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OB/GYN > High Risk Neonate > Flashcards

High Risk Neonate Flashcards

1
Q

What high risk conditions are associated with prematurity?

A 
Retinopathy of prematurity
Bronchopulmonary dysplasia
Hypo/hyper thermal
Sepsis
Intraventricular hemorrhage
Necrotizing enterocolitis
Effect of prematurity on growth and development
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2
Q

What two conditions are part of respiratory distress syndrome?

A

Retinopathy of Prematurity

Bronchopulmomary dysplasia

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3
Q

What conditions are associated with issues with gestational age?

A

SGA
LGA
IUGR
Post maturity syndrome

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4
Q

What are two types of IUGR?

A

Symmetric IUGR

Asymmetric IUGR

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5
Q

What condition is part of post-maturity syndrome?

A

Meconium aspiration syndrome (MAS)

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6
Q

What conditions are part of congenital anomalies?

A

Neural tube defects
Cleft lip/palate
Imperforate anus
Dislocated hip/club foot

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7
Q

GA: preterm infant

A

20-37 weeks

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8
Q

GA: late preterm infant

A

34-36 6/7 weeks

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9
Q

GA: Full term infant

A

39-40 6/7 weeks

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10
Q

GA: Late term infant

A

41-41 6/7 weeks

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11
Q

GA: Post-term infant

A

42 weeks and beyond

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12
Q

Infants who are __ or __ have 20x greater risk for death

A

IUGR or SGA

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13
Q

Low birth weight baby

A

<2500 grams
Less than 5.5 pounds
Regardless of gestation age

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14
Q

Very low birth weight baby

A

<1500 grams or <3.3 lbs

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15
Q

Extremely low birth wight baby

A

<1000g

<2.2 lbs

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16
Q

Small for gestational age baby

A

Plot below 10th percentile

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17
Q

Appropriate for gestational age baby

A

Plot between the 10th and 90th percentile

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18
Q

Large for gestational age baby

A

Above the 90th percentile or >4000g

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19
Q

How is IUGR defined?

A

Rate of growth does not meet expected growth pattern

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20
Q

What is symmetrical IUGR?

A

Weight, length, and head circumference all affected

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21
Q

What is asymmetrical IUGR/

A

Head normal, but body is disproportionally small (<10th percentile)

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22
Q

Preterm labor defined as…

A

Labor between 20-37 weeks of pregnancy

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23
Q

What is the number one perinatal and neonatal problem in the USA?

A

Pre term labor

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24
Q

Preterm labor accounts for __ of live births

A

11.4%

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25
Q

What are the fetal implications for preterm labor?

A

Increased morbidity and mortality
Increased risk of birth trauma
Maturational deficiencies

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26
Q

What is the number one cause of death among infants?

A

Preterm birth

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27
Q

What types of births account for the majority of preterm mortalities?

A

Peri-viabe births

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28
Q

What is the chance of survival at 22 weeks?

A

6%

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29
Q

What is the chance of survival at 23 weeks?

A

26%

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30
Q

What is the chance of survival at 24 weeks?

A

55%

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31
Q

What is the chance of survival at 25 weeks?

A

72%

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32
Q

Self-care measures to prevent preterm labor:

A mother should rest…

A

2-3 times per day laying on her left side

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33
Q

Self-care measures to prevent preterm labor:

Drink __ amount of fluid each day and avoid…

A

2-3 quarts

caffeine

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34
Q

Self-care measures to prevent preterm labor:

Empty bladder at least…

A

Every 2 hrs during waking hours

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35
Q

Self-care measures to prevent preterm labor:

Avoid lifting…

A

Heavy objects. Have small children climb onto lap instead of picking them up

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36
Q

Self-care measures to prevent preterm labor:

Avoid prenatal breast preparation such as…

A

Nipple rolling or rubbing nipples with a towel to avoid uterine irritability

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37
Q

Self-care measures to prevent preterm labor:

