High Risk Neonatal Nursing Care- 17 Flashcards
Very premature:
Neonates born at less than 32 weeks’ gestation
Premature
Neonates born between 32 and 34 weeks’ gestation.
Late premature
Neonates born between 34 and 37 weeks’ gestation.
Low birth weight
Less than 2,500 g at birth
Very low birth weight:
Less than 1,500 g at birth
Extremely low birth weight:
Less than 1,000 grams at birth
Types of risk factors
nonmodifiable risk factors-things you can’t change
Treatable/modifiable factors- things you can change.
Symmetric IUGR,
generalized proportional reduction in the size of all structures and organs except for heart and brain, occurs early in pregnancy and affects general growth.
Asymmetric IUGR
disproportional reduction in the size of structures and organs, results from maternal or placental conditions that occur later in pregnancy and impede placental blood flow.
IUGR
intrauterine growth restriction
Neonates with IUGR are at risk
● Labor intolerance
● Meconium aspiration related to asphyxia during labor.
● Hypoglycemia
● Hypocalcemia
IUGR s/s
● Large head in relationship to the body.
● Long nails.
● Large anterior fontanel.
● Decreased amounts of Wharton’s jelly present in the umbilical cord.
● Thin extremities and trunk.
● Loose skin due to a lack of subcutaneous fat.
● Dry, flaky, and/or meconium-stained skin. ●size below 10th percentile ● RDS can occur ● polycythemia ● hypothermia
large for gestational age (LGA)
has a weight above the 90th percentile
LGA risk factors
● Maternal diabetes
● Multiparity
● Previous macrosomic baby
● Prolonged pregnancy
LGA at risk for
● Cesarean births.
● Operative vaginal delivery.
● Shoulder dystocia.
● Breech presentation.
● Birth trauma.
● Cephalopelvic disproportion.
● Hypoglycemia.
● Hyperbilirubinemia.
Hyperbilirubinemia
increased levels of bilirubin in the blood
Physiological jaundice
results from hyperbilirubinemia that commonly occurs after the first 24 hours of birth and during the first week of life.
physiological characteristics of the neonate place it at risk for physiological jaundice:
● Increased RBC volume
● RBC life span of 70 to 90 days, compared to 120 days in adults
● High bilirubin production (6 to 8 mg/kg/day)
● Neonates reabsorb increased amounts of unconjugated bilirubin in the intestine
● Decreased hepatic uptake of bilirubin from the plasma
● Diminished conjugation of bilirubin in the liver
Physiological Jaundice s/s
●Physiological jaundice is typically visible after 24 hours of life.
● Total serum bilirubin levels generally peak on day 3 of life in term neonates and on days 5 or 6 in preterm neonates
● Jaundice is characterized by a yellowish tint to the skin and sclera of the eyes.
● As total serum bilirubin levels rise, jaundice will progress from the newborn’s head down toward the trunk and lower extremities.
Pathological Jaundice
results when various disorders exacerbate physiological processes that lead to hyperbilirubinemia of the newborn
Pathological Jaundice s/s
● Jaundice that occurs within the first 24 hours of life
● Total serum bilirubin levels that increase by more than 5 mg/dL per day
● Jaundice lasting more than 1 week in a term newborn or more than 2 weeks in a premature neonate day
● Risk factors, medical management, and nursing actions are similar for both physiological and pathological jaundice.
side effects of phototherapy:
● Eye damage
● Loose stools
● Dehydration
● Hyperthermia
● Lethargy
● Skin rashes
● Abdominal distention
● Hypocalcemia
● Lactose intolerance
● Thrombocytopenia
● Bronze baby syndrome: Dark gray-brown pigmentation of skin that disappears after phototherapy is discontinued.
Phototherapy
most widely used and effective treatment for hyperbilirubinemia.
CNS injuries risk factors
● Prematurity
● Birth trauma
● Breech delivery or other malpresentations
● Precipitous labor
● Difficult labor, traumatic delivery, and use of forceps
● Hypoxia, asphyxia, hypotension, ischemia, respiratory distress.
