

Late Premature

A

Neonates born between 34 and 37 weeks
-naughtiest and immediate to nicu

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8
Q

Normal Premature Assessment Findings
color

A

Usually pink or ruddy (support O2 at delivery - closing shunts)
maybe acrocyanotic (if no O2 supplemental)

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9
Q

Normal Premature Assessment Findings
skin

A

Reddened, translucent, blood vessels apparent; lack of sub-Q fat

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10
Q

Normal Premature Assessment Findings
lanugo

A

plentiful, widely distributed
- protect in amniotic

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11
Q

Normal Premature Assessment Findings
head size

A

large in relation to the body

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12
Q

Normal Premature Assessment Findings
skull

A

bones pliable
fontanels smooth and flat, sutures approximated or overriding

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13
Q

Normal Premature Assessment Findings
ears

A

minimal cartilage, pliable, folded over
- more premature the less cartilage they have
- put the ear backs so they don’t look dumbo

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14
Q

Normal Premature Assessment Findings
nails

A

Soft; short
- push in not enough Ca deposits

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15
Q

Normal Premature Assessment Findings
genitalia

A

Males:
-Nonrugated, small scrotum
- testes may or may not be descended.
Females:
-Prominent clitoris and labia minora
-Pseudomenstration not as much as term baby

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16
Q

Normal Premature Assessment Findings
posture

A

Flaccid (not flexed), froglike position
- lack of neurodevelopment
- need developmental aids

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17
Q

Normal Premature Assessment Findings
cry

A

weak, feeble
- depends on baby personality

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18
Q

Normal Premature Assessment Findings
reflexes

A

Poor suck, swallow, and gag
– affects eating (develops around 34 weeks they can eat)

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19
Q

The gag and swallow reflex develops around

A

34 weeks gestation then the neuro system develops

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20
Q

Normal Premature Assessment Findings
activity

A

Jerky, generalized movements
spastic

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21
Q

Determining gestational age in preterm newborns requires

A

knowledge and experience in administering gestational assessment tools
**Ballard Scale

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22
Q

Nursing Care for High-Risk Newborns

A

Continuous monitoring (pulse ox, HR, RR)
Establish and maintain respiration
Apply external warmth - lack of fat and small
Administer fluids and meds
Enteral feeding (gavage, nipple, breast)
Skincare - no baths and adhesive remover
Developmental and family-centered care
- bonding with family

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23
Q

If the premature high-risk infant is extremely sick, then what can be used to get their BP?

A

arterial line

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24
Q

What is the magic number for weaning a baby off of external warmth?

A

1800 grams

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25
Q

If the premature baby is under 34 weeks gestation, then how do you feed the baby?

A

gavage
- older they get to advance to nipple and breast

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26
Q

Do you bathe a baby straight away? why?

A

No, too weak for thermal regulation and skin tearing

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27
Q

5 Factors decreasing Thermoregulation in preterm infants

A

High ratio of BSA to wt
Very little SubQ fat
Thinner and more permeable skin
Posture flaccid
(no shivering) low ability to vasoconstrict superficial blood vessels and conserve heat in the body’s core

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28
Q

How do you maintain thermoregulation in a preterm baby?

A

reassess if still safe for a thermoneutral environment
temp every feeding time

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29
Q

maintenance of a Neutral Thermal Environment for minimizing

A

minimizes the oxygen consumption
- required to maintain a normal core temperature
prevents cold stress and facilitates growth
- by minimizing caloric and glucose expenditure to maintain body temperature

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30
Q

What should the baby’s temperature be for a preterm infant?

A

37C or 98.6F

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31
Q

Nursing Interventions of Neutral Thermoregulation

A

Allow skin to skin between parents and newborn - body temp rises for baby
Warm and humidify oxygen to minimize evaporative heat loss and decrease oxygen consumption
Place baby in a double-walled incubator (Isolat); Use Plexiglas heat shield with a single-walled incubator; Use radiant warmer and pipe in humidity
Avoid placing infants on cold surfaces. Use warmers during procedures; Pre-warm mattresses; warm hands and stethoscopes

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32
Q

Warm and humidifying Oxygen is used on preterm babies because

A

minimize evaporative heat loss and decrease oxygen consumption

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33
Q

Renal Alterations for Preterm Babies

A

limited in their ability to concentrate urine or to excrete excess amounts of fluid
affects ability to excrete drugs

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34
Q

The drugs of preterm babies is on what side of the recommended ranges for medication nd why?

