Exam 2 (5-8) Flashcards
1
Q
Risk Factors in Pregnancy
A
- age
- parity
- lifestyle
- low income
- existing health conditions
- genetics
- environment
2
Q
Age and Pregnancy Risk Factors
A
- being too young or old
- young: high BP, anemia, go into labor earlier, STI’s, decreased prenatal care
- old (over 35): higher risk for C-sections, delivery complications, prolonged labor, infants with genetic disorders
3
Q
Parity and Pregnancy Risk Factors
A
- 5 or more pregnancies
- risk for preterm labor
4
Q
Lifestyle and Pregnancy Risk Factors
A
- poor nutrition, vegetarian diet
- substance use: alcohol or drugs
5
Q
Low Income and Pregnancy Risk Factors
A
- no prenatal or inadequate care
- screen for drugs
6
Q
Existing Health Conditions and Pregnancy Risk Factors
A
- diabetes
- PCOS
- obesity
- zika
- autoimmune diseases: lupus, multiple sclerosis
- cardiac disease
- HIV/AIDS
7
Q
Genetics and Pregnancy Risk Factors
A
- defective -> chromosomal abnormalities could lead to spontaneous abortion
8
Q
Pregestational Pregnancies at Risk
A
- substance abuse
- diabetes
- anemia
- HIV/AIDS
- heart disease
9
Q
Gestational Onset Pregnancies at Risk
A
- hypertensive disorders
- spontaneous abortions
- ectopic pregnancies
- Rh alloimmunization
- herpes
- GBS+
- CMV (herpes)
- hyperemesis gravidarum
- gestational trophoblatic disease (multiple tumors)
10
Q
Substance Abuse During Pregnancy
A
- 30% of women
- rates higher in 1st and 2nd trimester
- universal screening for everyone
- may be associated with decreased fetal growth restriction, stillbirth, preterm birth, neurological development: hyperactivity, poor cognitive function
- increased use of medically assisted treatment
- most at risk: below poverty level, exposed to violence, DV, depression, less than high school education, unmarried, unemployed
- most common: smoking cannabis in white women
- frequently misdiagnosed
- autonomy vs nurse’s obligation
- fear of losing custody: decrease prenatal care
- prenatal use: withdrawl syndrome in newborn
11
Q
Heroin Treatment
A
behavioral therapy mized with pharmacological therapy (MAT) medical assisted therapy
* methadone
* buprenorphine
* naltrexone
12
Q
Methadone: Heroin Treatment
A
- most common
- during pregnancy, brings addicted woman into agencies that promote prenatal care
- help with withdrawl symptoms
13
Q
Buprenorphine: Heroin Treatment
A
- better treatment adherence with fewer side effects and overdoses in comparison to methadone
14
Q
Naltrexone: Heroin Treatment
A
- opioid antagonist, non-addictive, may improve compliance if an issue
- work through same opioid receptior, but safer
15
Q
Patho of Diabetes
A
diabetes: metabolic disease with hyperglycemia from insulin secretion defects
* makes blood more viscous and causes high BV, cellular dehydration, polyuria, and polydipsia (excessive thirst)
* starts to burn both proteins and fats = ketones and fatty acids which causes weight loss because of breakdown in tissue
* change in vascular circulation with organs
16
Q
Four Cardinal S/S of Diabetes
A
- Polyuria
- Polydypsia
- Weight Loss
- Polyphagia
17
Q
Polyuria in Diabetes
A
excrete large volumes of urine
* glucose hyperconcentrated = kidney loses ability to pull glucose from water
* osmotic pressure rises, H2O cannot be absorbed back into blood = urination
18
Q
Polydipsia in Diabetes
A
dehydration in cells, can be from polyuria
19
Q
Weight Loss in Diabetes
A
breakdown of fats and muscles to make ketones and fatty acids
20
Q
Polyphagia in Diabetes
A
tissue breakdown = starvation
person may eat excessive amounts of food
21
Q
Classifications of Diabetes Mellitus
A
- Type 1 DM: absolute insulin deficiency
- Type 2DM: insulin resistance
- Gestational Diabetes: any degree of glucose intolerance
22
Q
White’s Classification of Diabetes
A
in pregnancy
based on age of diabetes, duration of illness, presence of any organ involved
* eyes and kidneys
* classes A-C: positive pregnancy outcome if glucose controlled
* classes D-T: poor outcome, vascular damage
23
Q
Influence of Pregnancy of Diabetes on Physiological Changes in 1st Tri.
A
alter insulin requirements
* insulin decreases because increased estrogen and progesterone stimulates pancreas to make more insulin
* this increases peripheral use of glucose
* hypoglycemia with N/V
24
Q
Influence of Pregnancy of Diabetes on Physiological Changes in 2nd and 3rd Tri.
A
maternal metabolism directed toward supplying adequate nutrition for fetus
* placental hormones: cause insulin resistance
* promote more blood glucose to transfer through placenta
* fetus produces nore glucose when it gets glucose
25
Influence of Pregnancy of Diabetes on Hormones
* hPL
* somatotropin (growth hormone)
* promotes more insulin on bloodstream
* do not produce sufficient amount of insulin to maintain glucose homeostasis
26
Other Influences of Pregnancy in Diabetes
* accelerates progress of vascular disease
* more difficult to control in pregnancy
* fetus will get bigger since insulin turns into fat
27
Maternal Risks with Diabetes
* poor glycemic control = miscarriage and big baby (over 4000g)
* risk for C-section
* hydramnios: fetal urination, uterine dysfunction, infection
* hyperglycemia and ketoacidosis
* high risk for infections
* worsening retinopathy
28
Fetal Neonatal Risks with Diabetes
produce insulin around 14 wks = growth hormone
* macrosomia: could have birth injury delivering vaginally
* congenital abnormalities
* IUGR: interuterine growth retardation = decreased profusion to placenta with decreased vascularity
* respiratory distress syndrome: inhibit enzymes necessary for surfactant production
29
Clinical Therapy for Diabetes
* early detection and diagnosis
* assess risk at 1st visit
* if low risk: screen at 24-28wks
* if high: screen asap
30
Diabetes Levels
>128 mg/dL fasting glucose
>200 mg/dL random glucose
>6.5% ha1c
31
Increased Risk for Diabetes
* over 40
* family history
* obesity
* PCOS
* hypertension
* glucosuria
* prior macrosomic, malformed, stillborn
32
Screening for Gestational Diabetes
at 24-28wks
1hr 50g glucose tolerance test
33
Screening for Diabetes: Negative
lower than 140
routine care
34
Screening for Diabetes: Positive
over 140
3hr 100g GTT test
fasting 95
1hr: 180
2hr: 155
3hr: 140
if 2 values exceed these: positive
negaive = 1 value greater
35
Hemoglobin A1C Control
normal: 4-5.9%
hemoglobin will stick to RBC
* levels between 5-6 = fetal malformation rates comparable to those observed in normal pregnancy (2-3%)
* goal for HA1C = 3 months prior to conception
* HA1C concentration = fetal anomaly rate 20-25%
36
Pregnancy Complications
* Rh factor
* ABO incompatability
* ectopic pregnancy
* HSV
* GBS+
* preeclampsia/eclampsia
* gestational trophoblastic disease
37
Rh Alloimmunization
Rh = inherted protein on surface of RBC (+)
no protein (-)
38
Rh - Mother
Rh + baby
antibody-antigen response
sensitized mother
39
No Treatment to Sensitized Mother
* jaundice
