High risk Infant Flashcards
what may have compromised the fetus in utero?
- maternal medical and prenatal history
- prenatal care: socioeconomic status and maternal medical disorders
- gestational age
- maternal age: congenital anomalies
what occurred during labor that could compromise the infant
- duration and course of labor
- materal well being: use of nacre, analgesics, anesthia
- fetal well being:
neonatal mortality vs neonatal morbidity
- mortalitiy: possibility of death with first 28 days
- mordity: poor health outcome as a result of adverse fleuve or treatments acting either on the fetus during pregnancy and/or the infant during first 4 weeks of life
causes of intrauterine growth restriction
- chromosoms, early infections, malnutrition, alcohol
- decreased oxygen carrying capacity
- dysfucntional oxygen delivery system
- placental damage
patterns of symmetric IUGR
- growth failure is early
- small overall
patterns of asymmetric IUGR
- growth failure late
- small abdominal circumference compared to head circumference
complications of SGA/IUGR babies
- chronic hypoxia
- hypothermia
- hypoglycemia
- polycythemia
outcomes of a SGA/IUGR baby
- congenital malformations (birth defects): chromosomes, alcoholism, malnutrition, early infection (TORCH)
- cognitive, motor, neuro difficulties (decreased oxygen carrying capacity/ dysfunctional oxygen delivery system
Clinical therapy/care for SGA/IUGR
- early recognition: US, BPP
- medical management of potential problems: early delivery
- nursing care: gestational age assessment at birth, identify signs of potential complications
what to anticipate in a LGA baby
- diabetic mother
- maternal weight
- multiparity
Complications of LGA
- brith trauma related to cephalopelvic disproportion: increased c/s
- hypoglycemia
complications of an infant for a diabetic mother
- birth trauma
- hypoglycemia
- hypocalcemia
- hyperbilirubinemia
- polycythemia
- respiratory distress syndrome
- congenital malformations`
clinical therapy and nursing assessment of LGA abby
- control maternal glucose
- neonatal glucose hourly during first 4 hours and q4 for 24hrs: not below 45: early feeding, IV glucose infusion
- respiratory and cardiac status
- screen for jaundice
premature infant assessment
- gestational age
- new milestones each week in utero. need to know what is functioning and what is not functioning to guide care
infant of substance abusng mother
tobacco: SIS, premature, low birth weight
- weed: lbw, preterm,
- alcohol: FAS
- drugs: infections, developmental problems, birth defects
complications of drug exposed newborn
- respiratory
- neonatal jaundice
- congenital anomalies and growth restriction
- behavioral abnormalities
- withdrawal (neonatal abstinence syndrome)
nursing assessment too drug exposed newborn
- discovering mother’s last drug intake
- assess for congenital malformation or complications (STI) related to exposure
- anticipate and identify newborn withdrawal: drug screen: urine and meconium
- neonatal abstinence syndrome: scoring for severity
newborn withdrawal symptoms
- exaggerated reflexes
- irritability
- hyperactivity
nursing care of drug exposure newborn
- reduce withdrawal symptoms
- swaddle
- monitor pulse and respirations
- monitor temperature for hyperthermia
- provide small, frequency feedings
- administer medication as ordered
inborn errors of metabolic
hereditary enzyme defects that block metabolic pathway that causes toxin build up which affects end organ function ad energy production and protein use
inborn errors of metabolism: phenylketonuria
- most common amino acid disorder where babies lack enzyme beed to convert phenylalanine to tyrosine. the metabolites then build up in blood and brain tissues. This can cause progressive and permanent intellectual disability.
- use Guthrie blood test for PKU which measure amount of phenylalanine
cold stress
heat loss that forces newborn to compensate bu using metabolic resources (O2 and glucose)
signs and symptoms of cold stress
- increases movement
- increases respirations
- decreased skin temperature and peripheral perfusion
- hypoglycemia
interventions for cold stress infant
- maintian neutral thermal environment
- rewarm slowly: skin to skin, radiant heat lamps, monitor skin temperature q15-30 min, warm IV fluids
- check glucose levels
- assess for acidosis
- parent education
infants at risk for hypoglycemia
- LGA
- SGA
- preterm
- stressed
treatment and assessment of hypoglycemia
- blood glucose within 30-60minutes
- s/s: jittery
- treat: feed asap, IV glucose if needed
hyperbilirubinemia
why does it happen?
related to basic mechanisms for neonatal transition and also: hemolytic anemia, polycythemia, bruising, hypothermia, hypoglycemia, acidosis, drugs
-also affected by race, genetics, nutrition, material/fetal factors, GA, BW
pathologic hyperbilirubinemia
- jaundice before 24 hours of age
- serum rises .2/hr or more than 5/day
- total serum: greater than 12 mg/dL
- clinical jaundice lasts more than 8 days
kernicterus
- acute bilirubin encephalopathy
- neurologic sequelae which may include CP, sensory dysfunction, delayed development
- exaggerated moro, high pitch cry, neurologic irritability
nursing intervention for hyperbilirubinemia
- screen all newborns with transcutaneous bile
- exchange transfusion: if newborn has hemolysis, unconjugated bilirubin level of 14mg/dl wight less than 2500g, less than 24 hour old, exchange may be best
phototherapy nursing care
- assessment: VS, feedings, output
- warmth: avoid cold
- protect eyes, cover genitalitia
- tactile stimulation*
- reposition every 2hrs
- parent question, concerns, contact
newborns with infection/sepsis
- anticipate sepsis neonatorum
- immature immune system: unable to produce well defined inflammatory response and lack IgM to protect against bacteria because it doesn’t cross the placenta
assessment for sepsis
- watch for temperature instability (hypothermia)
- watch for feeding intolerance: regurgitation, diarrhea
- watch for subtle behavioral changes: lethargic, hard to arouse
- assess for jaundice, petechial hemorrhages
- assess VS, tachycardia initially followed by spells of apnea, bradycardia, hypotension