Pace necessary activities to avoid…

A

overexertion

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38
Q

Self-care measures to prevent preterm labor:

Eliminate sexual activity that leads to…

A

Orgasm or includes nipple stimulation

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39
Q

Self-care measures to prevent preterm labor:

Find pleasurable ways to help compensate for…

A

Limited sexual practices

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40
Q

Self-care measures to prevent preterm labor:

Try to focus on…

A

one day at a time rather than long periods of time

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41
Q

Self-care measures to prevent preterm labor:

If on bed rest get…

A

dressed each day and rest on couch rather than isolated to the bedroom

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42
Q

What social factors are risk factors for preterm labor?

A 
African American race
Smoking or substance abuse
Low socioeconomic status
Limited education
Late entry prenatal care
High levels of personal stress
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43
Q

What are health factors that increase the risk for preterm labor?

A 
History of genital tract infection
Bleeding during pregnancy
Uterine anomaly
Infertility treatment
Multi fetal pregnancy
Underweight or obese
Periodontal disease
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44
Q

What are common causes of INDICATED preterm birth

A 
DM or GDM
Chronic hypertension
Pre-eclampsia
Obstetrical disorders
Medical disorders
AMA
Fetal disorders
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45
Q

What does TTTS stand for?

A

twin to twin transfusion syndrome

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46
Q

What is TTTS?

A

The blood supply of one twin moves to the other and one is deprived of blood

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47
Q

When does TTTS occur?

A

Only in identical twins

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48
Q

Women with cervix length greater than __ are unlikely to give preterm birth even in the presence of contractions

A

30mm

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49
Q

How can preterm labor be predicted?

A

Using cervical length and fetal fibronectin

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50
Q

Which method of predicting preterm labor is not very effective? and why?

A

Using cervical length because changes in length occur over several weeks

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51
Q

What does FFN stand for?

A

fetal fibronectin

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52
Q

What is fetal fibronectin?

A

Glycoprotein found in vaginal and cervical secretions

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53
Q

How is a FFN test done?

A

Using a swab to collect secretions during a vaginal speculum exam

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54
Q

The FFN test is most valuable to detect who will…

A

NOT go into preterm labor

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55
Q

A negative FFN test means

A

the patient will not go into preterm labor

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56
Q

A negative FFN value is __

A

high

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57
Q

Women who have a high FFN value have a…

A

<1% chance of going into preterm labor within the next 2 weeks

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58
Q

How is preterm labor suppressed?

A

Tocolytics

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59
Q

What tocolytic is used to stop preterm labor?

A

Magnesium sulfate

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60
Q

How is magnesium sulfate given?

A

40g/1000cc piggyback to primary infusion

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61
Q

What is the loading dose of magnesium sulfate?

A

4-6g over 20-30 mins

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62
Q

What is the maintenance dose of magnesium sulfate?

A

1-4 grams per hour

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63
Q

What are side effects of magnesium sulfate?

A

Feeling flushed

Nausea and vomiting, weakness, dizziness

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64
Q

What is the therapeutic range of magnesium sulfate?

A

5-8 mg/dL

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65
Q

Why is magnesium sulfate given?

A

For near protection during preterm labor for women 24-32

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66
Q

When is magnesium sulfate stopped?

A

Shouldn’t be on longer than 24 hours

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67
Q

What respiratory rate should the nurse discontinue the mag sulfate?

A

RR <12

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68
Q

What urine output should the nurse discontinue the mag sulfate?

A

<25-30 mL/hr

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69
Q

What serum magnesium level should the nurse discontinue the mag sulfate?

A

9 mg/dL or higher

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70
Q

What patient s/s should the nurse discontinue the mag sulfate?

A 
Pulmonary edema
Absent DTRs
Chest pain
Severe hypotension
Altered LOC
Extreme weakness
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71
Q

How does terbutaline work?

