[Exam 2] Chapter 23 – Nursing Management of the Newborn with Special Needs Flashcards
Birthweight Vairations: Description of appropriate for gestational age (AGA)?
Newborn with weight that falls within 80% of all births. Have lower morbidity and mortality than other groups
Birthweight Vairations: Description for small for gestation age? (SGA)
Weigh less than 2500 g (5 lb 8 oz). Or if birthweight is below teh 10th percentile correlated to their gestational age
Birthweight Vairations: Description for large for gestational age?
Those who weight more than 4000 g (8 lb and 13 oz) due to accelerated overgrowth for length of gestation
Birthweight Vairations: Weight for low birthweight?
Less than 2500 g (5.5 lb)
Birthweight Vairations: Weight for very low birthweight?
Less than 1500 g (3 lb 5 oz)
Birthweight Vairations: Weight for extremely low birthweight?
Less than 1000 g (2lb 3 oz)
SGA Newborns: Those with fetal growth restriction are considered at risk for what
increased morbidity and mortality rates
SGA Newborns: What does symmetric FGR refer to?
Fetuses with equally poor growth rates of the brain, abdomen, and long bones and thought to result from early global insult
SGA Newborns: What is asymmetric FGR refer to?
Infants whose brain growth is spared comapred to their abdomen and internal organs
SGA Newborns and Nursing Assessment: Begins by reviewing for risk factors such as waht
smoking, drug abuse, alcohol consumption, preeclampsia, anemia, and intrauterine viral infection
SGA Newborns and Nursing Assessment: Observe for typical characteristics at birth such as?
Head disproportionately large compared to rest of body
Wasted appearance of extremities
Jittery
Temperature instability
SGA Newborns and Nursing Assessment: Maternal causes of this?
Chronic hypertension, soking, low socioeconomic status, abuse, preeclampsia
SGA Newborns and Nursing Assessment: Placental factors of this?
Abnormal cord insertion , placenta previa, decreased placental weight
SGA Newborns and Nursing Mx: Interventions for this may include what?
Obtaining weight, length, and head circumference, and comparing them to standards
SGA Newborns and Nursing Mx: What is Polycythemia?
Venous hematocrit above 65% and hemoglobin of more than 20 grams. Peaks between 6-12 hours of age.
SGA Newborns and Nursing Mx - Polycythemia: What does hyperviscosity of the blood lead to?
Increased reistance of blood flow an decreased oxygen delivery. Can cause abnormalities of central nervous sytem , hypoglycemia, and decreased renal function
SGA Newborns and Nursing Mx - Polycythemia: When should screenings occur?
Mothers who are diabetic put at risk. Screening at 2, 12 , and 24 hours of age
SGA Newborns and Nursing Mx - Polycythemia: What are some clinical signs of polycyhemia?
Respiratory distres, cyanosis, jitteriness, jaundice, ruddy skin color, and lethargy
SGA Newborns and Nursing Mx - Polycythemia: What will asymptomatic newborns with hematocrit between 65-70 be prescribed?
Fluids, close observation, and a repeat hematocrit level in 12 hours
SGA Newborns and Nursing Mx - Polycythemia: Tx if newborn is symptomatic?
Partial exchange transfusion with replacement of removed red blood cell volume with volume expanders.
LGA Newborns, Nursing Assessment: Maternal factors that increase risk of having this type of infant include what
diabetes/glucose intolerance, multiparity, prior hx of a macrosomic infant, postterm gestation, maternal obesity, and gestational weight gain
LGA Newborns, Nursing Assessment: How will they appear?
Large body and appears plump and full-faced. Have poor motor skills and difficulty regulating behavioral states
LGA Newborns, Nursing Assessment: Assess for traumatic injuries such as?
Fractured clavicles, brachial palsy, facial paralysis, phrenic nerve palsy, skull fractures, or hematoma
LGA Newborns, Nursing Assessment: Why are they at risk for hypoglycemia?