* anemia
* brain damage
* heart failure
* death
40
Maternal Alloimmunization
when woman's immunse system is sensitized to foreighn erythrocyte surface antigen
stimulates the production of IgG antibodies
41
Sensitized Woman
small amounts of fetal blood cross the placenta
maternal IgM antibodies are produced and RhoGam will not help since she is sensitized
42
2nd Pregnancy and Sensitized Woman
Rh+ child - IgG antibodies produced and cross placenta
risk for hemolysis of fetal RBC
43
Indirect Coomb's Test
identifies antigen that could cause problems in newborns or mother
possible need for transfusion
positive test = antibodies present, no RhoGam
negative test = no antibodies present
44
Amniocentesis and Rh Compatability
using amniocentesis to test if fetus is Rh + or -
45
Ultrasound and Hemolytic Anemia
faster blood flowing through ultrasound
46
Other Interventions for Rh Incompatability
* monitoring pregnancy
* intrauterine transfusions of newborn
* exchange transfusion of newborn: erythopoietin and iron
47
Goals of Rh Incompatability
* prevent sensitization
* treat isoimmune disease in newborn
48
RhoGam Shot
when mom is not sensitized with - titer of + fetus
300mcg Rh immune globulin (RhoGam) IM at 28 wks
repeat dose within 72 hrs with + newborn
also given if any mixing of blood occurs
49
ABO Incompatibility
common and mild type of hemolytic diseases in babies
mom type O and infant type A or B
50
Maternal Serum Antibodies Crossing the Placenta
* can cause hemolysis of fetal RBC
* mild anemia
* hyperbilirubinemia
* not treated antepartally
51
Perinatal Infections
* herpes simplex virus
* GBS
52
HSV
1:6 between ages 14-49 are infected
53
Fetal Neonatal Risks with HSV
* spontaneous abortion
* preterm labor
* intrauterine growth resistance
* neonatal infection
* varies with route of birth and presence of lesions
* c-section of outbreak during labor
54
Clinical Therapy of HSV
* antiviral after 36wks gestation
* acyclovir, famciclovir, valacyclovir
* can reduse the need for a c-section
55
GBS
* in lower gastrointestinal tracts, urogenital tracts
* fetal risk: unexpected intrapartum stillbirth
* clinical therapy guidelines
56
Hypertensive Disorders
* chronic hypertension
* chronic hypertension with superimposed preeclampsia
* preeclampsia/ecclampsia
* gestational hypertension
57
Preeclampsia Diagnosis
* BP of over 140/90 with proteinuria
58
Preeclampsia Diagnosis: Before 20 Weeks
* no stable proteinuria and chronic hypertension
* new or increased proteins and preeclampsia superimposed on chronic hypertension
59
Preeclampsia Diagnosis: After 20 Weeks
* proteinuria and preeclampsia
* no proteinuria and gestational hypertension
60
Patho of Preeclampsia
* affects 5-10% of women
* multiorgan disease
* spiral arteries of uterus do not increase in diameter to promote perfusion to placenta
* vascular remodeling does not happen and decrease in placental perfusion and hypoxia occur
* endothelial dysfunction and vasospasm
* imbalance of vasodialating hormones: prostacyclin and vasoconstricting hormones: thromboxane
61
Three Characteristics of Preeclampsia
1. vasospasm and decreased organ perfusion
2. intravascular coagulation
3. increased permeability and capilary leakage
62
Vasospasm and Decreased Organ Perfusion: Preeclampsia
* hypertension
* uteroplacental spasm - intrauterine growth restriction
* glomerular damage - oliguria (small amounts of urine)
* cortical brain spasms - CNS problems
* retinal arteriolar spasms - blurred vision
* hyperlipidema
* liver ischemia
63
Intrautuerine Coagulation: Preeclampsia
* hemolysis of RBC
* platelet adhesion - low platelet count and DIC (affects clotting)
* increased VIII antigen
64
Increased Permeability and Capilary Leakage: Preeclampsia
* decreased serum albumin levels and decreased intravascular volume as fluid with protein
* increase in blood viscosity
* proteinuria
* generalized edema
* pulmonary edema
65
Clinical Manifestations and Diagnosis
don't use mild
proteinuria is not an official criteria
BP over 140/90 on two occassions, 4hrs apart after 20wks
low platelets, renal insufficiency, impaired liver function
66
Risk Factors to Preeclampsia
* first pregnancy
* materal age below 19 and above 30
* african american or hispanic
* low socioeconomic status
* family history
* chronic hypertension
* diabetes
* lupus
* multigestation
* gestational trophoblastic disease
* fetal hydrops
67
Nursing Assessment: Worsening Preeclampsia
* increased edema
* scotomata (vision problems)
* blurred vision
* decreased urinary output
* epigastric pain
* vomiting
* bleeding gums
* persistent/severe headache
* neurological hyperactivity: deep tendon reflex, clonus (involuntary muscle contractions)
* pulmonary edema
* cyanosis
68
Eclampsia
* seizures or coma
* multifocal, focal, generalized
* nursing assessment suring seizure
* treatment: magnesium sulfate, antihypertensive agents
* fetal reaction to survive: should reconsider when mom stabilizes
69
Preeclampsia Treatment
* early detection
* treat symptoms
* early treatment: bedrest, regular diet, monitor BP, proteinuria
* hospitalization if more severe
* therapeutic goal: diastolic BP between 90-100
* meds: hydralazine, labetol, oral nifedipine, magnesium sulfate: CNS depressant, seizure prophylaxis, smooth muscle relaxant, safe for fetus
70
HELLP Syndrome
continuation of preeclampsia
H) hemolysis
E) elevated
L) liver enzymes
L) low P) platelet count
* associated with severe preeclampsia
* symptoms: N/V, malaise, epigastric pain
71
Postpartum and HELLP
* possibility of HELLP
* eclampsia for 48hrs
* increased cardiovascular issues in future
72
Preeclampsia Maternial Consequences
* with eclampsia: 20% maternal mortality rate
* risk of: abrupto placenta, retinal attachment, cardiac failure, cerebral hemorrhage/stroke
73
Preeclampsia Fetal Consequences
* fetal growth retardation
* fetal hypoxia
* fetal death
74
Ectopic Pregnancy
* pregnancy outside of uterine cavity (2% of all preg)
* 95% implant in the fallopian tubes
* normal cell growth and division
* pressure from growth causes symptoms
* will rupture if pressure is too great: maternal death in 1st trimester
75
Risk Factors to Ectopic Pregnancies
* history of STI's or PID
* previous tubal, pelvic, or abdominal surgery
* endometriosis
* IVF or other methods of assisted reproduction
* in utero: Diethylstilbestrol (DES) exposure with abnormalities of reproductive organs
* use of IUD
76
Management of Ectopic Pregnancies
* salpingostomy/salpingectomy (removal of conception product/tube)
* methotrexate
* monitor blood loss
* emotional support
77
Hydatiform Mole (Molar Pregnancy)
* abnormality of placenta from fertilization
* forms grape-like cysts that fill entire uterus instead of normal placental tissue
* vast proliferation of trophoblastic tissue associated with loss of preg and can lead to the development of cancer = choriocarcinoma
* 20% become malignant
78
2 Types of Molar Pregnancies
