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
2
Q
What two conditions are part of respiratory distress syndrome?
A
Retinopathy of Prematurity
Bronchopulmomary dysplasia
3
Q
What conditions are associated with issues with gestational age?
A
SGA
LGA
IUGR
Post maturity syndrome
4
Q
What are two types of IUGR?
A
Symmetric IUGR
Asymmetric IUGR
5
Q
What condition is part of post-maturity syndrome?
A
Meconium aspiration syndrome (MAS)
6
Q
What conditions are part of congenital anomalies?
A
Neural tube defects
Cleft lip/palate
Imperforate anus
Dislocated hip/club foot
7
Q
GA: preterm infant
A
20-37 weeks
8
Q
GA: late preterm infant
A
34-36 6/7 weeks
9
Q
GA: Full term infant
A
39-40 6/7 weeks
10
Q
GA: Late term infant
A
41-41 6/7 weeks
11
Q
GA: Post-term infant
A
42 weeks and beyond
12
Q
Infants who are __ or __ have 20x greater risk for death
A
IUGR or SGA
13
Q
Low birth weight baby
A
<2500 grams
Less than 5.5 pounds
Regardless of gestation age
14
Q
Very low birth weight baby
A
<1500 grams or <3.3 lbs
15
Q
Extremely low birth wight baby
A
<1000g
<2.2 lbs
16
Q
Small for gestational age baby
A
Plot below 10th percentile
17
Q
Appropriate for gestational age baby
A
Plot between the 10th and 90th percentile
18
Q
Large for gestational age baby
A
Above the 90th percentile or >4000g
19
Q
How is IUGR defined?
A
Rate of growth does not meet expected growth pattern
20
Q
What is symmetrical IUGR?
A
Weight, length, and head circumference all affected
21
Q
What is asymmetrical IUGR/
A
Head normal, but body is disproportionally small (<10th percentile)
22
Q
Preterm labor defined as…
A
Labor between 20-37 weeks of pregnancy
23
Q
What is the number one perinatal and neonatal problem in the USA?
A
Pre term labor
24
Q
Preterm labor accounts for __ of live births
A
11.4%
25
What are the fetal implications for preterm labor?
Increased morbidity and mortality
Increased risk of birth trauma
Maturational deficiencies
26
What is the number one cause of death among infants?
Preterm birth
27
What types of births account for the majority of preterm mortalities?
Peri-viabe births
28
What is the chance of survival at 22 weeks?
6%
29
What is the chance of survival at 23 weeks?
26%
30
What is the chance of survival at 24 weeks?
55%
31
What is the chance of survival at 25 weeks?
72%
32
Self-care measures to prevent preterm labor:
A mother should rest...
2-3 times per day laying on her left side
33
Self-care measures to prevent preterm labor:
Drink __ amount of fluid each day and avoid...
2-3 quarts
caffeine
34
Self-care measures to prevent preterm labor:
Empty bladder at least...
Every 2 hrs during waking hours
35
Self-care measures to prevent preterm labor:
Avoid lifting...
Heavy objects. Have small children climb onto lap instead of picking them up
36
Self-care measures to prevent preterm labor:
Avoid prenatal breast preparation such as...
Nipple rolling or rubbing nipples with a towel to avoid uterine irritability
37
Self-care measures to prevent preterm labor:
Pace necessary activities to avoid...
overexertion
38
Self-care measures to prevent preterm labor:
Eliminate sexual activity that leads to...
Orgasm or includes nipple stimulation
39
Self-care measures to prevent preterm labor:
Find pleasurable ways to help compensate for...
Limited sexual practices
40
Self-care measures to prevent preterm labor:
Try to focus on...
one day at a time rather than long periods of time
41
Self-care measures to prevent preterm labor:
If on bed rest get...
dressed each day and rest on couch rather than isolated to the bedroom
42
What social factors are risk factors for preterm labor?
```
African American race
Smoking or substance abuse
Low socioeconomic status
Limited education
Late entry prenatal care
High levels of personal stress
```
43
What are health factors that increase the risk for preterm labor?
```
History of genital tract infection
Bleeding during pregnancy
Uterine anomaly
Infertility treatment
Multi fetal pregnancy
Underweight or obese
Periodontal disease
```
44
What are common causes of INDICATED preterm birth
```
DM or GDM
Chronic hypertension
Pre-eclampsia
Obstetrical disorders
Medical disorders
AMA
Fetal disorders
```
45
What does TTTS stand for?
twin to twin transfusion syndrome
46
What is TTTS?
