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NRSG 206: OB > [Exam 2] Chapter 24 – Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions > Flashcards

[Exam 2] Chapter 24 – Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions Flashcards

1
Q

When do acquired disorders occur?

A

Typically occur at or soon after birth . May result from problems or conditions experienced by woman during her pregnancy

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2
Q

What are congenital disorders?

A

Structural or functional or metabolic abnormalities at birth

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3
Q

Most common congenital disorders?

A

Congenital heart defects, neural tube defects, and down sydrome

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4
Q

Acquired Disorders: Examples of this?

A

Perinatal asphyxia, respiratory distresstion syndrome, meconium aspiration syndrome, pulmonary hypertension, intraventricular hemorrhage

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5
Q

Acquired Disorders - Perinatal Asphyxia: What is this?

A

Characterized by clinical evidence of acute or subacute brain injury due to systemic hypoxemia or reduced cerebral blood flow.

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6
Q

Acquired Disorders - Perinatal Asphyxia: What is asphyxia?

A

Impairment of has exchange resulting in a decrease in blood oxygen levels and excess of carbon dioxide.

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7
Q

Acquired Disorders - Perinatal Asphyxia: What problems may those who have asphyxia develop?

A

Cerebral palsy, intellectual disability, speech disorders, hearing impairment, and learning disabilities

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8
Q

Acquired Disorders - Perinatal Asphyxia, Patho: When does asphyxia occur?

A

When oxygen delivery is insufficient to meet metabolci demands, resulting in hypoxia.

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9
Q

Acquired Disorders - Perinatal Asphyxia, Patho: What conditions may result in asphyxia?

A

Maternal hypoxia, maternal vascular disease, cord problems, and postterm pregnancies

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10
Q

Acquired Disorders - Perinatal Asphyxia, Patho: What compensatory mechanisms will the newborn use to bring oxygen?

A

Tachycardia and vasoconstriction

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11
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What perinatal risk factors may put them at risk for this?

A

trauma, injury to CNS or Peripheral

Intrauterine Asphyxia ,such as fetal hypoxia

Sepsis, acquired through bacterial or vaginal organisms

Malformation

Medication

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12
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What will uoi assess at birth?

A

Infants color, noting any pallor or cyanosis . Assess breathing and be alert for apnea. Evaluate heart rate. And determine the Apgar score.

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13
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What may a chest x-ray identify?

A

Structural abnormaliteis that might interfere with respiration.

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14
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What would blood work identify?

A

Infectious process or any maternal drugs in the newborn

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15
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Management includes what?

A

Immediate resuscitation. You need wall suction, oxygen source, newborn ventilation bag, and endoracheal tubes.

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16
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Procedure to remember newborn resuscitation is remember by ABCDs, which stands for

A

Airway, breathing, circulation, and drugs

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17
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Continue resuscitation until when?

A

Newbon has a pulse above 100 bpm, good healthy cry, and pink tongue

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18
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Why do you want to maintain a neutral thermal environment?

A

To prevent hypothermia, which would increase the newborns metabolic and oxygen demands

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19
Q

Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Who is therapeutic hypothermia used for?

A

Newborns with moderate to severe perinatal encephalopathy after perinatal asphyxia and has been incorporated into NICUs. Consists of cooling whole body to 33.5 degrees for 3 days

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20
Q

Acquired Disorders - Transient Tachypnea of Newborn: What is this?

A

Retention of lung fluid or transient pulmonary edema. REsolves by 72 hours.

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21
Q

Acquired Disorders - Transient Tachypnea of Newborn: Risk factors for this?

A

Lower gesttional age, cesareanbirth, and male sex independent factors

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22
Q

Acquired Disorders - Transient Tachypnea of Newborn - Patho: Why is someone who had a cesarean birth at risk for having excessive pulmonary fluid?

A

Because they didn’t experience stages of labor. During labor, canal compresses the thorax, which removes majority of fluid. Pulmonary circulation and lymphatic drainage remove remaining fluid after birth

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23
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Health HX and Physical Exam: Review for risk factors related to this such as

A

Absence of labor cesarean birth, precipitous delivery, prolonged labor, fetal macrosomia, and infants born early

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24
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Health HX and Physical Exam: What should you observe for within the first few hours of birth

A

achypneam expiratory grunting, retractions, labored breathing, nasal flaring, and mild cyanosis

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25
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Labs: What would chest x-ray reveal?

A

Mild symmetric lung overeaeraion and prominent perihilar interstitial markings and streaking

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26
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Labs: What do ABGs show?