1. complete molar preg: ovum with no functioning or missing nucleus or empty egg with normal sperm
2. partial: some fetal tissue present with normal ovum but two sperm
79
Increase Incidence of Molar Preg
* women with low protein intake
* >35 years old
* Asian women
* experienced prior miscarriage
* undergone ovulation stimulaiton (clomid)
80
S/S of Molar Preg
* rapid vaginal growth
* vaginal bleeding
* N/V
* hypertension
* abnormally high hCG levels
* no fetal heartbear
* ultrasound: only cysts and no fetus
81
Management of Molar Preg
* D&C
* monitor for malignancy through serial hCG levels
* no preg for 1 year
* emotional support
82
Complications of Labor
1. bleeding disorders (PP and PA)
2. placenta previa
3. placental abruption
4. polyhydramnios
5. oligohydrammios
83
Placenta Previa
* implantation in lower uterine segment, over or near cervical os (the opening in the cervix at each end of the endocervical canal)
* may be multifactional uterine scarring predisposes to lower segment implantation
84
Risk Factors: Placenta Previa
* scarring from previos previa, prior C/S, abortion, multiparity
* large placenta, multigestation
* infertility, non-white, low SES, short interpregnancy interval
* impeded endometrial vascularistriction: >35 years old, diabetes, smoking, cocaine
* hemorrhage for mom
* prematurity, malpresentation, IUGR/fetal anemia for fetus
85
S/S of Placenta Previa
* painless, intermittent bleeding
* confirmed by ultrasound
* lower uterine segment not as responsive to oxytocin - use methergine
86
Nursing Assessment: Placenta Previa
* avoid vaginal exams
* monitor vitals and SpO2
* continuous EFM (electronic fetal monitoring)
* assess for preterm labor, non-stress test
* BPP (biophysical profile), amniocentesis for lung maturity studies
87
Active Bleeding in Placenta Previa
* large bore IV access
* meaure I and O
* weigh pads
* CBC, coagulation studies, T and X
* O2 at 95%
* anticipate possible c-section birth
88
Placental Abruption
* premature separation of a normally implanted placenta
* bleeding may be external or concealed
* severity depends on degree or separation
* types: partial or complete
89
Risk Factors of Placental Abruption
* hypertension
* seizures
* blunt trauma to maternal abdomen
* short umbilical cord
* previous history of abruption
* smoking or cocaine use
90
S/S of Placental Abruption
* sudden onset of intense, sharp abdoment pain
* uterine irritabilitym tachysystole, increased resting tone
* vaginal bleeding may or may not be present
* dark "port wine" stained amniotic fluid
* fetal heart rate patterns indicative of compromise
* maternal tachycardia
91
Management of Placental Abruption
* assess fundal height
* consider abdominal girth measurements
* assess for increased pain or tenderness
* assess for S/S of shick
* I and O
* weigh pads
* provide continuous EFM
* provide O2 to maintain above 95%
* anticipate and prepare for emergency delivery
* observe for DIC, administer blood products
92
Polyhydraminos
* excessive amniotic fluid, over 2000mL
* associated with fetal GI abnormalities and maternal diabetes
* treatment: shortness of breath and pain - amniocentesis
93
Oligohydramnios
* scanty amniotic fluid, less than 500mL
* etiology - unknown
* risks: detal adhesions and malformation
* treatment: amnioinfusion
94
Assessment Prenatally
* anticipate what may have compromised fetus in utero
* maternal and prenatal history: blood type, lab values, GBS/HIV/HepB, diabetes, preeclampsia, smoking/substance abuse, trauma and disorta wiht high glucose levels
95
Assessment Intrapartum
anticipate what will occur in labor
* analgesia/anesthesia, prolonged rupture of membranes, meconium stained amniotic fluid, nuchal cord, use of forceps/vacuun, evidence of fetal distress, precipitous birth
96
Timing/Frequency of Assessments
* 1st assessment right at 30sec
* about 85-90% do not need any assistance to life
* placed skin-to-skin
* ABC immediately at birth
* thermoregulation
* APGAR scoring
* physical exam of newborn
* considerations of newborn's classification
97
Timing of Newborn Assessment
* admission assessment: 2nd assessment
* physical exam
* general measurements
* gestational age assessment
* attachment
98
Ongoing Assessments
* process of adaptation to extrauterine life
* nutritional status: ability to feed
* behavioral state/organizational abilities
99
General Measurements
* weight: avg 2500-400g, 70-75% of body is water weight
* head circumference: avg 33-35cm, 2cm greater than chest circ
* chest circ: nipple line
* abdominal circ
* length: range of 18-22in (48-52cm)
100
Birth Weight and Gestational Age Classes
1. LGA (large)
2. AGA (appropriate)
3. SGA (small)
101
Gestational Assessment: New Ballard Scale
* neuromuscular activity
* physical maturity
* maturity rating table
102
Estimating GA
first 4hrs after birth
* can preduct at-risk infants and keep alert of problems
* Ballard Tool
103
Ballard Tool
* each finding given point value: -5 to +5
* maternal conditions may affect certain components: stress and diabetes
104
Physical Maturity Characteristics Assessment
* skin
* lanugo
* sole (plantar) creases
* areola and breast bud tissues
* ear/eye formation
* genitalia
105
Skin
7 sub-classifications from transparent skin to peeling
106
Lanugo
thin, soft hair usually arounf 24-25wks
107
Sole Creases
full term: deep sole creases down to and including heel as skin loses fluid and dries after birth
108
Ear Forming and Cartilage
more premature: not as thick of cartilage
109
Eyes
fused eyelids premature
see how tight or loose
110
Male Genitals
should have 5-10mL breast buds
term infant: fully descended testes and entire surface of scrotum is covered by rugae
111
Female Genitals
prominent clitoris, labia majora widely separated, labia minora protudes beyond labia majora
LM can be dark in some ethnic groups
112
Neuromuscularity in Newborn
* posture in supine position
* square window
* arm recoil
* popliteal angle
* scarf sign
* heel to ear
113
Preterm Resting Posture
supine, undisturbed, should be more flexed with increased tone but is more flaccid
114
Full Term Resting Posture
increased tone and more flexed
115
Square Window Sign
bending wrist
full term infant will be able to touch hand to wrist
116
Arm Recoil
* lying in supine: flex both elbows, hold for 5sec, extend arms at baby's side, and release
* angle of recoil to which forearm springs back into flexion is noted
* preterm will not have any arm recoil
117
Popliteal Angle
* bend knee and push foot towards head
* mature: little flex and cannot bend over 90 degrees
* preterm: straight leg and lots of flex
118
Scarf Sign
* extend infant arm across body
* mature: bend elbow, not very flexible
* preterm: straight arm, lots of flexibility
119
Scarf Sign
* extend infant arm across body
* mature: bend elbow, not very flexible
* preterm: straight arm, lots of flexibility
120
Heel to Ear
* extend foot to ear