A

Smooth muscle relaxant and bronchodilator

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72
Q

How is terbutaline given?

A

SQ injection

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73
Q

What is the dose for terbutaline?

A

0.25 mg every 4 hrs for 24 hrs

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74
Q

What type of drug is terbutaline?

A

B mimetic

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75
Q

What are side effects of terbutaline?

A

Palpitations, tachycardia, headache, nausea, vomiting, hypotension, hyperglycemia

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76
Q

When should terbutaline be discontinued?

A 
HR >130
BP <90/60
Chest pain
Arrhythmia 
MI
Pulmonary edema
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77
Q

A patient with heart disease is having toxic effects of magnesium, can you give her terbutaline?

A

NO

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78
Q

A patient with diabetes is having toxic effects of magnesium, can you give her terbutaline?

A

NO

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79
Q

A patient with preeclampsia is having toxic effects of magnesium, can you give her terbutaline?

A

NO

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80
Q

A patient with hyperthyroidism is having adverse effects of magnesium, can you give her terbutaline?

A

NO

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81
Q

A patient with chorioamnionitis is having toxic effects of magnesium, can you give her terbutaline?

A

NO

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82
Q

A patient who is hemorrhaging is having adverse effects of magnesium, can she be given terbutaline?

A

NO

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83
Q

What medication is given to reverse cardiac effects of terbutaline?

A

Inderal

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84
Q

What tocolytic suppresses uterine smooth muscle by inhibiting prostaglandin?

A

Indomethacin/indocin

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85
Q

What is the dosage of indomethacin/indocin?

A

Intially 50 mg PO and then 25-50mg every 6 hrs for 48 hrs

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86
Q

Indomethacin/Indocin is only used gestations __ weeks

A

less than 32

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87
Q

Why is indomethacin/indocin only used in gestations less than 32 weeks?

A

Must have adequate amniotic fluid volume and function of ductus arteriosus before beginning treatment

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88
Q

What are the maternal side effects of indomethacin/indocin?

A 
Nausea
Vomiting
Heartburn
GI bleeding
Thrombocytopenia
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89
Q

What are the fetal side effects of indomethacin/indocin?

A

Constriction of ductus arteriosus
oligohydramnios
neonatal pulmonary hypertension

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90
Q

A mother with renal disease is going into preterm labor. Can you give her indomethacin/indocin?

A

NO

91
Q

A mother with liver disease is going into preterm labor. Can you give her indomethacin/indocin?

A

NO

92
Q

A mother with active peptic ulcers is going into preterm labor. Can you give her indomethacin/indocin?

A

NO

93
Q

A mother with poorly controlled asthma is going into preterm labor. Can you give her indomethacin/indocin?

A

NO

94
Q

A mother with hypertension is going into preterm labor. Can you give her indomethacin/indocin?

A

NO

95
Q

A mother with a coagulation disorder is going into preterm labor. Can you give her indomethacin/indocin?

A

NO

96
Q

What are the contraindications of indomethacin/indocin?

A 
Renal or liver disease
Active peptic ulcers
Poorly controlled asthma
Hypertension
Coagulation disorders
97
Q

What are brand names of nifedipine?

A

Adalat

Procardia

98
Q

What type of medication is nifedipine?

A

Calcium channel blocker

99
Q

How does nifedipine work?

A

Calcium channel blocker - works by relaxing smooth muscle by blocking calcium entry

100
Q

What is the usually prescription for nifedipine?

A

10-20 mg PO q 3-6 hrs until contractions have stopped or are rare

101
Q

After a patient has finished the first prescription of nifedipine, what is the second prescription?

A

30-60 mg long acting every 8-12 hrs for 48 hrs while steroids are given to baby for lung maturity

102
Q

What are the side effects of nifedipine?

A

Head ache, flushing, dizziness, hypotension

103
Q

What two medications are contraindicated while using nifedipine?