The blood supply of one twin moves to the other and one is deprived of blood
47
When does TTTS occur?
Only in identical twins
48
Women with cervix length greater than __ are unlikely to give preterm birth even in the presence of contractions
30mm
49
How can preterm labor be predicted?
Using cervical length and fetal fibronectin
50
Which method of predicting preterm labor is not very effective? and why?
Using cervical length because changes in length occur over several weeks
51
What does FFN stand for?
fetal fibronectin
52
What is fetal fibronectin?
Glycoprotein found in vaginal and cervical secretions
53
How is a FFN test done?
Using a swab to collect secretions during a vaginal speculum exam
54
The FFN test is most valuable to detect who will...
NOT go into preterm labor
55
A negative FFN test means
the patient will not go into preterm labor
56
A negative FFN value is __
high
57
Women who have a high FFN value have a...
<1% chance of going into preterm labor within the next 2 weeks
58
How is preterm labor suppressed?
Tocolytics
59
What tocolytic is used to stop preterm labor?
Magnesium sulfate
60
How is magnesium sulfate given?
40g/1000cc piggyback to primary infusion
61
What is the loading dose of magnesium sulfate?
4-6g over 20-30 mins
62
What is the maintenance dose of magnesium sulfate?
1-4 grams per hour
63
What are side effects of magnesium sulfate?
Feeling flushed
| Nausea and vomiting, weakness, dizziness
64
What is the therapeutic range of magnesium sulfate?
5-8 mg/dL
65
Why is magnesium sulfate given?
For near protection during preterm labor for women 24-32
66
When is magnesium sulfate stopped?
Shouldn't be on longer than 24 hours
67
What respiratory rate should the nurse discontinue the mag sulfate?
RR <12
68
What urine output should the nurse discontinue the mag sulfate?
<25-30 mL/hr
69
What serum magnesium level should the nurse discontinue the mag sulfate?
9 mg/dL or higher
70
What patient s/s should the nurse discontinue the mag sulfate?
```
Pulmonary edema
Absent DTRs
Chest pain
Severe hypotension
Altered LOC
Extreme weakness
```
71
How does terbutaline work?
Smooth muscle relaxant and bronchodilator
72
How is terbutaline given?
SQ injection
73
What is the dose for terbutaline?
0.25 mg every 4 hrs for 24 hrs
74
What type of drug is terbutaline?
B mimetic
75
What are side effects of terbutaline?
Palpitations, tachycardia, headache, nausea, vomiting, hypotension, hyperglycemia
76
When should terbutaline be discontinued?
```
HR >130
BP <90/60
Chest pain
Arrhythmia
MI
Pulmonary edema
```
77
A patient with heart disease is having toxic effects of magnesium, can you give her terbutaline?
NO
78
A patient with diabetes is having toxic effects of magnesium, can you give her terbutaline?
NO
79
A patient with preeclampsia is having toxic effects of magnesium, can you give her terbutaline?
NO
80
A patient with hyperthyroidism is having adverse effects of magnesium, can you give her terbutaline?
NO
81
A patient with chorioamnionitis is having toxic effects of magnesium, can you give her terbutaline?
NO
82
A patient who is hemorrhaging is having adverse effects of magnesium, can she be given terbutaline?
NO
83
What medication is given to reverse cardiac effects of terbutaline?
Inderal
84
What tocolytic suppresses uterine smooth muscle by inhibiting prostaglandin?
Indomethacin/indocin
85
What is the dosage of indomethacin/indocin?
Intially 50 mg PO and then 25-50mg every 6 hrs for 48 hrs
86
Indomethacin/Indocin is only used gestations __ weeks
less than 32
87
Why is indomethacin/indocin only used in gestations less than 32 weeks?
Must have adequate amniotic fluid volume and function of ductus arteriosus before beginning treatment
88
What are the maternal side effects of indomethacin/indocin?
```
Nausea
Vomiting
Heartburn
GI bleeding
Thrombocytopenia
```
89
What are the fetal side effects of indomethacin/indocin?
Constriction of ductus arteriosus
oligohydramnios
neonatal pulmonary hypertension
90
A mother with renal disease is going into preterm labor. Can you give her indomethacin/indocin?