A

The degree of gas exchange and acid-base balance. Typically demonstrates mild hypoxemia, mildly elevated CO2 and a normal pH

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27
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: How is management performed?

A

Supportive. Retained lung fluid is abosbred by the infant’s lymphatic system and pulmonary status improves

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28
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: What does management focus on?

A

Providing adequate oxygenation and whether newborns respiratory manifestatiosn appear to be resolving or persisting

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29
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: What supoprive care will be provided while fluids are in lings?

A

Administer IV fluidss or gavage feedings until rr decreases enough to allow oral . Also provide supplemental oxygen and maintain neutral thermal environment

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30
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: How high will respiratory rates be here?

A

As high as 100 to 140 breaths per minute

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31
Q

Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: How do you know this has resolves?

A

Newborns RR declines to 60 breaths per minute, O2 requirement decreases, and X-Ray shows resoltuion of perihilar streaking

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32
Q

Acquired Disorders - Respiratory Distress Syndrome: What is this?

A

Breathing disorder resulting from lung immaturity and lack of alveolar surfactant, which keeps the air sacs in the lungs from collapsing and allows them to inflate easily.

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33
Q

Acquired Disorders - Respiratory Distress Syndrome: What happens wihtout surfactant?

A

Alveoli collapse at end of expiration

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34
Q

Acquired Disorders - Respiratory Distress Syndrome: Why have prenatal steroids been introduced?

A

To accelerae lung maturity and development of synthetic surfactant

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35
Q

Acquired Disorders - Respiratory Distress Syndrome: When does this typically occur?

A

50% of preterm born at 26-28 weeks

30% of those born at 30-31 weeks

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36
Q

Acquired Disorders - Respiratory Distress Syndrome Patho: What happens to the work of breathign here?

A

Is increased because increased pressure similar to that required to initiate the firth breath

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37
Q

Acquired Disorders - Respiratory Distress Syndrome Patho: What complications can happen if this is not resolved?

A

Hypoxemia and acidemia, leading to vasoconstriction of the pulmonary vasculature

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38
Q

Acquired Disorders - Respiratory Distress Syndrome Patho: What happens as the disease progresses?

A

Fluid and fibrin leak from the pulmonary capillaries, causing hyaine membranes to form in bronchioles, alveolar ducts, and alveoli

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39
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: Most common risk factors for this?

A

Preamture birth , Cesarean birth, male gender, and asphyxia

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40
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: What signs will the infant show?

A

Expiratory grunting, shallow breathing, nasal flaring, chest wall retractions adn seesaw respirations

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41
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: What abnormalities will you note?

A

Tachycardia, fine inspiratory crackles, and tachypnea

42
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: What is the Silverman-Anderson Index?

A

Assessment scoring system to evlaute the five parameters of work of breathing, scored from 0-2.

Includes retractions of upper chest, lower chest, xiphoid, nasal flaring and expiratory grunt

43
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Labs: Diagnosis of this is based on what?

A

Clinical picture, lung ultrasound, x-ray findings and ABGs that show hypoxemia and acidosis .

44
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Labs: What does a chest x-ray reveal?/

A

Hypoaeration, underexpansion, and a ground glass pattern

45
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What care does infant need until surfactant produced?

A

Supportive care. This includes conventional mechanical ventilation, continuous positive airway pressure, or postive end-expiratory pressure

46
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What has become the standard of care for this?

A

Exogenous surfactant replacement therapy to stabilzie the newborns lungs until postnatal surfactant synthesis matures

47
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What should be done to ensure that newborns have the best outcomes?

A

Have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritonal support, and suport of circulation to maintain adequate tissue perfusion

48
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What does therapy focus on?

A

Improving oxygenation and maintaining optimal lung volumes

49
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What is the prophylactic administration approach for surfactant replacement therapy?

A

Given within minutes after birth, thus providing replacement surfactant before severe RDS develops

50
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: When is rescue treatment indicated?

A

for newborns with establlished RDS who require mechanical ventilation and supplemetnal oxygen. Earlier its administered, the better the effect on gas exchange

51
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What will you do with oxygen?

A

Administer via nasal canula.

52
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What interventions will be done for these newborns?

A

Continuously monitor infants cardiopulmonary status

Monitor oxygen saturation levels

Closely monitor VSs

Administer broad-spectrum antibiotics if blood +

53
Q

Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: Be alert for complicactions from tx, which may include?

A

Air leak syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, congestive heart failure.

54
Q

Acquired Disorders - Meconium Aspiration Syndrome: What is meconium?