A

lower and titrate up to function lowered because the kidney function is still developing and can not concentrate the urine

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35
Q

The preterm baby should have a bowel mvmt when?

A

within 24 hours

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36
Q

You should have a wet diaper when?

A

after every feeding

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37
Q

At birth, glycogen is stored in what organ?

A

liver

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38
Q

The glycogen of the preterm baby is used ________ leading to

A

rapidly for energy
- high risk for hypoglycemia

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39
Q

Iron is stored in what organ?

A

liver

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40
Q

Iron is stored in the liver when? If premature?

A

3rd trimester
- premature has low iron stores because mom never transferred the iron

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41
Q

Babies have how many mL of blood per Kgof body weight

A

80 mL, ONLY NEED 1 mL of blood from them

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42
Q

The more blood out of the baby for test means

A

more blood they need to infuse because the baby can not start making their RBCs yet
- they do not have functioning kidneys to make erythropoietin

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43
Q

The liver in preterm babies affects what

A

iron
glycogen
bilirubin

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44
Q

The conjugation of bilirubin in a preterm baby is treated by

A

radiation lights sooner
Due to liver impairment

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45
Q

Immune system of Preterm babies

A

IgG is acquired in the last trimester so babies have only a few antibodies at birth

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46
Q

IgA is found in _______ BUT

A

breast milk and because of preterm infants inability to feed-
they do not get sufficient IgA

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47
Q

What places the baby at great risk for nosocomial infections?

A

skin is easily excoriated
with multiple invasive procedures

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48
Q

Prevention of Infection in Preterm Babies

A

minimizing preterm’s exposure to pathogenic organisms
Strict hand washing
no jewelry
Use separate equipment for each infant (same with twins)
Standard Precautions recommended by CDC of isolating every baby
Short-trimmed nails and no artificial nails
2 to 3 min scrub using antimicrobial solutions

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49
Q

TPN for Preterm Babies used for when feeding is

A

contraindicated through the GI Tract

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50
Q

In TPN, what is separated from other liquids?

A

lipids

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51
Q

TPN provides

A

complete nutrition for metabolic requirements and growth to the infant intravenously

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52
Q

Gavage feeding

A

lack or have a poorly coordinated suck-swallow-breathing pattern, are ill or ventilator-dependent
- with nipple
3-4 hours (slowly or continuous
- minimal enteral nutrition for gavage

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53
Q

PICC and PCVC are used with

A

low birth weight babies to deliver higher concentrations of glucose
carefully monitor

54
Q

How to prevent fatigue during feedings?

A

passive methods (pacifiers)
- Never feed if under stress
- only to 30 minutes (if over 30 minutes then gavage
conserve energy and calories
replaced with nipple

55
Q

Signs of readiness for nipple feedings

A

Strong gag reflex
Presence of non-nutritive sucking
Rooting behavior: looking for food

56
Q

Bottle Feedings for Premature

A

Need suck-swallow breathing coordination
Readiness to feed behaviors include:
- remain engaged in feeding,
- Able to organize oral-motor function,
- can maintain physiologic stability
Infant fed in semi-sitting position and burped after each 15ml
Feeding should take no longer than 15 to 30 minutes
Start with one session a day and increase slowly

57
Q

Breastfeeding in Premature

A

Should be put to the breast as soon as there is a coordinated suck-swallow-breathe coordination, consistent weight gain, and control of body temperature without a heat source
Preterm infants tolerate breastfeeding with better transcutaneous oxygen pressures and body temperature maintenance than with bottle feeding
flexible feeding schedule
Mothers can pump and milk be given by gavage

58
Q

Before breastfeeding, you should do what

A

try bottle feeding to see what they do

59
Q

How do you do strict I&Os for breastfeeding?

