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
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
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
4
Q
Why do young and unplanned pregnancies cause risk for prematurity?
A
no prenatal care
hide or don’t know about it
5
Q
Very premature
A
Neonates born at less than 32 weeks’ gestation
6
Q
Premature
A
Neonates born between 32 and 34 weeks’ gestation
7
Q
Late Premature
A
Neonates born between 34 and 37 weeks
-naughtiest and immediate to nicu
8
Q
Normal Premature Assessment Findings
color
A
Usually pink or ruddy (support O2 at delivery - closing shunts)
maybe acrocyanotic (if no O2 supplemental)
9
Q
Normal Premature Assessment Findings
skin
A
Reddened, translucent, blood vessels apparent; lack of sub-Q fat
10
Q
Normal Premature Assessment Findings
lanugo
A
plentiful, widely distributed
- protect in amniotic
11
Q
Normal Premature Assessment Findings
head size
A
large in relation to the body
12
Q
Normal Premature Assessment Findings
skull
A
bones pliable
fontanels smooth and flat, sutures approximated or overriding
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
14
Q
Normal Premature Assessment Findings
nails
A
Soft; short
- push in not enough Ca deposits
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
16
Q
Normal Premature Assessment Findings
posture
A
Flaccid (not flexed), froglike position
- lack of neurodevelopment
- need developmental aids
17
Q
Normal Premature Assessment Findings
cry
A
weak, feeble
- depends on baby personality
18
Q
Normal Premature Assessment Findings
reflexes
A
Poor suck, swallow, and gag
– affects eating (develops around 34 weeks they can eat)
19
Q
The gag and swallow reflex develops around
A
34 weeks gestation then the neuro system develops
20
Q
Normal Premature Assessment Findings
activity
A
Jerky, generalized movements
spastic
21
Q
Determining gestational age in preterm newborns requires
A
knowledge and experience in administering gestational assessment tools
**Ballard Scale
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
23
Q
If the premature high-risk infant is extremely sick, then what can be used to get their BP?
A
arterial line
24
Q
What is the magic number for weaning a baby off of external warmth?
A
1800 grams
25
If the premature baby is under 34 weeks gestation, then how do you feed the baby?
gavage
- older they get to advance to nipple and breast
26
Do you bathe a baby straight away? why?
No, too weak for thermal regulation and skin tearing
27
5 Factors decreasing Thermoregulation in preterm infants
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
28
How do you maintain thermoregulation in a preterm baby?
reassess if still safe for a thermoneutral environment
temp every feeding time
29
maintenance of a Neutral Thermal Environment for minimizing
**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
30
What should the baby's temperature be for a preterm infant?
37C or 98.6F
31
Nursing Interventions of Neutral Thermoregulation
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**
32
Warm and humidifying Oxygen is used on preterm babies because
minimize evaporative heat loss and decrease oxygen consumption
33
Renal Alterations for Preterm Babies
limited in their ability to concentrate urine or to excrete excess amounts of fluid
affects ability to excrete drugs
34
The drugs of preterm babies is on what side of the recommended ranges for medication nd why?
**lower** and titrate up to function lowered because the **kidney function is still developing and can not concentrate the urine**
35
The preterm baby should have a bowel mvmt when?
within 24 hours
36
You should have a wet diaper when?
after every feeding
37
At birth, glycogen is stored in what organ?
liver
38
The glycogen of the preterm baby is used ________ leading to
rapidly for energy
- high risk for hypoglycemia
39
Iron is stored in what organ?
liver
40
Iron is stored in the liver when? If premature?