A

Magnesium sulfate

terbutaline

104
Q

Why is mag sulfate contraindicated with the use of nifedipine?

A

Skeletal muscle blockade

105
Q

Why is terbutaline contraindicated with the use of nifedipine?

A

Effects on heart rate and blood pressure

106
Q

What method of administration is contraindicated for nifedipine?

A

Sublingual

107
Q

What is the major syndrome preterm babies are at risk for developing?

A

Respiratory distress

108
Q

Why are preterm babies at risk for developing respiratory distress?

A

Have not yet developed adequate alveoli in their lungs where surfactant is produced

109
Q

What are alveoli?

A

the terminal air scas at the ends of each lung branch

110
Q

What is the role of surfactant in the lungs?

A

acts like a grease to keep the lung surfaces slippery so they don’t stick together and cause atelectasis

111
Q

What is the last part of the lung to form?

A

Alveoli

112
Q

How can surfactant development be stimulated in a preterm baby?

A

Giving the mother betamethasone

Rupture of membranes

113
Q

Why two steroids are given for fetal lung maturity?

A

Betamethasone

Dexamethasone

114
Q

What type of steroids are given for fetal lung maturity?

A

Glucocorticoids

115
Q

What other organs do betamethasone and dexamethasone help to mature?

A

Kidneys
Brain
Gut

116
Q

What is the MOA of glucocorticoids for lung maturity?

A

Releases enzymes that cause production of lung surfactant

117
Q

What gestational age are preterm babies able to get betamethasone injection?

A

24-34 weeks

118
Q

Why are steroid injections given when the baby is 24-34 weeks?

A

These babies have reduced risk of inter ventricular hemorrhage, NEC, and neonatal death

119
Q

What is the dosing of betamethasone?

A

12 mg IM x 2 doses 24 hrs apart

120
Q

What is the dosing of dexamethasone?

A

6 mg IM x 4 doses 12 hrs apart

121
Q

Where should the nurse administer beta or dexamethasone?

A

DEEP IM in the ventral gluteal or vests lateralis

122
Q

What are nursing considerations for administering betamethasone/dexa?

A

Injection is painful
Assess blood glucose levels
Women will DM may need increased insulin

123
Q

What skeletal issue do preterm babies have that make them at increased risk for respiratory distress?

A

Bony thorax is insufficiently calcified/hardened so it collapses easily

124
Q

What respiratory problem do preterm babies have that puts them at risk for distress?

A

Respiratory passages are tiny and easily obstructed

Weak or absent gag reflex

125
Q

What are four treatments for respiratory distress syndrome in preterm babies?

A

Oxygen
Surfactant administration
Thermoregulation
ECMO

126
Q

How is oxygen given to preterm babies with RDS?

A

CPAP
Mechanical ventilation
or high frequency ventilation

127
Q

What is the role of ECMO in preterm babies with RDS?

A

Modified heart/lung machines that allows the baby’s lungs to rest/heal

128
Q

What are two complications of respiratory distress in preterm babies?

A 
Retinopathy of prematurity
Bronchopulmonary dysplasia (BPD)
129
Q

When do retinas reach maturity?

A

42-43 weeks

130
Q

What causes retinopathy of premature babies?

A

When o2 is discontinued, hemorrhage and fibrosis may occur due to the vasoconstriction of o2

131
Q

How long are babies with bronchopulmonary dysplasia on mechanical ventilation?

A

Greater than 14 days

132
Q

What is bronchopulmonary dysplasia?

A

a condition that involves inflammation, architectural disruption, and disordered or delayed development of the infant lung

133
Q

What is the treatment for bronchopulmonary dysplasia?

A

O2
Fluid restriction
Nutrition
Steroids

134
Q

What is the normal progression of bronchopulmonary dysplasia?

A

Progresses to normalization usually

135
Q

What is the normal respiratory rate of an infant?