* mature: unable to do this
* premature: touch foot to ear
121
General Appearance of Newborn
head large for body
tend to stay in flexed position, can hold head up
122
Pulse Rates
* 110-160
* sleep can go down to 70
* crying can go up to 180
* check apical pulse for 1min
123
Respiratory Rates
* 30-60 resp/min
* diaphragmatic but synchronus with abdominal movement
* count for 1 full minute
124
BP Rates
* 70/50 and 45/30 at birth
* 90/60 at day 10
125
Temperature
* normal range: 97.7-99.4
* axillary: 97.7-99
* skin 96.8-97.7
* rectal 97.8-99
126
Anterior Fontanelle
* diamond shaped
* closes in 18mo
* palpable with 2nd and 3rd finger
127
Posterior Fontanelle
* triangle shaped, no buldging
* closes 8-12 wks
* depression: dehydrated or decreased intracranial pressure
* bulging: increased intracranial pressure or trauma
128
Molding
baby in vertex positions for vaginal delivery
* pressure on head against cervix
* flat forehead and rises to point at posterior of skull "cone head"
129
Cephalohematoma
* collection of blood from broken blood vessels that build up under scalp
* does not cross suture line
130
Craniosynostasis
* premature fusion of cranial sutures
* results in growth restriction perpendicular to affected sutures and compensatory overgrowth in unrestricted regions
* will need surgery
131
Plagiocephaly
* rapidly growing head attempts to expand and meets type of resistance such as flat surface like crib
* helmets used to fix aesthetically
132
Eyes: Physical Assessment
* tearless crying: immature lacrimal ducts
* peripheral vision: like close up objects
* can fixate on near objects
* can perceive faces, shapes, colors
* blink in response to bright light
* pupillary reflex present
133
Ears: Physical Assessment
* soft and plaiable
* ready recoil
* pinna parallel with inner and outer canthus
134
Eye and Ear Variations
* low set ears: chromosomal abnormalities or renal problems
* abnormal malformations: absent pinna, abnormal folds
* edema in eyelids from delivery or subconjunctival hemorrhage
* transient strabismus: cross-eyed
135
Nose
* small and narrow
* must breath through nose
* may sneeze a lot
* assess for choanal atresia: abstract one nare at a time
* could have obstruction of posterior nasal passage
136
Mouth
* pink lips, small amounts of saliva
* intact pallate when placing finger on roof of mouth
* ankyloglossa (tongue tied) because short frenulum - hard to breastfeed
* flat phitrum - chromosomal abnormality
* epstein pearls: keratin containing cysts
137
Chest
* size, shape, symmetry, movement
* chest: cylindrical measuring around the nipple line
* breasts: engorged, whitish secretion (witch's milk)
* respirations: diaphragmatic, 30-60
* HR: heard at left nipple, may have murmur in 1st 24 hrs
138
Signs of Distress
* nasal flaring
* sucking in for air: intercostal, substernal
* expiratory grunting or sighing
* seesaw up and down
* tachypnea: greater than 60
* central cyanosis
139
Cardiac Variations
* low pitched murmur: blood moving through turbulent part of heart
* decreased strength or absence of femoral pulses: narrowing aorta can affect it
* CHD: O2 sat monitors
* BP assessment if lost lots of volume, pale, no femoral pulse
140
Abdomen
* cylindrical and soft, no distention
* bowel sounds present by 1hr after birth
* umbilical cord should be white and gelatinous: 2 arteries and 1 vein
* 1 artery can lead to renal problems
141
Extremities
* short, flexible, move symmetrically
* legs: equal in length and symmetrical creases
142
Musculoskeletal Variations
* xiphoid cartilage
* fractured clavicle: palpate each to see intactness
* no splinting, heals quickly
143
Variations in Extremities
* gross deformities
* extra digits or webbing
* clubfoot
* hip dislocation
144
Hip Assessment
baby in Frank Breech position
145
Barlow Test
* grasp and adduct infant thigh and apply gentle downward pressure
146
Ortolani Test
* finger over greater trochanter and lift thigh to bring femoral head from posterior position toward acetabulum
147
Female Genitalia Variations
* pseudomenstration vs uric acid crystals
* labia swollen and darker
* vaginal tags will resolve
148
Hypospadias
* meatus located on ventral surface of glands
* groove that extends from usual area of meatus internally
149
Epispadias
urethral meatus occurs on dorsal surface of penis, undescended testes
150
Cryptorchidism
* if testes cannot be pushed into scrotum manually
151
Phimosis
* uncircumsized
* foreskin unable to be retracted
152
Hydrocele
collection of fluid around testes and scrotum
153
Acrocyanosis
bluish discolorization from poor peripheral circulation
* basal motor instability and capilary stasis
* exposed to cold
154
Mottling
lacey pattern of dilated blood vessels under leg
* general circulation fluctuations
* can also be from apnea, sepsis, hydrothyroidism
155
Jaundice
yellowish skin and mucous membranes
head to toe direction
156
Erythema Toxicum
rash 24-48hrs long, normal finding
157
Facial Milia
raised white spots on sebaceous glands
158
Vernix Caeosa
whote substance protecting baby's skin and lubricated it
* reabsorbed and may peel
159
Forcept Marks
disappear after 1-2 days
160
Telangiectatic Nevi
stork bites
pink/red spots on eyelids, nose, and nape of neck
161
Nevus Flammeus
port-wine stain
capiliary angioma
162
Mongolian Spots
bluish/black, grey/blue
on dorsal area in different darkened skin races
fade gradually and can be mistaken for bruises
163
Moro Reflex
arms flare out and fingers form C shape
164
Stepping Reflex
able to "walk"
disappears at 2mo
165
Palmar Reflex
fingers will grasp your finger
166
Plantar Reflex
toes will wrap around your finger
167
Rooting Reflex
stroke cheek, will turn head towards
168
Babinski Reflex
stroke foot, foot and toes flare out
169
Trunk Incurvation
prone position, stroke vertebral column, move buttox in curving motion towards side being stroked
170
Protective Reflexes
blink, yawn (overstim), cough/gag, extrusion (tongue pushes out foreign object), sneeze
171
Sleep-Wake States
1. deep sleep
2. light sleep
3. drowsiness
4. quiet alert
5. active alert
6. crying
172
Behavioral Response
influenced by state of newborn, temperment, and self-regulation
173
Engagement Cues
behavior that signals ready to interact with caregiver
174
Disengagement Cues
reduction in stimulus
175
Dr. T. Berry Brazelton: Neonatal Behavioral Assessment
1. habituation
2. orienting response
3. motor organization
4. consolability
5. cuddliness
176
Habituation
ability of infant to lessen their response to repeated stimulus
177
Orienting Response
respond virtually and auditorally to both animate and inanimate objects
follow with eyes and head, react to voices that are high-pitched
178
Motor Organization
spontaneous body activity in response to internal stimulus (hunger, temp, noisy env)
move arms like a bike, jerky movements
179
Consolability
how well they can console themselves or be consoled by others
180