NO
91
A mother with liver disease is going into preterm labor. Can you give her indomethacin/indocin?
NO
92
A mother with active peptic ulcers is going into preterm labor. Can you give her indomethacin/indocin?
NO
93
A mother with poorly controlled asthma is going into preterm labor. Can you give her indomethacin/indocin?
NO
94
A mother with hypertension is going into preterm labor. Can you give her indomethacin/indocin?
NO
95
A mother with a coagulation disorder is going into preterm labor. Can you give her indomethacin/indocin?
NO
96
What are the contraindications of indomethacin/indocin?
```
Renal or liver disease
Active peptic ulcers
Poorly controlled asthma
Hypertension
Coagulation disorders
```
97
What are brand names of nifedipine?
Adalat
| Procardia
98
What type of medication is nifedipine?
Calcium channel blocker
99
How does nifedipine work?
Calcium channel blocker - works by relaxing smooth muscle by blocking calcium entry
100
What is the usually prescription for nifedipine?
10-20 mg PO q 3-6 hrs until contractions have stopped or are rare
101
After a patient has finished the first prescription of nifedipine, what is the second prescription?
30-60 mg long acting every 8-12 hrs for 48 hrs while steroids are given to baby for lung maturity
102
What are the side effects of nifedipine?
Head ache, flushing, dizziness, hypotension
103
What two medications are contraindicated while using nifedipine?
Magnesium sulfate
| terbutaline
104
Why is mag sulfate contraindicated with the use of nifedipine?
Skeletal muscle blockade
105
Why is terbutaline contraindicated with the use of nifedipine?
Effects on heart rate and blood pressure
106
What method of administration is contraindicated for nifedipine?
Sublingual
107
What is the major syndrome preterm babies are at risk for developing?
Respiratory distress
108
Why are preterm babies at risk for developing respiratory distress?
Have not yet developed adequate alveoli in their lungs where surfactant is produced
109
What are alveoli?
the terminal air scas at the ends of each lung branch
110
What is the role of surfactant in the lungs?
acts like a grease to keep the lung surfaces slippery so they don't stick together and cause atelectasis
111
What is the last part of the lung to form?
Alveoli
112
How can surfactant development be stimulated in a preterm baby?
Giving the mother betamethasone
| Rupture of membranes
113
Why two steroids are given for fetal lung maturity?
Betamethasone
| Dexamethasone
114
What type of steroids are given for fetal lung maturity?
Glucocorticoids
115
What other organs do betamethasone and dexamethasone help to mature?
Kidneys
Brain
Gut
116
What is the MOA of glucocorticoids for lung maturity?
Releases enzymes that cause production of lung surfactant
117
What gestational age are preterm babies able to get betamethasone injection?
24-34 weeks
118
Why are steroid injections given when the baby is 24-34 weeks?
These babies have reduced risk of inter ventricular hemorrhage, NEC, and neonatal death
119
What is the dosing of betamethasone?
12 mg IM x 2 doses 24 hrs apart
120
What is the dosing of dexamethasone?
6 mg IM x 4 doses 12 hrs apart
121
Where should the nurse administer beta or dexamethasone?
DEEP IM in the ventral gluteal or vests lateralis
122
What are nursing considerations for administering betamethasone/dexa?
Injection is painful
Assess blood glucose levels
Women will DM may need increased insulin
123
What skeletal issue do preterm babies have that make them at increased risk for respiratory distress?
Bony thorax is insufficiently calcified/hardened so it collapses easily
124
What respiratory problem do preterm babies have that puts them at risk for distress?
Respiratory passages are tiny and easily obstructed
| Weak or absent gag reflex
125
What are four treatments for respiratory distress syndrome in preterm babies?
Oxygen
Surfactant administration
Thermoregulation
ECMO
126
How is oxygen given to preterm babies with RDS?
CPAP
Mechanical ventilation
or high frequency ventilation
127
What is the role of ECMO in preterm babies with RDS?
Modified heart/lung machines that allows the baby's lungs to rest/heal
128
What are two complications of respiratory distress in preterm babies?
```
Retinopathy of prematurity
Bronchopulmonary dysplasia (BPD)
```
129
When do retinas reach maturity?
42-43 weeks
130
What causes retinopathy of premature babies?
