[Exam 2] Chapter 24 – Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions Flashcards
When do acquired disorders occur?
Typically occur at or soon after birth . May result from problems or conditions experienced by woman during her pregnancy
What are congenital disorders?
Structural or functional or metabolic abnormalities at birth
Most common congenital disorders?
Congenital heart defects, neural tube defects, and down sydrome
Acquired Disorders: Examples of this?
Perinatal asphyxia, respiratory distresstion syndrome, meconium aspiration syndrome, pulmonary hypertension, intraventricular hemorrhage
Acquired Disorders - Perinatal Asphyxia: What is this?
Characterized by clinical evidence of acute or subacute brain injury due to systemic hypoxemia or reduced cerebral blood flow.
Acquired Disorders - Perinatal Asphyxia: What is asphyxia?
Impairment of has exchange resulting in a decrease in blood oxygen levels and excess of carbon dioxide.
Acquired Disorders - Perinatal Asphyxia: What problems may those who have asphyxia develop?
Cerebral palsy, intellectual disability, speech disorders, hearing impairment, and learning disabilities
Acquired Disorders - Perinatal Asphyxia, Patho: When does asphyxia occur?
When oxygen delivery is insufficient to meet metabolci demands, resulting in hypoxia.
Acquired Disorders - Perinatal Asphyxia, Patho: What conditions may result in asphyxia?
Maternal hypoxia, maternal vascular disease, cord problems, and postterm pregnancies
Acquired Disorders - Perinatal Asphyxia, Patho: What compensatory mechanisms will the newborn use to bring oxygen?
Tachycardia and vasoconstriction
Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What perinatal risk factors may put them at risk for this?
trauma, injury to CNS or Peripheral
Intrauterine Asphyxia ,such as fetal hypoxia
Sepsis, acquired through bacterial or vaginal organisms
Malformation
Medication
Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What will uoi assess at birth?
Infants color, noting any pallor or cyanosis . Assess breathing and be alert for apnea. Evaluate heart rate. And determine the Apgar score.
Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What may a chest x-ray identify?
Structural abnormaliteis that might interfere with respiration.
Acquired Disorders - Perinatal Asphyxia, Nursing Assessment: What would blood work identify?
Infectious process or any maternal drugs in the newborn
Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Management includes what?
Immediate resuscitation. You need wall suction, oxygen source, newborn ventilation bag, and endoracheal tubes.
Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Procedure to remember newborn resuscitation is remember by ABCDs, which stands for
Airway, breathing, circulation, and drugs
Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Continue resuscitation until when?
Newbon has a pulse above 100 bpm, good healthy cry, and pink tongue
Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Why do you want to maintain a neutral thermal environment?
To prevent hypothermia, which would increase the newborns metabolic and oxygen demands
Acquired Disorders - Perinatal Asphyxia, Nursing Mx: Who is therapeutic hypothermia used for?
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
Acquired Disorders - Transient Tachypnea of Newborn: What is this?
Retention of lung fluid or transient pulmonary edema. REsolves by 72 hours.
Acquired Disorders - Transient Tachypnea of Newborn: Risk factors for this?
Lower gesttional age, cesareanbirth, and male sex independent factors
Acquired Disorders - Transient Tachypnea of Newborn - Patho: Why is someone who had a cesarean birth at risk for having excessive pulmonary fluid?
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
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Health HX and Physical Exam: Review for risk factors related to this such as
Absence of labor cesarean birth, precipitous delivery, prolonged labor, fetal macrosomia, and infants born early
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
achypneam expiratory grunting, retractions, labored breathing, nasal flaring, and mild cyanosis
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Labs: What would chest x-ray reveal?
Mild symmetric lung overeaeraion and prominent perihilar interstitial markings and streaking
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Assessment and Labs: What do ABGs show?
The degree of gas exchange and acid-base balance. Typically demonstrates mild hypoxemia, mildly elevated CO2 and a normal pH
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: How is management performed?