A

30-60 breath per minute

136
Q

Babies use their __ __ to breathe

A

abdominal muscles

137
Q

What are early signs of respiratory distress syndrome?

A

Flaring of the nares with expiratory gut

138
Q

What are late signs of respiratory distress syndrome?

A

Retractions, apneas spells, seesaw breathing pattern

Change in color from pink to cyanotic (circumoroal and then general)

139
Q

What 3 factors make preterm babies especially at risk for thermoregulation issues?

A

Lack of flexed posture for preserving heat
Very thin skin with capillaries close to surface
Lack of subq fat

140
Q

What characteristics make normal babies subject to thermoregulation issues?

A 
Large surface are to body ratio
Decreased subq fat
Greater water body content
Immature skin leading to increased water evaporation and heat loss
Can't shiver
Altered skin blood flow
141
Q

Respiratory distress syndrome occurs in babies primarily as a response to…

A

metabolic acidosis

142
Q

What are 5 other issues that can cause respiratory distress syndrome in ALL babies?

A 
Hypothermia
Sepsis
Hypoglycemia
Asphyxia
Meconium aspiration syndrome
143
Q

What are 4 major symptoms of hypothermia?

A

Respiratory distress
Apnea
Hypoxemia
Metabolic acidosis

144
Q

What are other signs of hypothermia in babies?

A 
Acrocyanosis 
Cool, mottles, pale skin
Transient hyperglycemia
Bradycardia
Tachypnea
Restlessness
Shallow irregular breaths
Lethargy
Hypotonia
Feeble cry 
Poor feeding
Poor weight gain
145
Q

What are signs and symptoms of hyperthermia in babies?

A 
Tachycardia
Tachypnea
Apnea
Warm extremities 
Flushing
Dehydration
Lethargic
Hypotonia
Irritability
Weak cry
146
Q

What are potential causes of fetal hyperthermia?

A 
Overheating
Maternal fever
Epidural anesthesia
Phototherapy
Infection
CNS disorders
Dehydration
147
Q

What is the most important consequence of hyperthermia?

A

Respiratory distress

148
Q

What are consequences of hyperthermia in infants?

A 
Hypotension 
Dehydration
Seizures
Apnea
Hypernatremia
Respiratory distress
149
Q

Why does hyperthermia result in hypotension and dehydration in the infant?

A

Results from increased insensible water loss

150
Q

What is the management of hyperthermia in the infant?

A

Move away from heat source or lower air temperature in incubator
Frequent breast feeding to replace lost fluids

151
Q

What are three factors that contribute to infants becoming septic?

A

Shortage of maternal immunoglobulins
Impaired ability to make antibodies
Compromised integumentary system (think skin, fragile capillaries)

152
Q

What are signs/symptoms of sepsis in infants?

A 
Temperature instability
Lethargy
Irritability
Change in color
Cardio instability 
GI problems
Metabolic acidosis
Repository distress
153
Q

Because preterm babies will not perform the same in growth and development as their peers…

A

The age of all preemies is adjusted when development is evaluated

154
Q

When are preterm babies usually discharged??

A

36-40 week post conception age

155
Q

A preterm baby at 36-40 weeks should have head lag response…

A

Baby should raise head parallel to body when lift from a prone position

156
Q

A preterm baby at 36-40 weeks should have the ability to cry…

A

vigorously when hungry

157
Q

A preterm baby at 36-40 weeks should have an appropriate weight and pattern…

A

of growth curves

158
Q

A preterm baby at 36-40 weeks should have neurologic responses appropriate for corrected age such as…

A

able to follow examiner with eyes

159
Q

Intraventricular hemorrhage in preterm babies can be mild or include…

A

cerebral palsy
hydrocephalus
severe learning disabilities
death

160
Q

Incidence of intraventricular hemorrhage is highest in which group?

A

Babies less than 1500 grams or less than 35 weeks

161
Q

Increased risk for intraventricular hemorrhage

A

Birth trauma

Decreased clotting factors

162
Q

What are common symptoms of intraventricular hemorrhage?