When o2 is discontinued, hemorrhage and fibrosis may occur due to the vasoconstriction of o2
131
How long are babies with bronchopulmonary dysplasia on mechanical ventilation?
Greater than 14 days
132
What is bronchopulmonary dysplasia?
a condition that involves inflammation, architectural disruption, and disordered or delayed development of the infant lung
133
What is the treatment for bronchopulmonary dysplasia?
O2
Fluid restriction
Nutrition
Steroids
134
What is the normal progression of bronchopulmonary dysplasia?
Progresses to normalization usually
135
What is the normal respiratory rate of an infant?
30-60 breath per minute
136
Babies use their __ __ to breathe
abdominal muscles
137
What are early signs of respiratory distress syndrome?
Flaring of the nares with expiratory gut
138
What are late signs of respiratory distress syndrome?
Retractions, apneas spells, seesaw breathing pattern
| Change in color from pink to cyanotic (circumoroal and then general)
139
What 3 factors make preterm babies especially at risk for thermoregulation issues?
Lack of flexed posture for preserving heat
Very thin skin with capillaries close to surface
Lack of subq fat
140
What characteristics make normal babies subject to thermoregulation issues?
```
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
Respiratory distress syndrome occurs in babies primarily as a response to...
metabolic acidosis
142
What are 5 other issues that can cause respiratory distress syndrome in ALL babies?
```
Hypothermia
Sepsis
Hypoglycemia
Asphyxia
Meconium aspiration syndrome
```
143
What are 4 major symptoms of hypothermia?
Respiratory distress
Apnea
Hypoxemia
Metabolic acidosis
144
What are other signs of hypothermia in babies?
```
Acrocyanosis
Cool, mottles, pale skin
Transient hyperglycemia
Bradycardia
Tachypnea
Restlessness
Shallow irregular breaths
Lethargy
Hypotonia
Feeble cry
Poor feeding
Poor weight gain
```
145
What are signs and symptoms of hyperthermia in babies?
```
Tachycardia
Tachypnea
Apnea
Warm extremities
Flushing
Dehydration
Lethargic
Hypotonia
Irritability
Weak cry
```
146
What are potential causes of fetal hyperthermia?
```
Overheating
Maternal fever
Epidural anesthesia
Phototherapy
Infection
CNS disorders
Dehydration
```
147
What is the most important consequence of hyperthermia?
Respiratory distress
148
What are consequences of hyperthermia in infants?
```
Hypotension
Dehydration
Seizures
Apnea
Hypernatremia
Respiratory distress
```
149
Why does hyperthermia result in hypotension and dehydration in the infant?
Results from increased insensible water loss
150
What is the management of hyperthermia in the infant?
Move away from heat source or lower air temperature in incubator
Frequent breast feeding to replace lost fluids
151
What are three factors that contribute to infants becoming septic?
Shortage of maternal immunoglobulins
Impaired ability to make antibodies
Compromised integumentary system (think skin, fragile capillaries)
152
What are signs/symptoms of sepsis in infants?
```
Temperature instability
Lethargy
Irritability
Change in color
Cardio instability
GI problems
Metabolic acidosis
Repository distress
```
153
Because preterm babies will not perform the same in growth and development as their peers...
The age of all preemies is adjusted when development is evaluated
154
When are preterm babies usually discharged??
36-40 week post conception age
155
A preterm baby at 36-40 weeks should have head lag response...
Baby should raise head parallel to body when lift from a prone position
156
A preterm baby at 36-40 weeks should have the ability to cry...
vigorously when hungry
157
A preterm baby at 36-40 weeks should have an appropriate weight and pattern...
of growth curves
158
A preterm baby at 36-40 weeks should have neurologic responses appropriate for corrected age such as...
able to follow examiner with eyes
159
Intraventricular hemorrhage in preterm babies can be mild or include...
cerebral palsy
hydrocephalus
severe learning disabilities
death
160
Incidence of intraventricular hemorrhage is highest in which group?
Babies less than 1500 grams or less than 35 weeks
161
Increased risk for intraventricular hemorrhage
Birth trauma
| Decreased clotting factors
162
What are common symptoms of intraventricular hemorrhage?
Seziures, posturing, coma, or decreased consciousness. Also respiratory distress and bulging fontanel
163
What are 3 conditions necrotizing enterocolitis is associated with?