A

Viscous green substance composed primarily of water and other GI secretions, made as early as 10-16 weeks. First stool after birth

55
Q

Acquired Disorders - Meconium Aspiration Syndrome: Factos that promote passage in utero include?

A

Plaacental insufficiency, maternal hypertension, preeclampsia, fetal hypoxia, and maternal drug abuse

56
Q

Acquired Disorders - Meconium Aspiration Syndrome: When does this occur?

A

When newborn inhales particulate meconium mixed with amniotic fluid into the lung while still in utero or taking first breath after birth.

57
Q

Acquired Disorders - Meconium Aspiration Syndrome: What can severe MAS lead to?

A

Persistent pulmonary hypertnsion and death

58
Q

Acquired Disorders - Meconium Aspiration Syndrome, Patho: Why may Hypoxia cause meconium to enter fluid?

A

Fetus may bear down and pass meconium into the amniotic reflex when attempting to breathe . They then suck or swallow the amniotic fluid in utero

59
Q

Acquired Disorders - Meconium Aspiration Syndrome, Patho: How does meconium alter amniotic fluid?

A

Reduces antibacterial activity and increases risk of perinatal bacterial infection

60
Q

Acquired Disorders - Meconium Aspiration Syndrome, Patho: What happens when meconium is in the lungs?

A

Blocks the bronchioles, causing an inflammatory reaction as well as a decrease ins urfactant prpoduction .

61
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: Predisposing factors for this include

A

postterm pregnancy, breech presentation, forceps, or vacuum extractions, nuliparity, ethnicity, and intrapartum feveer

62
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: What does green stained amniotic fluid suggest?

A

Presence of meconium in the amnioitc fluid and should be reported immediately

63
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: What does yellowish-green staining of umvilical cord and nails/skin indicate?

A

That meconium has been present for some tim e

64
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: What physical characteristics will they have?

A

Barrel-shaped chest with an increased anteriorposterior chest diameter, prolonged tachypnea, progression from mild-to-severe respiratory distress

65
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What does this focus on?

A

Ensuring adequate tissue perfusion and minimizing oxygen demand and energy expenditure

66
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What occurs as infant born?

A

Nasal cavity wiped and may be suctioned.

67
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What will you do when infant placed in NICU?

A

Maintain neutral thermal environment, minimize handling to reduce energy. And administer oxygen.

68
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: Why would hyperoxygenaation be prescribed?

A

To dilate the pulmonary vasculature and close the ductus arteriosus or nitric oxide inhalation to decrease pulmonary vascular resistance

69
Q

Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What interventions will be performed?

A

Cluster newborn care.

Maintain an optimal thermal environment to minimize oxygen consumption.

Tx hypotention

Incorporate developmental care practices

Administer broad-spectrum ntibiotics

70
Q

Persistent Pulmonary Hypertension of N: What is this?

A

Cardiopulmonary disorder characaterized by marked pulmonary hypertension that causes right-to-left extrapulmonary shunting of blood and hypoxemia. Occurs when system does not have normal transition after birth

71
Q

Persistent Pulmonary Hypertension of N: Can occur as complication of what

A

perinatal asphyxia, MAS, maernal smoking, maternal obesity, and asthma

72
Q

Persistent Pulmonary Hypertension of N: What medications may cause this”?

A

SSRI taken in late pregnancny

73
Q

vWhat happens here?

A

Pulmonary pressure remains increased. Leads to hypoxemia and acidosis, leading to vasoconstriction.

74
Q

Persistent Pulmonary Hypertension of N, Nursing Assessment: What signs will theys how?

A

Tachypnea within 12 hours. Observev for marked cyanosis, grunting, respiratory distress and tachypnea.

75
Q

Persistent Pulmonary Hypertension of N, Nursing Mx: What does this focus on?

A

Ensuring adequate tissue profusion and minimizing oxygen demand and energy expenditure.

76
Q

Persistent Pulmonary Hypertension of N, Nursing Mx: Goals of therapy?

A

Improving alveolar oxygenation, inducing metabolic aklalosis by administering sodium bicarbonate, correcting hypovolemia and hypotension.

77
Q

Persistent Pulmonary Hypertension of N, Nursing Mx: What will occur after birth?

A

immediate resuscitation and administer oxygen as ordered.

78
Q

Periventricular-Intraventricular Hemorrhage: What is this?