Cuddliness
how baby molds into contours of caregiver's body
181
Daily Newborn Care
1. thermoregulation: cold depletes O2 and glucose
2. feeding practices: feeding in 1st hr of life
3. skin/cord care: clean w water and mild soap
4. prevention of infection: around cord and eye to prevent opthalmia neonatorum
5. security: ankle bracelets
182
Opthalmic Ointment
erythromycin, single dose, 1/4 on lower conjunctival surface
183
Daily Assessments
1. vitals
2. weight: compare against birth weight, lose 7% if breastfed, 3.5% bottle
3. overall color
4. intake and output
5. umbilical cord
6. newborn feeding
7. attachment
184
Preparation for Discharge
* hep b vaccine
* metabolic screening / PKU
* hearing screening
* CHD screening
185
Parental Education
* how to pick up newborn
* holding and feeding infant
* changing diaper
* interpreting newborn cues
* bathing newborn
* cord and circumcisions
* newborn and hearing screening
* void and stool pattern
* safety: car seat and shaken baby
* sleeping positions: sids
186
Circumcision Care
* keeping area clean
* check for bleeding
* apply petroleum ointment
187
Signs of Illness
* temp above 100.4 or below 97.7
* forceful or frequent vomiting
* difference in awaking baby
* cyanosis with or without feeding
* increasing jaundice
* breathing differently, absense of breathing longer than 20 sec
* inconsolable infant / high-pitched cry
* discharge / bleeding from cord, circumcision, any opening
* no wet diapers for 18-24 hrs
* develop eye drainage
188
Care of Newborn at Delivery
85-90% do not need assistance
others: need NRP - neonatal resuscitation program
189
N) Neonatal
provide warmth, clear airway, dry, stimulate
rapid assessment: breathing, muscle tone, color
wet when born, put on mom with blankets, keep warm
190
R) Resuscitation
assess breathing
provide effective ventilations
191
P) Program
assess heart rate
provide effective ventilations or chest compressions
192
Targeted Pre-Ductal SpO2 After Birth
1. 1 minute: 60-65%
2. 2 min: 65-70%
3. 3 min: 70-75%
4. 4 min: 75-80%
5. 5 min: 80-85%
6. 10 min: 85-90%
193
Thermoregulation
balance of heat loss and heat protection
* hypothermia: common because of decrease subcutaneous fat, blood vessels close to surface of skin
194
4 Types of Heat Loss Mechanisms
1. evaporation
2. convection
3. conduction
4. radiation
195
Convection
air flowing by skin and carrying away body heat with it
* air currents
196
Radiation
transfer of heat between 2 objects that are not in contact with each other
* indirect source, cool window warm baby
197
Evaporation
moisture on body lost to the environment
* H2O/vapor, baby born wet and needs to be dried
198
Conduction
loss of hear from body surface to cool surface and in contact
* cold scale and warm baby
199
Neutral Thermal Environment
maintenance of thermal balance
* babies maintain this through non-shivering thermogenesis by using the metabolism of brown fat instead of shivering
200
Temperature Regulation
increased muscle activity, acrocyanosis, increased cellular metabilic activity, increased O2
* can create respiratory distress because temperature is dropping and less adipose tissue
* large body surface in relation to mass
201
Transition of Respiratory System into Extrauterine Life
* 6-12 hours after birth
* exchange of O2 and CO2
* maintenance of acid/base balance
* in utero: received O2 via placenta thru cord and 10% of CO is profusing
202
3 Needs of Respiratory System Once Born
1. air replacing fluid
2. onset of breathing
3. increasesd pulmonary blood flow
203
Inflation of Breathing Mechanisms
* systemic vascular resistance increases
* pulmonary vascular resistance decreases
* all increases profusion of lungs
204
Air Replaces Fluid: Absorption
rest of fluid absorbed by blood vessels in lymphatics
205
Initial Inflation of Lungs
mechanical stimulation in utero: breathing amniotic fluid to promote growth and differentiation of lungs
* first breath: decrease in secretion into pulmonary fluid and reabsorb
206
Surfactant and Alveolar Stability
surfactant needed
* 6th-7th month: cells develop lecithin so thin walls of alveoli do not collapse after each breath
* surface tension pulls on film of fluid in alveoli and lecithin is a surface acting agent that reduces surface tension of fluid by reducing muscular effor needed to draw air into lungs
* increases compliance
207
The First Breath
hardest thing for neonate to do
* requires pressure 10-15x that of later breaths
* inflating all alveoli
* 40% of air remains as residual because of surfactant
208
4 Initiations of Breathing
occur in respitory center in medulla
1. mechanical
2. sensory
3. thermal
4. chemical
209
Mechanical Initiation of Breathing
compression of fetal chest as it moves through birth canal
* chest recoild and creates negative intrathoracic pressure
* passive inspiration of air = replacement of fluid with air
210
Sensory Initiation of Breathing
tactile, visual, auditory
211
Thermal Initiation of Breathing
change in temperature signals respiratory system
212
Chemical Initiation of Breathing
* mild hypercapnia: increasing CO2 levels
* hypoxia: low O2 levels
* acidosis: low pH
* all stimulate respiratory system via peripheral chemoreceptors
* prostaglandins suppress respirations and drop with clamping cord
213
Increase in Pulmonary Blood
blood flow increases to lungs
* 10% of cardiac output perfuses pulmonary vasculature with replacement of fluid by air in lungs
* pressure shift: increased vascular resistance now decreases and leads to increased perfusion
* gas exchange can now occur at the level of capilaries
214
Characteristics of Newborn Respiration
* normal rate: 30-60 breaths/min
* shallow and diaphragmatic with brief pauses (5-15sec)
* apnea: over 20sec and may have skin or HR changes
* nose breathers since reflex to open mouth not there
* use of intercostal muscles, grunting, flaring indicates distress
215
Neonatal Circulatory System
1 cord vein: O2 and blood
2 cord arteries: deox blood
* systemic vascular resistance increases, pulmonary artery pressure decreases and when cord is clamped: placental circulation lost
* closure of fetal shunts: foramen ovale, ductus arteriosus, ductus venosus
216
Characteristics of Cardiac Function
right ventricle stronger in cardiac workload (2/3 of work)
* 4pt BP pressure different in arms and legs
217
APGAR Scores
assessed at 1 and 5 minutes, indicates extrauterine transition
* 7-10 = minimal no difference
* 4-6 = moderate difference
* 0-3 severe distress
218
APGAR: 0 Points
Activity: absent muscle tone
Pulse: absent
Grimace: flaccid reflexes
Appearance: blue, pale
Respiration: absent
219
APGAR: 1 Point
Activity: arms and legs flexed
Pulse: below 100 bpm
Grimace: some flex
Appearance: body pink, extremities blue
Respiration: slow and irregular
220
APGAR: 2 Points
Activity: active
Pulse: over 100 bpm
Grimace: active - sneezing, coughing, pulling away
Appearance: pink
Respiration: crying
221