Supportive. Retained lung fluid is abosbred by the infant’s lymphatic system and pulmonary status improves
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: What does management focus on?
Providing adequate oxygenation and whether newborns respiratory manifestatiosn appear to be resolving or persisting
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: What supoprive care will be provided while fluids are in lings?
Administer IV fluidss or gavage feedings until rr decreases enough to allow oral . Also provide supplemental oxygen and maintain neutral thermal environment
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: How high will respiratory rates be here?
As high as 100 to 140 breaths per minute
Acquired Disorders - Transient Tachypnea of Newborn, Nursing Mx: How do you know this has resolves?
Newborns RR declines to 60 breaths per minute, O2 requirement decreases, and X-Ray shows resoltuion of perihilar streaking
Acquired Disorders - Respiratory Distress Syndrome: What is this?
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.
Acquired Disorders - Respiratory Distress Syndrome: What happens wihtout surfactant?
Alveoli collapse at end of expiration
Acquired Disorders - Respiratory Distress Syndrome: Why have prenatal steroids been introduced?
To accelerae lung maturity and development of synthetic surfactant
Acquired Disorders - Respiratory Distress Syndrome: When does this typically occur?
50% of preterm born at 26-28 weeks
30% of those born at 30-31 weeks
Acquired Disorders - Respiratory Distress Syndrome Patho: What happens to the work of breathign here?
Is increased because increased pressure similar to that required to initiate the firth breath
Acquired Disorders - Respiratory Distress Syndrome Patho: What complications can happen if this is not resolved?
Hypoxemia and acidemia, leading to vasoconstriction of the pulmonary vasculature
Acquired Disorders - Respiratory Distress Syndrome Patho: What happens as the disease progresses?
Fluid and fibrin leak from the pulmonary capillaries, causing hyaine membranes to form in bronchioles, alveolar ducts, and alveoli
Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: Most common risk factors for this?
Preamture birth , Cesarean birth, male gender, and asphyxia
Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: What signs will the infant show?
Expiratory grunting, shallow breathing, nasal flaring, chest wall retractions adn seesaw respirations
Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: What abnormalities will you note?
Tachycardia, fine inspiratory crackles, and tachypnea
Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Hx and Physical Exam: What is the Silverman-Anderson Index?
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
Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Labs: Diagnosis of this is based on what?
Clinical picture, lung ultrasound, x-ray findings and ABGs that show hypoxemia and acidosis .
Acquired Disorders - Respiratory Distress Syndrome Nursing Assess Labs: What does a chest x-ray reveal?/
Hypoaeration, underexpansion, and a ground glass pattern
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What care does infant need until surfactant produced?
Supportive care. This includes conventional mechanical ventilation, continuous positive airway pressure, or postive end-expiratory pressure
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What has become the standard of care for this?
Exogenous surfactant replacement therapy to stabilzie the newborns lungs until postnatal surfactant synthesis matures
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What should be done to ensure that newborns have the best outcomes?
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
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What does therapy focus on?
Improving oxygenation and maintaining optimal lung volumes
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What is the prophylactic administration approach for surfactant replacement therapy?
Given within minutes after birth, thus providing replacement surfactant before severe RDS develops
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: When is rescue treatment indicated?
for newborns with establlished RDS who require mechanical ventilation and supplemetnal oxygen. Earlier its administered, the better the effect on gas exchange
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What will you do with oxygen?
Administer via nasal canula.
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: What interventions will be done for these newborns?
Continuously monitor infants cardiopulmonary status
Monitor oxygen saturation levels
Closely monitor VSs
Administer broad-spectrum antibiotics if blood +
Acquired Disorders - Respiratory Distress Syndrome Nursing Mx: Be alert for complicactions from tx, which may include?
Air leak syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, congestive heart failure.
Acquired Disorders - Meconium Aspiration Syndrome: What is meconium?
Viscous green substance composed primarily of water and other GI secretions, made as early as 10-16 weeks. First stool after birth
Acquired Disorders - Meconium Aspiration Syndrome: Factos that promote passage in utero include?