A

Bleeding that usually originates in the subependymal germinal matrix region of the brain, extending into the ventricular system

79
Q

Periventricular-Intraventricular Hemorrhage: Complications resulting from this includes

A

hydrocephalus, seizure disorder, cerebral palsy, learning disabilities , vision or hearing defcits

80
Q

Periventricular-Intraventricular Hemorrhage Patho: What causes this?/

A

Due to intrinsic weakness of germinal vasculature and to the fluctuation in the cerebral blood flow

81
Q

Periventricular-Intraventricular Hemorrhage Patho: Preterm at greatest risk for IVH why?

A

Because cerebral vascular development is immature, making it more vulnerable to injury

82
Q

Periventricular-Intraventricular Hemorrhage Nursing Assessment: Risk factors for this include?

A

Preterm birth, low birth weight, acidosis, asphyxia, and seizures.

83
Q

Periventricular-Intraventricular Hemorrhage Nursing Assessment: What would the newborn be evaluated for?

A

Unexplained drop in hematocrit, pallor,a nd poor perfusions as evidenced by respiratory distress and oxygen desaturation.

84
Q

Periventricular-Intraventricular Hemorrhage Nursing Mx: What is essential in preventing IVH?

A

Prevention of preterm birth

85
Q

Periventricular-Intraventricular Hemorrhage Nursing Mx: What care is provided for one with IVH?

A

Supportiive. Correct anemia, acidosis, and hypotension with fluids and meds. Administer fluids slowly.

86
Q

Periventricular-Intraventricular Hemorrhage Nursing Mx: How do you minimize fluctuations in intracranial pressure?

A

Keep the newborn in a flexed contained positioned with head elevated

87
Q

Periventricular-Intraventricular Hemorrhage Nursing Mx: What are some signs of hemorrhage to monitor for?

A

changes in level of consciousness, bulging fontaneal, seizures, apnea, and reduced activity level

88
Q

Periventricular-Intraventricular Hemorrhage Nursing Mx: Developmental care principles include what?

A

Avoiding lifting the lower extremities above the midline with diaper changes, giving rapid fluidboluses, and high oxygen and ventilation

89
Q

Necrotizing Enterocolitis: What is this?

A

Inflammatory diseease of the bowel which can cause ischemic and necrotic injury in the GI tract.

90
Q

Necrotizing Enterocolitis: What are some ways to improve GI function and reduce risk of this?

A

Enteral antibitoocs, judicious administration of parenteral fluids, human milk feedings, and antenatal corticosteroids

91
Q

Necrotizing Enterocolitis Patho: What three major pathologic mechanisms lead to NEC?

A

Bowel hypoxic-ischemia events, perinatal stressors, and immature intestinal barrier

92
Q

Necrotizing Enterocolitis Nursing Assessment: What signs will the infant show as the disease worsens?

A

Septic shock (respiratory distress, temperature instability, lethargy, hypotension, and oliguria)

93
Q

Necrotizing Enterocolitis Nursing Assessment and Health Hx and Physical Exam: Common signs and symptoms?

A

Cardiorespiratory baseline changes, feeding intolerance, bloody stools, diarrhea, respiratory distress, temperature instability, and signs of sepsis

94
Q

Necrotizing Enterocolitis Nursing Assessment and Labs: Whatdoes a KUB and Abdominal X-Ra show?

A

Presence of pneumatosis inestinalis and persistently dilated loops of bowel

95
Q

Necrotizing Enterocolitis Nursing Assessment and Labs: What does an abdominal X-Ray show?

A

Dilated bowel oops , abnormal gas patterns, air bubbles

96
Q

Necrotizing Enterocolitis Nursing Mx: What does management focus on?

A

Maintaining fluid and nutritional status, providing supportive care, and txing family about condiiton and prognosis

97
Q

Necrotizing Enterocolitis Nursing Mx: Theapeutic management consists of

A

bowel rest and antibiotic therapy

98
Q

Necrotizing Enterocolitis Nursing Mx: What happens if all treatments don’t work?

A

Surgical intervention will be necessary to resect portion of necrotic bowel while preserving as much of intestinal length as possible

99
Q

Necrotizing Enterocolitis Nursing Mx, Nutrition: What to do if NEC suspected?

A

Immediately stop enteral feedings until diagnosis made. Administer IV fluids to restore proper fluid balance. TPN ordered to support nutritionally.

100
Q

Necrotizing Enterocolitis Nursing Mx, Nutrition: Why would IV antibiotics be given?

A

To prevent sepsis from the necrotic bowel .

101
Q

Infants of Diabetic Mothers: What complications are infants at risk for?

A

Preterm birth, polycythemia, asphyxia, respiratory distress, and hypoglycemia.

NRSG 206: OB (42 decks)

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