Phase 1 Transition Phase
period of reactivity: 1-2 hrs
* bonding, head to toe assessments, breastfeeding, increased motor activity, minimal bowel sounds, saliva
222
Phase 2 Transition Phase
sleep period: 1-4 hrs
* deep sleep to stabilize HR and RR
223
Phase 3 Transition Phase
second period of reactivity: 2-8 hrs
* breastfeeding, lots of mucus, meconium
224
Nursing Care During Transition
* review of prenatal birth info
* initial rapid assessment
* newborns' adaptation to extrauterine life
* vital signs per protocol
* assessment of blood glucose if needed
* weight and measurement
225
Difficult Transitions: Maternal Conditions
* increased age
* diabetes
* hypertension
* substance use
* prior history of stillborn
* fetal demise
226
Difficult Transitions: Fetal Conditions
* prematurity/postmaturity
* congenital abnormailities of cardiac system
227
Difficult Transitions: Antepartum Conditions
* placental abnormalities (previa, poly/oligohydraminos)
* breech
* infections
* asphyxia in utero
* narcotics close to delivery time (decrease RR of fetus)
228
Difficult Transitions: Delivery Complications
* assistive devices
* C-section
229
Difficult Transitions: Neonatal Difficulties
* lack of respiratory effors: neurologically depressed, impaired muscle function
* mucus blockages
* respiratory distress from impaired cardiac/lung functioning
230
Blood Volume of Newborn
80-90mL/kg of body weight
* dependent on cord clamping, could be 100
231
Delaying Cord Clamping
enhances pulmonary profusion
* increases iron stores
* risk of jaundice due to high number of RBC and organ damage from the viscosity of blood
232
Erythropoietin Saturation in Fetus
increases due to 50% saturation of fetal blood
* decreases production after birth
* resumes response to low hemoglobin = jaundice
* RBC lifespan 33% less than adult
* leukocytosis = normal and increase in WBC
233
Gastrointestinal Adaptations
* stomach: size of marble
* 36-38 wks: adequate intestinal and pancreatic enzymes
* proteins require more digestion but absorn and digest fats less efficiently
234
Colostrum and the Stomach
correlate with the maturity of enzymes - amylase and lipase lacking of ar birth
* decreased fat, increased antibody and protein in colostrum
235
Swallowing
experience it in utero
* gastric emptying in utero: swallow vernix
236
Air and the Stomach
enters immediately after birth
* hits small intestine 2-12 hrs
* hear bowel sounds hr after birth
* meconium 8-24 hrs
237
Weight Loss
1st 3-4 days
* colostrum acts as a laxative
* 3.5% formula fed
* 7% breastfed
* regained by day 10
238
Urinary Adaptations
* at risk for fluid shifts because kidneys are immature
* glomerular filtration rate low
* limited capacity to concentate urine
* void in the 1st 24 hrs - uric acid crystals
239
Water and Newborns
cannot reabsorb water to maintain vital organ functioning
* risk for over and dehydration
240
Hepatic Adaptations
liver takes up 40% of abdominal cavity
iron storage, bilirubin conjucation, coagulation of blood
241
Iron Storage: Hepatic Adaptations
mom's iron intake lasts for 5-6 months
242
Glucose: Hepatic Adaptations
diffuses across the placenta, not insulin, fetus makes own
* cuts off at birth, rapidly utilize from stress of delivery
* goes to glycogen if depleted - liver needs to be able to do this
* no greater than 40 mg/dL
243
Jaundice
normal biological response
refers ot the increased yellow pigment in tissues from high levels of bilirubin
244
Bilirubin
product of fetal RBC destruction
* heme: iron
* globin: protein
245
Unconjucated Bilirubin
indirect bilirubin from the heme
* fat soluble and unable to be excreted
* crosses the placenta
246
Conjucated Bilirubin
direct bilirubin
247
Total Bilirubin
total of unconjugated and conjugated
* 2-3 mL/dL then 5-6mL/dL in 3-5 days
248
RBC in Newborn
hemolysis occurs as lungs oxygenate newborn
249
Hyperbilirubinemia: A Breakdown
* bili enzymatically converted in liver, water soluble bili excreted in the urine
* glucantranferase: responsible for urine/stool color
* enzyme is lacking since liver immature, this impairs liver's ability to conjugate bili and excrete it
* creates excessive amounts of bili in the blood, risk to cross the blood-brain barrier
250
Normal Intestinal Flora and Bili
reduces conjugated bili to urobilinogen
* excreted in the kidneys and stercobilinogen and excreted in the feces
* requires adequate calories and hydration
* delay in feeds causes reabsorption
251
Transcutaneous Bilirubin
* done prior to discharge
* non-invasive measurement using light to measure bili in blood
* if suspicious: draw blood
252
Bilirubin Levels
high-risk
high-intermediate
low-intermediate
low-risk
253
Why Newborns are Prone to Bili
* accerated destruction of RBC
* blood type or Rh incompatibility
* bruising from instruments, cephalohematoma
* decreased hepatic function
* decreased albumin levels
* drugs that interfere with conjugated bili: indomethacin, sulfa drugs, salicylates
* maternal enzymes in breastmilk inhibit conjugation
254
BF and Jaundice
* early onset, decreased intake of BM
* BF infants have more bili
* peaks 2-4 days
* associated with poor feeding
255
Meconium and Jaundice
leads to dehydration and delay in passing this
* mec has conjugated bili and if not passed in a timely manner, reabsorbs and transported to liver
* enterohepatic circulation
256
BM and Jaundice
* related to milk composition, rare
* late onset = 2-3 wks
* newborns are healthy
* treatment: monitor serum bili levels
* may stop BF for 12-24 hrs and if bili levels drop = BMJ
* genetic component
257
Passive Immunologic Adaptations: IgG
IgG crosses placenta
* 3rd trimester
* begin immunizations at 2 months because of low levels of antibodies and immature WBC
* more vulnerable infections
* Hep B: given at birth
258
Passive Immunologic Adaptations: IgA
in colostrum
* protects against GI and respiratory infections
259
Neurologic Functioning
* lots of neuro development in postpartum period
* time of high risk to intellectual development
* brain: one quarter size of adult brain
* myelination of nerve fibers incomplete
260
Nutrition Across Lifespan
* need lots of nutrients
* most vulnerable to poor nutrition during periods of rapid growth - unborn and 1st yr of life
261
Healthy People 2020
BF = unequalled way of providing ideal food for healthy growth and devlopment of infants
* 81.9% of mom's initiate BF in early postpartum period
* 25.5% exclusively BF at 6 months
* 34% continue at 1 year
* 25.4% of BF infants receive formula before 2 day and want to go down to 14.2%
* 2.9% birth in places with recommended BF care and want to go down to 8.1%
262
Breastfeeding and Other Foods
* 1 mil infants die because given food too early and not breast fed
* rooming in with unrestricted BF
* no food or drink than BM unless medically necessary
263
Contraindications to BF
1. HIV
2. Active Untreated TB
3. Human T-cell leukemia virus type 1