Plaacental insufficiency, maternal hypertension, preeclampsia, fetal hypoxia, and maternal drug abuse
Acquired Disorders - Meconium Aspiration Syndrome: When does this occur?
When newborn inhales particulate meconium mixed with amniotic fluid into the lung while still in utero or taking first breath after birth.
Acquired Disorders - Meconium Aspiration Syndrome: What can severe MAS lead to?
Persistent pulmonary hypertnsion and death
Acquired Disorders - Meconium Aspiration Syndrome, Patho: Why may Hypoxia cause meconium to enter fluid?
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
Acquired Disorders - Meconium Aspiration Syndrome, Patho: How does meconium alter amniotic fluid?
Reduces antibacterial activity and increases risk of perinatal bacterial infection
Acquired Disorders - Meconium Aspiration Syndrome, Patho: What happens when meconium is in the lungs?
Blocks the bronchioles, causing an inflammatory reaction as well as a decrease ins urfactant prpoduction .
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: Predisposing factors for this include
postterm pregnancy, breech presentation, forceps, or vacuum extractions, nuliparity, ethnicity, and intrapartum feveer
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: What does green stained amniotic fluid suggest?
Presence of meconium in the amnioitc fluid and should be reported immediately
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: What does yellowish-green staining of umvilical cord and nails/skin indicate?
That meconium has been present for some tim e
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Assess: What physical characteristics will they have?
Barrel-shaped chest with an increased anteriorposterior chest diameter, prolonged tachypnea, progression from mild-to-severe respiratory distress
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What does this focus on?
Ensuring adequate tissue perfusion and minimizing oxygen demand and energy expenditure
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What occurs as infant born?
Nasal cavity wiped and may be suctioned.
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What will you do when infant placed in NICU?
Maintain neutral thermal environment, minimize handling to reduce energy. And administer oxygen.
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: Why would hyperoxygenaation be prescribed?
To dilate the pulmonary vasculature and close the ductus arteriosus or nitric oxide inhalation to decrease pulmonary vascular resistance
Acquired Disorders - Meconium Aspiration Syndrome, Nursing Mx: What interventions will be performed?
Cluster newborn care.
Maintain an optimal thermal environment to minimize oxygen consumption.
Tx hypotention
Incorporate developmental care practices
Administer broad-spectrum ntibiotics
Persistent Pulmonary Hypertension of N: What is this?
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
Persistent Pulmonary Hypertension of N: Can occur as complication of what
perinatal asphyxia, MAS, maernal smoking, maternal obesity, and asthma
Persistent Pulmonary Hypertension of N: What medications may cause this”?
SSRI taken in late pregnancny
vWhat happens here?
Pulmonary pressure remains increased. Leads to hypoxemia and acidosis, leading to vasoconstriction.
Persistent Pulmonary Hypertension of N, Nursing Assessment: What signs will theys how?
Tachypnea within 12 hours. Observev for marked cyanosis, grunting, respiratory distress and tachypnea.
Persistent Pulmonary Hypertension of N, Nursing Mx: What does this focus on?
Ensuring adequate tissue profusion and minimizing oxygen demand and energy expenditure.
Persistent Pulmonary Hypertension of N, Nursing Mx: Goals of therapy?
Improving alveolar oxygenation, inducing metabolic aklalosis by administering sodium bicarbonate, correcting hypovolemia and hypotension.
Persistent Pulmonary Hypertension of N, Nursing Mx: What will occur after birth?
immediate resuscitation and administer oxygen as ordered.
Periventricular-Intraventricular Hemorrhage: What is this?
Bleeding that usually originates in the subependymal germinal matrix region of the brain, extending into the ventricular system
Periventricular-Intraventricular Hemorrhage: Complications resulting from this includes
hydrocephalus, seizure disorder, cerebral palsy, learning disabilities , vision or hearing defcits
Periventricular-Intraventricular Hemorrhage Patho: What causes this?/
Due to intrinsic weakness of germinal vasculature and to the fluctuation in the cerebral blood flow
Periventricular-Intraventricular Hemorrhage Patho: Preterm at greatest risk for IVH why?