3rd trimester
- premature has low iron stores because mom never transferred the iron
41
Babies have how many mL of blood per Kgof body weight
80 mL, ONLY NEED 1 mL of blood from them
42
The more blood out of the baby for test means
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
43
The liver in preterm babies affects what
iron
glycogen
bilirubin
44
The conjugation of bilirubin in a preterm baby is treated by
radiation lights sooner
Due to liver impairment
45
Immune system of Preterm babies
**IgG is acquired in the last trimester** so babies have only a **few antibodies at birth**
46
IgA is found in _______ BUT
breast milk and because of preterm infants **inability to feed**-
they do not get sufficient IgA
47
What places the baby at great risk for nosocomial infections?
skin is easily excoriated
with multiple invasive procedures
48
Prevention of Infection in Preterm Babies
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**
49
TPN for Preterm Babies used for when feeding is
contraindicated through the GI Tract
50
In TPN, what is separated from other liquids?
lipids
51
TPN provides
complete nutrition for metabolic requirements and growth to the infant intravenously
52
Gavage feeding
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
53
PICC and PCVC are used with
low birth weight babies to deliver higher concentrations of glucose
**carefully monitor**
54
How to prevent fatigue during feedings?
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
Signs of readiness for nipple feedings
Strong gag reflex
Presence of non-nutritive sucking
Rooting behavior: looking for food
56
Bottle Feedings for Premature
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
Breastfeeding in Premature
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
Before breastfeeding, you should do what
try bottle feeding to see what they do
59
How do you do strict I&Os for breastfeeding?
TIME (minutes)
60
You should breastfeed for how long until the bottle at the end for satisfaction guaranteed
20-30 minutes
61
Parent-Infant Attachment interventions
**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
Developmentally Supportive Care
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
Signs of Stress or Fatigue in Neonates
hr drop
stop breathing
instability
fluctuating tone
lack of control over mvmt
disorganized
closed eyes and sleeplike withdrawal (opossum)
64
Thermoregulation aka
Cold stress
65
Cold stress occurs when what happens and leads to this chain of events
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
Risk Factors of Cold Stress
- premature
- decrease sub Q fat
- hypoglycemic (no fuel)
- small for gestational age (lower 10th percentile)
67
S/S of Cold Stress
- low temp (below 36.5 C)
- Cold to touch
- Lethargic
- Pale
- Weak sucking
- increase respiration
- grunting
- Nasal flares
- Flaccid tone
68
Nursing Actions to decrease risk for cold stress
Dry after birth, increase room temp., skin-to-skin contact, stocking cap, socks, warm clothing, warm equipment, and hands
69
Actions when neonate displays signs of cold stress
Same as decreasing risking
**Radiate warmer** (only in the nude with a diaper)
- Monitor with temp robe
- Check **every 30 minutes**
69
Care of the Post mature Newborn
69
Post mature Newborn
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
Complications of Post-mature Infant
Postmaturity syndrome
- low placenta function
71
low placenta function in post-mature syndrome leads to
hypoglycemia
hypoxemia
72
Physical Characteristics of Post-mature Syndrome
**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
What type of staining can occur in utero when post-mature babies and what can it lead to
Meconium staining - stressed poop too soon
- leads to respiratory issues
74
Interventions for postmaturity Syndrome
similar to cold stress
- tx hypoglycemia
- thermoregulation
- **O2 for respiratory illness**
75
Jaundice in Baby's patho
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
If the baby is jaundice in 1st 24 hour, what is occurring?
Hemolytic Hyperbilirubinemia
77
Hyperbilirubinemia within the first 24 hours is most often the result of
Hemolytic disease of the newborn.
78
What needs to be checked if the baby has jaundice within 24 hours?
Type and Cross for
ABO incompatibility
Rh incompatibility
79
ABO example for incompatibility
Mother has blood type O and a newborn with A or B blood
80
Rh Factor incompatibility
Develops when an Rh negative conceives a Rh Positive infant
81
What happens to the mom when she delivers a baby with a different Rh factor?