4. exposure to toxic chemicals
5. use of illegal drugs
6. children with metabolic disorders / allergies (galactosemia)
7. some meds given to mom = antimetabolites and therapeutic radiopharmaceuticalas
264
Growth in Neonatal Period
most rapid
* rate tapers off at 2nd half of 1st year
265
Birth Weight Trends
* doubles by 4-6 months and triples by one year
* 4-6 oz per week for first 5-6 months
* meet inital birth weight at day 10-14
266
Nutritional Requirements
calories: 100-120 calories
* proteins for cell growth: whey and casein
* carbs for energy
* fat for brain and CNS
* fluids 100-150 mL/kg/day
* iron: reserves depleted 5-6 months
* vitamin D and K
267
Metabolic Screening
PKU test
* newborn genetic screening aimed at early detection of genetic diseases that can result in severe health problems not symptomatic at birth
* blood sample heel stick and administer on paper
268
Preterm Infant Characteristics
* larger proportion of warer
* little subcu fat
* poorly calcified bones
* incomplete nerve and muscle development
* suck reflex week (usually present at 32-34 weeks)
* limited ability for digestion, absorption, and renal function
* immature liver lacking development in metabolic enzyme system or adequate iron stores
* feeding tubes and supplements for calories
269
Colostrum
* comes in 16 weeks gestation
* high density, thick, gel-like
* yellow in color from high beta keratin
* high in proteins, fat soluble vitamins a and e, minerals than mature milk
* coats gut to prevent adherence of pathogens and promote gut closure
* easy to digest, maternal antibodies
270
BM Transition
* decrease in immunoglobulins and protein
* high in lactose and fat
* longer you breastfeed, higher the fat concentration
271
BF Assessment
* alignment, areolar grasp, compression, audible swallowing
* let down reflex
* nipple condition
* maternal comfort during feeding
* infant's weight and output
272
Infant Stomach
* day 1: 5-7mL
* day 3: 0.75-1oz
* day 7: 1.5-2oz
273
Signd of Effective BF
* nursing 8 times or more in 24 hrs
* mom hears infant swallowing
* number of wet diapers increases
* infant's stools lighten
274
Formula Fed Infants
* can cause harm to GI tracts
* gut is sterile and immature with tight junctions of GI mucosa not mature
* pathogens enter with open junctions
* necrotizing endocolitis
* interfere with flora and pH of gut
275
Formula Prep
* powder or liquid concentrate, ready to feed
* discard if offered to infant or unfridgerated after 1 hr
* water can make intoxication and decreased electrolyte status
276
Baby Bottle Syndrome
* hold them during feeding and rotate sides
* do not prop bottle - risk for aspiration and formation of dental problems over time
277
Newborn at Risk
greater than average chance of morbidity (illness) or mortality because of conditions present at birth or stress of birth
278
High Risk Period
encompasses human growth and development from age of viability up to 28 days after birth
279
Common Problems that Appear with NB
* gestational age and birth weight problems
* drug exposure
* congenital abnormalities
* hypothermia
* hypoglycemia
* TTN
* MAS
* PPHN
* sepsis
* hyperbili
280
Anticipation of NB
* what may have compromised fetus in utero maternal medical and prenatal history
* what occurred in labor
281
Conditions Present at Birth
* IUGR
* SGA
* LGA
* diabetic mother
* preterm baby
* CHD
* inborn error of metabolism
* substance abuse
282
Classification According to Size
* preterm
* full term
* late preterm
* postterm
283
IUGR
* deveiation and restriction in expected fetal growth pattern
* multiple adverse conditions may cause cong. abnormalities
* pathologic: do not get enough nutrients and O2
284
SGA
below 10th precentile
* physically and neurologically mature but smaller
* may be premature, full term, post term
* fetal growth problems
285
IUGR Fetal Factors
* affect genetic growth potential
* chromosomal abnormalities
* heart disease/hemolytic
* IU infection
* TORCH
* malformations
* multiple gestations
286
TORCH
toxoplasomosis
rubella
cytomegalovirus
herpes
287
IUGR Maternal Factors
* hypertension
* age
* drugs/smoking
* anemia/sickle cell
* cardiac/renal/vasc disese
* asthma
* multiple gestations
* no prenatal care/low SES
* grand multiparity
288
IUGR Placental Factors
inadequate delivery of nutrients
* previa
* abruption
* abnormal venous connection
* drugs that decrease blood flow
* diabetes
* chorioamnionitis
* small placenta
289
IUGR Environmental Factors
* high altitude
* X-ray exposure
290
Patterns of IUGR
depends on timing
* symmetrical and asymmetrical
291
Symmetrical IUGR
weight, length, head circ. plot similarly on growth curve and all organ systems small, normally happens in 1st trimester
* poor long term prognosis
* chromosomal abnormailties
* teratogenic effects / TORCH
* may not grow as big as their counterparts
292
Asymmetrical IUGR
disproportion reduction in size of all structures and organs, happens later in preg 2nd/3rd
* from either maternal or placental conditions that occur later in pregnancy and impede on placental blood flow
* preeclampsia, placental infarcts, maternal malnut.
* head size spaired but overall weight and organ sizes decrease
* better prognosis
293
IUGR Risks
* labor intolerance related to placental insufficiency and inadequate nutritional O2 reserves
* mec aspiration from asphyxia
* hypoglycemia: heat loss
* hypocalcemia down 7.5mg/dL
* jittery, tetany, seizures
294
Assessment Findings: IUGR
* large head
* long nails
* large anterior font
* decreased wharton's kelly
* thin extremities and trunk
* loose skin and decreased subq fat
* dry, flaky/mec stained skin
* hypothermia, polycythemia
295
SGA Risk Factors
* maternal diabetes
* multiparity
* previoud macrosomic baby
* prolonged preg
* hypertension
* cardiac disease
* renal disease
296
LGA Outcomes
* C-section
* operative vag delivery
* shoulder dystocia
* breech
* birth trauma
* cephalopelvic disproportion
* hypoglycemia
* hyperbili
297
LGA Assessment
* fractured clavicles
* brachial nerve damage
* facial nerve damage
* fepressed skull fractures
* cephalohematoma
* intracranial hemorr
* asphyxia
298
SGA Assessments
* head large for body
* wasted apperance of extremities
* deceased subq fat
* decreased amount of breast tissue
* scaphoid abdomen
* wide skull sutures
* poor muscle tone
* loose and dry skin
* thin umb cord
299
SGA Complications
* hypoxia
* little room to tolerate L and D
* organ dysfunction
* hypoglycemia
* hypothermia
* polycythmia: response to chronic hypoxia, bone marrow stimulation to increase production of RBC
300
SGA Complication Factors
* congenital malormations
* IU infection - TORCH
* hypoxia: cog diff, learning dis.
301
SGA Interventions
* monitor O2, color, RR
* monitor temp over 97.6, hold bath
* free from hypoglycemia
* monitor hypocalcemia
* weigh daily - maybe need to increase caloric intake
* monitor feeding intolerance - may have had placental insuf.