A

TIME (minutes)

60
Q

You should breastfeed for how long until the bottle at the end for satisfaction guaranteed

A

20-30 minutes

61
Q

Parent-Infant Attachment interventions

A

positive parental feelings toward infant
Involve parents early in care and decisions
- and siblings if not infectious season
skin to skin
point out the infant’s patterns of behavior and unique characteristics and responses
infant’s sleep/wake states and optimal times for interacting with infants
- cluster all feedings around eating
** Teach caregiving skills** and assist in understanding premature infant behavioral characteristics
daily participation regardless of the hour and difficult decisions
parents bonding time
skin to skin (kangaroo)
rooming-in

62
Q

Developmentally Supportive Care

A

Family-centered care improves the outcomes of critically ill
- containment when moving like suctioning
- gentle touches
- not postural
- self-consoling “nesting”
- swaddle in flexed extremities and hands can meet the face
- soft or fleece-like blankets and gel beds
- silence alarms, lower voice, an islet with darkness, cluster care
- non-nutritive sucking (pacifiers)
- grasp objects

63
Q

Signs of Stress or Fatigue in Neonates

A

hr drop
stop breathing
instability
fluctuating tone
lack of control over mvmt
disorganized
closed eyes and sleeplike withdrawal (opossum)

64
Q

Thermoregulation aka

A

Cold stress

65
Q

Cold stress occurs when what happens and leads to this chain of events

A

low environ. temp
low body temp
high HR and RR
High O2 consumption
low glucose
low surfactant (coating of lungs)
respiratory distress
lead to needed glucose and O2

66
Q

Risk Factors of Cold Stress

A
  • premature
  • decrease sub Q fat
  • hypoglycemic (no fuel)
  • small for gestational age (lower 10th percentile)
67
Q

S/S of Cold Stress

A
  • low temp (below 36.5 C)
  • Cold to touch
  • Lethargic
  • Pale
  • Weak sucking
  • increase respiration
  • grunting
  • Nasal flares
  • Flaccid tone
68
Q

Nursing Actions to decrease risk for cold stress

A

Dry after birth, increase room temp., skin-to-skin contact, stocking cap, socks, warm clothing, warm equipment, and hands

69
Q

Actions when neonate displays signs of cold stress

A

Same as decreasing risking
Radiate warmer (only in the nude with a diaper)
- Monitor with temp robe
- Check every 30 minutes

69
Q

Care of the Post mature Newborn

A
69
Q

Post mature Newborn

A

born after 42 weeks
4-14% of pregnancies
result of inaccurate estimated date of birth (EDB)
normal sie and health over 4 kg
greek, Italy, australia

70
Q

Complications of Post-mature Infant

A

Postmaturity syndrome
- low placenta function

71
Q

low placenta function in post-mature syndrome leads to

A

hypoglycemia
hypoxemia

72
Q

Physical Characteristics of Post-mature Syndrome

A

Dry, cracking, parchment-like skin. Long fingernails, absence of lanugo
Appears long and thin, fat layers are non-existent, frequently meconium stained
dry = no vernix

73
Q

What type of staining can occur in utero when post-mature babies and what can it lead to

A

Meconium staining - stressed poop too soon
- leads to respiratory issues

74
Q

Interventions for postmaturity Syndrome

A

similar to cold stress
- tx hypoglycemia
- thermoregulation
- O2 for respiratory illness

75
Q

Jaundice in Baby’s patho

A

RBCs die off in large #s after birth (because of Rh factor is different from mom’s)
Bilirubin is created
Liver not mature processes it slowly
very little bilirubin leaves the body
excess of unprocessed bilirubin to build up

76
Q

If the baby is jaundice in 1st 24 hour, what is occurring?

A

Hemolytic Hyperbilirubinemia

77
Q

Hyperbilirubinemia within the first 24 hours is most often the result of

A

Hemolytic disease of the newborn.

78
Q

What needs to be checked if the baby has jaundice within 24 hours?