Because cerebral vascular development is immature, making it more vulnerable to injury
Periventricular-Intraventricular Hemorrhage Nursing Assessment: Risk factors for this include?
Preterm birth, low birth weight, acidosis, asphyxia, and seizures.
Periventricular-Intraventricular Hemorrhage Nursing Assessment: What would the newborn be evaluated for?
Unexplained drop in hematocrit, pallor,a nd poor perfusions as evidenced by respiratory distress and oxygen desaturation.
Periventricular-Intraventricular Hemorrhage Nursing Mx: What is essential in preventing IVH?
Prevention of preterm birth
Periventricular-Intraventricular Hemorrhage Nursing Mx: What care is provided for one with IVH?
Supportiive. Correct anemia, acidosis, and hypotension with fluids and meds. Administer fluids slowly.
Periventricular-Intraventricular Hemorrhage Nursing Mx: How do you minimize fluctuations in intracranial pressure?
Keep the newborn in a flexed contained positioned with head elevated
Periventricular-Intraventricular Hemorrhage Nursing Mx: What are some signs of hemorrhage to monitor for?
changes in level of consciousness, bulging fontaneal, seizures, apnea, and reduced activity level
Periventricular-Intraventricular Hemorrhage Nursing Mx: Developmental care principles include what?
Avoiding lifting the lower extremities above the midline with diaper changes, giving rapid fluidboluses, and high oxygen and ventilation
Necrotizing Enterocolitis: What is this?
Inflammatory diseease of the bowel which can cause ischemic and necrotic injury in the GI tract.
Necrotizing Enterocolitis: What are some ways to improve GI function and reduce risk of this?
Enteral antibitoocs, judicious administration of parenteral fluids, human milk feedings, and antenatal corticosteroids
Necrotizing Enterocolitis Patho: What three major pathologic mechanisms lead to NEC?
Bowel hypoxic-ischemia events, perinatal stressors, and immature intestinal barrier
Necrotizing Enterocolitis Nursing Assessment: What signs will the infant show as the disease worsens?
Septic shock (respiratory distress, temperature instability, lethargy, hypotension, and oliguria)
Necrotizing Enterocolitis Nursing Assessment and Health Hx and Physical Exam: Common signs and symptoms?
Cardiorespiratory baseline changes, feeding intolerance, bloody stools, diarrhea, respiratory distress, temperature instability, and signs of sepsis
Necrotizing Enterocolitis Nursing Assessment and Labs: Whatdoes a KUB and Abdominal X-Ra show?
Presence of pneumatosis inestinalis and persistently dilated loops of bowel
Necrotizing Enterocolitis Nursing Assessment and Labs: What does an abdominal X-Ray show?
Dilated bowel oops , abnormal gas patterns, air bubbles
Necrotizing Enterocolitis Nursing Mx: What does management focus on?
Maintaining fluid and nutritional status, providing supportive care, and txing family about condiiton and prognosis
Necrotizing Enterocolitis Nursing Mx: Theapeutic management consists of
bowel rest and antibiotic therapy
Necrotizing Enterocolitis Nursing Mx: What happens if all treatments don’t work?
Surgical intervention will be necessary to resect portion of necrotic bowel while preserving as much of intestinal length as possible
Necrotizing Enterocolitis Nursing Mx, Nutrition: What to do if NEC suspected?
Immediately stop enteral feedings until diagnosis made. Administer IV fluids to restore proper fluid balance. TPN ordered to support nutritionally.
Necrotizing Enterocolitis Nursing Mx, Nutrition: Why would IV antibiotics be given?
To prevent sepsis from the necrotic bowel .
Infants of Diabetic Mothers: What complications are infants at risk for?
Preterm birth, polycythemia, asphyxia, respiratory distress, and hypoglycemia.