302
LGA
bw over 90%
birth trauma: cephalopelvic disproportion
macrosomia
C-sections
hypoglycemia
polycythemia
303
Infant of Diabetic Mother
* hypoglycemia/calcemia/mag
* hyperbili
* birth trauma
* polycythemia
* RDS
* congen malfor
* low musc tone
* hypoxic: ischemic encephalopathy
* periventricular leukomalacia
* poor feeding
304
Post Term Newborn
* after 42 wks
* post maturity syndrome
* risk for asphyxia and mec passage
* polycythemia/hypoglycemia/hypothermia
* decreased amn fluid
* risk for cord compression and thicker mec stained amn fluid
* risk for morb/mort
* decreased placental fxn from altered O2 and nutrient transport
* increase hypoxia and hypoglycemia
305
PTN Risk Factors
* ancephaly
* 1st preg
* history of postterm preg
* grand multipar
306
PTN Complications
* mec aspiration
* fetal hypoxia: cord comp
* neuro conditions: seizures from fetal asphyxia in labor
* birth trauma
307
PTN Findings
* dry, cracked, peeling skin
* lack of vernix
* profuse hair
* long fingernails
* thin wasted appearance
* mec staining (green/yellow)
* hypogly
* poor feeding
308
Preterm Newborn Class
* Very: less than 32 wks
* Premat: 32-34 wks
* Late: 34-37 wks
309
Preterm Newborn Weights
* LBW: < 2500
* VLBW < 1500
* ELBW < 1000
310
Preterm Findings
* decreased tone and posture
* skin transparent and red
* decreased subq
* lanugo
* creases not on foot or limited
* eyelids fused and open 26-30 wks
* overriding sutures
* pinna: soft and folded
* weak cry
* testes not desc
* immature suck
* apnea and bradycardia
* anemia
311
Preterm Risk Factors
nonmodifiable and modifiable
312
CHD
* screening
* pulse ox to detect diminished O2 delivery
* find mitrial stenosis, hypoplastic left heart, coarctation of aorta, patent dictus arteriosus, transposition of great vessels
313
Inborn Errors of Metabolism
* hereditary disorders, enzyme defects, block met pathway and toxins can accumulate
* afefct organ and energy fxn and production
314
Sub. Abusing Mother
* tobacco
* alcohol
* drugs
315
FAS
* phenotypic features: growth restriction, CNS abnormalities, facial dysmorphology
* long term behavioral and cognitive disab
* reduce environmental stim
* extra time to feed
* reinforce parenting
316
Newborn Withdrawl Syndrome
* hyperactivity
* increased musc tone/exaggerateed reflexes
* tremors
* sneezing, hiccuping, yawning, short unquiet sleep
* fever
* tachyplea, excessive secretions
* vigorous suck
* vom, drooling, dia
* sensitive gag reflex
* poor feeding
* stuffy nose, yawning, flushing, sweatung
* sudden pallor
* excoriated buttocks, knees, elbows
* facial structures
* pressure-point abrasions
317
Nursing Interventions: Sub Abuse Infants
* reduce withdrawl symp
* monitor pulse, resp, temp, small freq feedings
* admin meds as ordered
* swaddling
318
Eat Sleep Console
Finnegan Symptom Prioritization
* newborn inability to take in age-appropriate vol of food, sleep more than one hour after feeding, or be consoled within ten mins
319
Birth Related Stress
* cold
* hypogly
* hyperbili
* infection
* RDS
* TTN
* MAS
* PPHN
320
Cold Stress
* heat loss that newborn compensates for
* increased met rate
* decreased surfactant production and hypoxemia
* increased consumption of glucose and hypogly
* met acid increases risk for jaundice
321
Cold Clinical Intervention
* rewarm w skin to skin, heat lamos, swaddling
* monitor gluc levels
* monitor O2
322
Newborn With Hypoglycemia
want glucose over 40 mg/dL
* jittery
* tachypnea
* diaphoresis
* hypotonia
* lethargy
* apnea
* temp instability
323
Physiological Jaundice
* common after first 24 hours
* increased bili from polycythemia and short life span of FRBC
* decreased uptake of bili by liver
* decreased enzyme activity and ability conjugate bili
* decreased ability to excrete bili
* increased enterohepatic circ
* breastfeeding
324
Pathological Jaundice
* in 1st 24 hrs of life
* total serum level above 12 in term
* total 15 in preterm
* serum bili increase more than 5 mg per day
* conj bili: more than 2
* jaundice lasting 1 wk term
325
Bili Encephalopathy
unconj bili in excess that binds to albumin and crosses BBB
* cause neurotoxicity
* lethargy, irritability
* arching of neck and trunk (retrocollis and opisthonos)
* kernicterus: movement disorfer, athetoid form of CP, deafness, seizure, coma, limited upward gaze
326
Interventions with High Bili
* phototherapy
* exchange transfusion if newborn has active hemolysis, unconj bili level of 14, weighs less than 2500 and less tha. 24 hrs old
327
Phototherapy Nursing Care
* assessments: feedings, BM status
* warmth
* eyepatches, cover genitals
* positioning q2h
328
Newborns with Infection
* anticipate sepsis neonatorum
* immature immune system
* vertical transmission: transplacental, ascending (prolonged ROM), intrapartal
* horizontal: nosocomial infec, transmitted from hospital equiptment or staff
329
Risk Factors for Neonatal Inf: Maternal
* poor prenatal nut
* low SES
* Hx STI
* prolonged ROM: 12 hrs
* GBS
* chorioamnionitis
* maternal temp in labor
* premature labor
* diff labor
* fetal scalp electrode use
* invasive procedures
* UTI
330
Risk Factors for Neonatal Inf: Neonate
* prematurity
* LBW
* diff delivery
* birth asphyxia
* mec staining
* cong abnor
* male
* multi gest
* invasive procedure
* length of stay
* humidifcaion in incubator or vent
* broad spectrum antibiotics
331
Assess for Sepsis
* resp
* temp
* cardovasc
* neuro
* gastro
* skin
* metabolic
* immature total neutrophil ratio >0.2 suggests infection
332
Nursing Interventions for Reducing Sepsis
* hand hygene
* blood cultures, CBCD, urine culture
* supportive care: reso, cardio, fluid/electrolytes, hypogly, acidosis
333
RDS Summary
* hyaline mem disease
* primary absence/def of pul surfantant
* indicated failure to synth adequate surfactant
* lec/spin ratio 2:1
334
RDS Assessment
* grunting, flaring, retracting, tachypnea, skin color gray or dusky
* hypoxemia
* acidosis from sustained hypoxemia
335
RDS Management
* pulse ox
* cardiac monitoring
* exogenous surfactant replacement
* O2 therapy by mask, hoord, cannula
* CPAP
* mech vent
* extracorporeal mem ox therapy (ECMO) if vent not working
336
Transient Tachypnea of Newborn (TTN)
* failure to clear lung fluid, mucus, debris
* exhibit signs of distress shortly after birth
* expiratory grunting and nasal flaring
* subcostal retractions
* slight cyanosis
* maintain adequate resp, nut, hydration
337
Meconium Aspiration Syndrome (MAS)
* mechanical obstruction of airways
* chem pneum
* vasocon of pul vessels
* inactivation of natural surfactant
* assess for complications related to MAS
* mantain adequate resp, nut, hydration