A

Type and Cross for
ABO incompatibility
Rh incompatibility

79
Q

ABO example for incompatibility

A

Mother has blood type O and a newborn with A or B blood

80
Q

Rh Factor incompatibility

A

Develops when an Rh negative conceives a Rh Positive infant

81
Q

What happens to the mom when she delivers a baby with a different Rh factor?

A

shot of Rh factor to prevent rejection of another baby

82
Q

Physiologic Jaundice

A

Not associated with any pathologic process
Immature hepatic function
Increased bilirubin load due to RBC hemolysis
Onset after 24 hours typically peaks around 3 – 4 days

83
Q

Physiology Jaundice Tx

A

under lights
feedings increased
- poop out

84
Q

Hyperbilirubinemia Dx eval

A

yellow eyes to toes
Transcutaneous bilirubin
- put on head 3 times
If abonormal, then lab vlaues

85
Q

Hyperbilirubinemia Tx

A

Bili lights off during blood draws when doing care
IV IgG
Baby needs eye protection on
Expose different parts of the body so change positioning

86
Q

If they have birth trauma could affect the breakdown and influence of

A

hyperbilirubinemia

87
Q

Prognosis of hyperbilirubinemia

A

good if early, if not could lead to the yellowing of the brain

88
Q

Neonatal Sepsis

A

-Prenatally acquired (mom to placenta to baby)
-During labor (prolonged rupture membranes)
- GROUP B STREPTOCOCCUS Normal flora can lead to sepsis if ingested by the baby

89
Q

If mom is showing digns of infection, then concern

A

sepsis for baby

90
Q

Early sepsis (1-3 days of age)

A

Prenatally
labor
Strept

91
Q

Late sepsis (1-3 weeks)

A

nosocomial staph and e. coli

92
Q

Sepsis s/s

A

early on subtle clinical signs to
Increased episodes of apnea and bradycardia
Color changes (greenish gray)
Temperature instability (hypothermic)
Feeding intolerance; vomiting, diarrhea, abdominal distention (bloated)
The nurse should immediately inform clinician of changes and implement the ordered treatment plan

93
Q

When a nurse notices sepsis on a neonate

A

The nurse should immediately inform clinician of changes and implement the ordered treatment plan

94
Q

Dx eval of Infections

A

Cultures of blood, urine, cerebrospinal fluid
Complete blood count, hemoglobin, hematocrit
C reactive protein - inflammatory response

95
Q

What test is run for inflammatory response and to show a late sign of sepsis?

A

C reactive protein

96
Q

The nurse on a Neonate gets how many sticks on a patient

A

1

97
Q

Tx of Neonate Sepsis

A

Vigorous antibiotic therapy (broad spectrum) 7-10 days
Supportive therapy (O2, transfusions)
NPO need TPN and fluids
Prognosis is variable (longer the wait the poor the outcome)

98
Q

After the 3rd day of antibiotics with no symptoms and negative for infection, then

A

stop antibiotics

99
Q

Prognosis of Sepsis for Neonates

A

Prognosis is variable (longer the wait the poor the outcome)

100
Q

Infant Care of a Diabetic Mother

A

considered at high risk and require close observation the first few hours - first few days of life
severe diabetes or diabetes of long duration associated with renal, retinal, cardiac, or vascular disease may give birth to an SGA infant
Typical IDM, when diabetes is poorly controlled or gestational is LGA

101
Q

IDM Charcteristics

A

Macrosomia (big), ruddy (Red)
Has excess adipose tissue
Umbilical cord thick, placenta large
Decreased total body water, particularly in extracellular spaces
Excessive weight due to increased weight of visceral organs, cardiomegaly (hypertrophy) and increased body fat

102
Q

What is not affected by IDM?

A

brain

103
Q

IDM babies progress to hypoglycemia why?