shot of Rh factor to prevent rejection of another baby
82
Physiologic Jaundice
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
Physiology Jaundice Tx
under lights
feedings increased
- poop out
84
Hyperbilirubinemia Dx eval
yellow eyes to toes
Transcutaneous bilirubin
- put on head 3 times
If abonormal, then lab vlaues
85
Hyperbilirubinemia Tx
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
If they have birth trauma could affect the breakdown and influence of
hyperbilirubinemia
87
Prognosis of hyperbilirubinemia
good if early, if not could lead to the yellowing of the brain
88
Neonatal Sepsis
-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
If mom is showing digns of infection, then concern
sepsis for baby
90
Early sepsis (1-3 days of age)
Prenatally
labor
Strept
91
Late sepsis (1-3 weeks)
nosocomial staph and e. coli
92
Sepsis s/s
**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
When a nurse notices sepsis on a neonate
The nurse should immediately inform clinician of changes and implement the ordered treatment plan
94
Dx eval of Infections
Cultures of blood, urine, cerebrospinal fluid
Complete blood count, hemoglobin, hematocrit
C reactive protein - inflammatory response
95
What test is run for inflammatory response and to show a late sign of sepsis?
C reactive protein
96
The nurse on a Neonate gets how many sticks on a patient
1
97
Tx of Neonate Sepsis
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
After the 3rd day of antibiotics with no symptoms and negative for infection, then
stop antibiotics
99
Prognosis of Sepsis for Neonates
Prognosis is variable (longer the wait the poor the outcome)
100
Infant Care of a Diabetic Mother
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
IDM Charcteristics
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
What is not affected by IDM?
brain
103
IDM babies progress to hypoglycemia why?
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
With IDM babies need what intervention
early and frequent feedings
105
Complications of IDM
**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
Nursing Mgmt of IDM
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
Babies are not born addicted to substances they are
dependent
- will kill if an abrupt stop gives **Methadone**
108
neonatal abstinence syndrome:
physiologic dependence that we must
help them through
- COMBINATION GASTROINTESTINAL, PHYSIOLOGY AND NEUROLOGICAL S/S
chart decision of the court or CPS
109
Substance Abuse Exposure Tx
Methadone
110
Substance Abuse Exposure drug testing for accuracy
SAMPLE meconium and blood screen the cord
Hair and urine sample
111
Assessment findings of Neonatal abstinence syndrome
Signs of neonatal withdrawal
Fetal alcohol syndrome (FAS)
Alcohol-related birth defects (ARBD)
Alcohol-related neurodevelopmental disorders (ARND)
112
Neurological withdrawal s/s of neonates
Irritability
Seizures
Hyperactivity
High – pitched cry
Tremors
Exaggerated Moro reflex
Hypertonicity of muscles
113
GIl withdrawal s/s of neonates
Poor Feeding
Diarrhea
Dehydration
Vomiting
Frantic, uncoordinated suck
Gastric Residuals
114
autonomic withdrawal s/s of neonates
Diaphoresis
Fever
Mottled Skin
Nasal Stuffiness
115
Misc withdrawal s/s of neonates
Disrupted sleep patterns
Diaphoresis
Tachypnea (>60)
Excoriations
Temperature instability
116
The more s/s of withdrawal the
more likely they are
117
What is the best way to help the withdrawal babies?
prevention
118
What should a nurse make sure to prevent from doing to the family?
not be judgemental and compassionate with resources
119
What drugs are they using for NAS?
Methadone
Versed
Morphine
minimal stim room and want love and affection
hold when awake
120
Failure to Thrive r/o
neglect
121
FTT result of
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
FTT is what percentile
5th
123
FTT pattern
Pattern Of Consistent Deviation In Growth Pattern
- FTT Usually The Result Of **Mixed** Causes
124
INadequate Calorie Intake
Incorrect Formula Prep, Neglect, Fad Foods, Poverty, Behavioral Problems Affecting Eating, CNS Issues
125
Inadequate Absorption
Cystic Fibrosis, Celiac Disease, Biliary Atresia
126
Increased Metabolism
Hyperthyroidism, Congenital Heart Defects
127
FTT Assessment
**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
Nursing Mgmt for FTT
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**