Due to early depletion of glycogen stores in their liver. Obtain frequent glucose levels.
LGA Newborns, Nursing Assessment: Clinical signs of hypoglycemia?
Lethargy, drowsiness, tachypnea, weak cry, jitteriness, seizures, bradycardia
LGA Newborns, Nursing Mx - Hypoglycemia: What level is this at?
Below 40 mg/DL
LGA Newborns, Nursing Mx - Hypoglycemia: Associated with variety of neonatal conditions like what
prematurity, FGR, and maternal diabetes
LGA Newborns, Nursing Mx - Hypoglycemia: Initial tx option in asymptomatic hypoglycemia?
Supervisied breast-feeding or formula
LGA Newborns, Nursing Mx - Hypoglycemia: How should symptomatic hypoglycemia be treated?
Continuous infusion of parenteral dextrose. Need at rate above 12 mg/kg/min
LGA Newborns, Nursing Mx - Hypoglycemia: When should you assess glucose levels?
Within 30 mins of birth adn repeat the screening every hour
LGA Newborns, Nursing Mx: Polycythemia and hyperviscosity are associated with what problems?
fine and gross motor delays, speech delays, and neurologic sequelae
Gestational Age Variations: Mean age of pregnancy?
280 days or 40 weeks.
Gestational Age Variations: When is a preterm newborn born?
Before 37 weeks
Gestational Age Variations: When is a postterm infant born?
After 42 weeks
Gestational Age Variations: When is a late preterm infant born?
BEtween 34 to 36 weeks
Posterm Newborn: What happens to the placenta after 42 weeks?
Ability to provide adequate oxygen and nutrients compromised. Placenta begins aging . Begins to use its own resources and begins to waste away
Posterm Newborn - Nursing Assessment: Nursing care activites include what
asseessing neonate complication, assessing for birth trauma, maintaining body tem,p, and offering emotional support
Posterm Newborn - Nursing Assessment: What characteristics do they often exhibit?
Dry, cracked, peeling skin
Long, thin extremities
Wide-eyed, alert expression
Abundant hair on scalp
Long fingernails
Posterm Newborn - Nursing Assessment: What to do with meconium?
Observe for meconium-stained umbilical cord and fingernails to assess for meconium aspiration
Posterm Newborn - Nursing Assessment: What other typical complications can be associated here?
Perinatal asphyxia, hypoglycemia, hypothermia, and polycythemia
Posterm Newborn - Nursing Mx: At high risk for perinatal asphyxia, which is attributed to?
Placental deprivation or eligohydramnios that leads to cord compression, thereby reducing perfusion to the fetus
Posterm Newborn - Nursing Mx: What can help stabilize blood glucose levels?
Give them intravenous dextrose 20% or initiate early feedings to help stabilize the blood glucose levels
Posterm Newborn - Nursing Mx: What will you observe of the infant?
Skin temp, respiration characteristics, results of blood studies, like aBGs and serum bilirubin levels
Posterm Newborn - Nursing Mx: How do you treat polycythemia?
This leads to hyperbilirubinemia due to rbc destruction. Providing adequate hydration helps reduce the viscosity of the newborns blood
Preterm Newborn: Continue to be at high risk for neurodevelopmental disorders such as
cerebral palsy or mental retardation, intraventricular hemorrhage, congenital anomalies, and behavioral problems
Preterm Newborn: Most common complications seen here?
Respiratory distress syndrome, hemorrhage, retinopathy, anemia, and hypoglycemia
Preterm Newborn - Effects on Body System, Resp. System: How is this developmental wise?
One of the last body systems to mature. Greatest risk for resp complications
Preterm Newborn - Effects on Body System, Resp. System: When problems here affect the newborns breathing?
Surfactant deficiency.
Unstable chest wall, leading to atelectasis
Immature respiratory control centers
Smaller respiratory passages
Inability to clear fluid from passages