A

The baby is exposed to sugars and learn to produce insulin to regulate blood sugar
The cord is cut but the baby still produces insulin with no sugar from the mom

104
Q

With IDM babies need what intervention

A

early and frequent feedings

105
Q

Complications of IDM

A

Hypoglycemia
Hypocalcemia – DM mom don’t have calcium (might have tremors)
Hyperbilirubinemia - BIG
Birth Trauma
Polycythemia – extra insulin production effects O2 consumption
Respiratory Distress Syndrome – deactive cerfactant production
Congenital Malformations – cardiac and renal defects

106
Q

Nursing Mgmt of IDM

A

Early detection and ongoing monitoring for hypoglycemia, polycythemia, respiratory distress, and hyperbilirubinemia
- glucose hourly after feedings q4
if not maintained, IV glucose (D10W)
assess for birth trauma and congenital anomalies

107
Q

Babies are not born addicted to substances they are

A

dependent
- will kill if an abrupt stop gives Methadone

108
Q

neonatal abstinence syndrome:

A

physiologic dependence that we must
help them through
- COMBINATION GASTROINTESTINAL, PHYSIOLOGY AND NEUROLOGICAL S/S
chart decision of the court or CPS

109
Q

Substance Abuse Exposure Tx

A

Methadone

110
Q

Substance Abuse Exposure drug testing for accuracy

A

SAMPLE meconium and blood screen the cord
Hair and urine sample

111
Q

Assessment findings of Neonatal abstinence syndrome

A

Signs of neonatal withdrawal
Fetal alcohol syndrome (FAS)
Alcohol-related birth defects (ARBD)
Alcohol-related neurodevelopmental disorders (ARND)

112
Q

Neurological withdrawal s/s of neonates

A

Irritability
Seizures
Hyperactivity
High – pitched cry
Tremors
Exaggerated Moro reflex
Hypertonicity of muscles

113
Q

GIl withdrawal s/s of neonates

A

Poor Feeding
Diarrhea
Dehydration
Vomiting
Frantic, uncoordinated suck
Gastric Residuals

114
Q

autonomic withdrawal s/s of neonates

A

Diaphoresis
Fever
Mottled Skin
Nasal Stuffiness

115
Q

Misc withdrawal s/s of neonates

A

Disrupted sleep patterns
Diaphoresis
Tachypnea (>60)
Excoriations
Temperature instability

116
Q

The more s/s of withdrawal the

A

more likely they are

117
Q

What is the best way to help the withdrawal babies?

A

prevention

118
Q

What should a nurse make sure to prevent from doing to the family?

A

not be judgemental and compassionate with resources

119
Q

What drugs are they using for NAS?

A

Methadone
Versed
Morphine
minimal stim room and want love and affection
hold when awake

120
Q

Failure to Thrive r/o

A

neglect

121
Q

FTT result of

A

Physical
- calories need more
- cystitic fibrosis
- cardiac
Psychosocial Issues
- means for formulas
Poverty
- home care
Health Beliefs
- older child fasting
-fasting
-eating behaviors
Family Stress
- The older they get
Feeding Issues
- assess how they are and watch them mix

122
Q

FTT is what percentile

A

5th

123
Q

FTT pattern

A

Pattern Of Consistent Deviation In Growth Pattern
- FTT Usually The Result Of Mixed Causes

124
Q

INadequate Calorie Intake

A

Incorrect Formula Prep, Neglect, Fad Foods, Poverty, Behavioral Problems Affecting Eating, CNS Issues

125
Q

Inadequate Absorption

A

Cystic Fibrosis, Celiac Disease, Biliary Atresia

126
Q

Increased Metabolism

A

Hyperthyroidism, Congenital Heart Defects

127
Q

FTT Assessment

A

History (Especially Diet History) Daily Schedule
Parent Height
Physical full assess
Assessment Of Mealtime Rituals, Behaviors (no distractions)
Parent-child interaction or concerns
R/O Lead Toxicity, Anemia, Ova & Parasites, Etc.

128
Q

Nursing Mgmt for FTT

A

Provide A Positive Feeding Environment
Document the Child’s Feeding Behavior And The Patient-Child Interaction During Feeding
Provide Primary Core for nurses
Avoid Distractions
Introduce New Foods Slowly

Module 5 (Pediatrics) (27 decks)

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