A

Seziures, posturing, coma, or decreased consciousness. Also respiratory distress and bulging fontanel

163
Q

What are 3 conditions necrotizing enterocolitis is associated with?

A

Intestinal ischemia due to hypoxia
Bacterial colonization of gut
Enteral feedings (versus breast feeding)

164
Q

10% of all low birth weight babies will have __ __

A

necrotizing enterocolitis

165
Q

What percentage of babies with necrotizing enterocolitis are preemies?

A

More than 90%

166
Q

What is the mortality rate of necrotizing enterocolitis?

A

30%

167
Q

When does necrotizing enterocolitis occur?

A

Usually within 1-3 days after birth but can take up to 30 days

168
Q

How is necrotizing enterocolitis treated?

A 
Surgery
NPO
TPN
ABX
May have bowel transplant if severe
169
Q

What are maternal lifestyle factors that contribute to small gestational age?

A

Poor weight gain
Drugs
Alcohol abuse

170
Q

What are maternal disease factors that contribute to small gestational age?

A

Hypertension

Preeclampsia

171
Q

What are environmental factor can contribute to SGA?

A

Teratogens

172
Q

What placental factor can contribute to SGA?

A

Aging due to post maturity

173
Q

What fetal factors contribute to SGA?

A

Infections

Chromosomal abnormalities

174
Q

What fetal factors contribute to large gestational age?

A

Male neonates

Beckwith-Wiedemann syndrome

175
Q

What is Beckwith-Wiedemann syndrome?

A

Genetic abnormality that causes overgrowth syndrome

176
Q

What maternal health factors can contribute to LGA?

A

Multiparous
Excessive weight gain
Erythroblastosis fetalis
DM

177
Q

Diabetes in pregnancy often results in…

A

Macrosomia

178
Q

What race of women are more at risk for having LGA baby?

A

Hispanic

179
Q

What is symmetric IUGR caused by?

A

Long-term maternal conditions

180
Q

How is IUGR diagnosed?

A

On ultrasound

181
Q

What does IUGR symmetric affect?

A

Growth in size of organs, weight, length, and head circumference

182
Q

What causes asymmetric IUGR?

A

Acute compromise of uretoplacental blood flow

183
Q

Asymmetric IUGR is not present before…

A

the third trimester

184
Q

__ __ is usually spared in asymmetric IUGR

A

Head growth

185
Q

What are the parameters of asymmetric IUGR?

A

Birth weight SGA

Length and head circumference AGA

186
Q

What are 9 complications of SGA or IUGR

A 
Hypoxia
Meconium aspiration syndrome
Hypothermia
Hypoglycemia
Polycythemia
Congenital malformations
intrauterine infections
Continued growth difficulties
Cognitive difficulties
187
Q

What are 11 complications of LGA or post maturity?

A 
CPD
Hypoglycemia
Polycythemia
Hypocalcemia
Hyperviscosity
Hyperbilirubinemia 
MAS
Seizures
Cold stress
RDS
Birth defect
188
Q

What is meconium aspiration syndrome?

A

When fetus becomes hypoxic it causes relaxation of anal sphincter and meconium is released. Reflex gasping causes meconium to enter fetal lungs obstructing breathing after birth

189
Q

What is a potential neural tube defect?

A

Anencephaly

Spina bifida

190
Q

What is hydrocephalus?

A

Accumulation of CSF in subdural or subarachnoid space caused by overproduction or reduced reabsorption of CSF

191
Q

What types of spina bifida can be seen from outside the baby?

A

Meningocele

Myelomeningocele

192
Q

What is the greatest immediate risk of cleft lip or palate?

A

Aspiration during feedings

193
Q

When does imperforate anus occur in development?

A

5-7th week

194
Q

Half of babies with anorectal malformations have other abnormalities such as…

A 
Kidney tract problems
Reproductive 
Spinal
Tracheal esophageal fistula 
Limb defects (forearm)
Down syndrome
195
Q

Most babies with an anorectal malformation will require..

A

surgery

196
Q

What is clubfoot?

A

Tendons connecting the muscles to the bones are shorter than usual

197
Q

How is clubfoot treated?

A

Usually without surgery using casting or braces to realign ankles

198
Q

What is developmental dislocation of the hip? DDH

A

hip joint not formed fully, ball is loose in socket

199
Q

How is DDH treated?

A

Plavik harness for 6-12 weeks. If unsuccessful surgery

200
Q

What are symptoms of DDH?

A

Legs different lengths
Uneven skin folds of the thigh
Less mobility or flexibility on one side

201
Q

What are risk factors for DDH?

A 
Girls
First born children
Breech (especially with feet by shoulders)
Family history
Oligohydramnios
202
Q

What percentage of pregnancies are complicated by substance abuse?

A

15%

203
Q

What are barriers to treatment for pregnant women who abuse drugs?

A 
Social stigma
Guilt
Long wait lists
Labelling 
Criminal prosecution
Fear of losing custody of their children
204
Q

What at the the most commonly abused substances during pregnancy?

A

Smoking
Alcohol
Cocaine
Opioids

205
Q

Smoking during pregnancy is associated with…

A 
LBW
IUGR
Placenta previa
Placental abruption
PPROM
Ectopic pregnancy
SIDS
206
Q

Drinking while pregnant is associated with…

A

Cognitive impairment
Issues with juvenile delinquency
Cognitive anomalies

207
Q

Using cocaine while pregnant is associated with…

A 
Miscarriage
Preterm labor
Placental abruption
Stillbirth
Birth defects
208
Q

Abusing opioids while pregnant is associated with…

A

Neonatal abstinence syndrome

209
Q

Opioids rapidly…

A

cross the placenta

210
Q

What are the symptoms of NAS?

A

Irritability, sleep disorders, feeding problems that persist for weeks

211
Q

What are complications of NAS?

A 
Respiratory distress
Jaundice 
Congenital anomalies
IUGR
Behavioral abnormalities
Withdrawal
212
Q

What is the modified Finnegan Neonatal Abstinence score sheet?

A

Assessment too that scores severity of withdrawal from opioids

213
Q

What is included in the Finngan Neonatal Abstinence score sheet?

A

21 most frequently observed symptoms given a score

214
Q

When should the nurse use the Finnegan Neonatal Abstinence score sheet?

A

Two hours after birth to establish a baseline then every 4 hours after each feeding until the infant is ad lib

215
Q

If the infant scores an 8 or greater on the Finnegan Neonatal Abstinence score sheet, what should the nurse do?

A

Score every 2 hours until NAS medication started, then every 4 hours or after every feeding

216
Q

When are ad lib infants scored using the neonatal abstinence score sheet?

A

After every feeding

217
Q

What is the initial treatment of a baby born with NAS?

A 
Supportive- skin to skin 
Safe swaddling
Gentle waking
Quiet
minimal stimulation
Low lighting
Calm music
Massage therapy
218
Q

What are nursing interventions for a baby born with NAS?

A

Supportive care
Cluster care
Encourage parental involvement
Continue breast feeding

219
Q

Mothers on methadone or buprenorphine should be encourage to…

A

continue breastfeeding

220
Q

Mothers who are still using opioids still continue to breast feed because…

A

It can delay the onset and decrease the severity of withdrawal symptoms as well as decrease the need for pharmacological treatment

221
Q

What are the most common first line medications used to treat NAS?

A

Morphine and methadone

222
Q

Which is better, oral or sublingual morphine?

A

SL, linked to shorter hospital stays

223
Q

What is the discharge criteria for infants born with NAS?

A

Be off all NAS-related medications

Continue to score for 72 hours

OB/GYN (11 decks)

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