Intestinal ischemia due to hypoxia
Bacterial colonization of gut
Enteral feedings (versus breast feeding)
164
10% of all low birth weight babies will have __ __
necrotizing enterocolitis
165
What percentage of babies with necrotizing enterocolitis are preemies?
More than 90%
166
What is the mortality rate of necrotizing enterocolitis?
30%
167
When does necrotizing enterocolitis occur?
Usually within 1-3 days after birth but can take up to 30 days
168
How is necrotizing enterocolitis treated?
```
Surgery
NPO
TPN
ABX
May have bowel transplant if severe
```
169
What are maternal lifestyle factors that contribute to small gestational age?
Poor weight gain
Drugs
Alcohol abuse
170
What are maternal disease factors that contribute to small gestational age?
Hypertension
| Preeclampsia
171
What are environmental factor can contribute to SGA?
Teratogens
172
What placental factor can contribute to SGA?
Aging due to post maturity
173
What fetal factors contribute to SGA?
Infections
| Chromosomal abnormalities
174
What fetal factors contribute to large gestational age?
Male neonates
| Beckwith-Wiedemann syndrome
175
What is Beckwith-Wiedemann syndrome?
Genetic abnormality that causes overgrowth syndrome
176
What maternal health factors can contribute to LGA?
Multiparous
Excessive weight gain
Erythroblastosis fetalis
DM
177
Diabetes in pregnancy often results in...
Macrosomia
178
What race of women are more at risk for having LGA baby?
Hispanic
179
What is symmetric IUGR caused by?
Long-term maternal conditions
180
How is IUGR diagnosed?
On ultrasound
181
What does IUGR symmetric affect?
Growth in size of organs, weight, length, and head circumference
182
What causes asymmetric IUGR?
Acute compromise of uretoplacental blood flow
183
Asymmetric IUGR is not present before...
the third trimester
184
__ __ is usually spared in asymmetric IUGR
Head growth
185
What are the parameters of asymmetric IUGR?
Birth weight SGA
| Length and head circumference AGA
186
What are 9 complications of SGA or IUGR
```
Hypoxia
Meconium aspiration syndrome
Hypothermia
Hypoglycemia
Polycythemia
Congenital malformations
intrauterine infections
Continued growth difficulties
Cognitive difficulties
```
187
What are 11 complications of LGA or post maturity?
```
CPD
Hypoglycemia
Polycythemia
Hypocalcemia
Hyperviscosity
Hyperbilirubinemia
MAS
Seizures
Cold stress
RDS
Birth defect
```
188
What is meconium aspiration syndrome?
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
What is a potential neural tube defect?
Anencephaly
| Spina bifida
190
What is hydrocephalus?
Accumulation of CSF in subdural or subarachnoid space caused by overproduction or reduced reabsorption of CSF
191
What types of spina bifida can be seen from outside the baby?
Meningocele
| Myelomeningocele
192
What is the greatest immediate risk of cleft lip or palate?
Aspiration during feedings
193
When does imperforate anus occur in development?
5-7th week
194
Half of babies with anorectal malformations have other abnormalities such as...
```
Kidney tract problems
Reproductive
Spinal
Tracheal esophageal fistula
Limb defects (forearm)
Down syndrome
```
195
Most babies with an anorectal malformation will require..
surgery
196
What is clubfoot?
Tendons connecting the muscles to the bones are shorter than usual
197
How is clubfoot treated?
Usually without surgery using casting or braces to realign ankles
198
What is developmental dislocation of the hip? DDH
hip joint not formed fully, ball is loose in socket
199
How is DDH treated?
Plavik harness for 6-12 weeks. If unsuccessful surgery
200
What are symptoms of DDH?
Legs different lengths
Uneven skin folds of the thigh
Less mobility or flexibility on one side
201
What are risk factors for DDH?
```
Girls
First born children
Breech (especially with feet by shoulders)
Family history
Oligohydramnios
```
202
What percentage of pregnancies are complicated by substance abuse?
15%
203
What are barriers to treatment for pregnant women who abuse drugs?
```
Social stigma
Guilt
Long wait lists
Labelling
Criminal prosecution
Fear of losing custody of their children
```
204
What at the the most commonly abused substances during pregnancy?
Smoking
Alcohol
Cocaine
Opioids
205
Smoking during pregnancy is associated with...
```
LBW
IUGR
Placenta previa
Placental abruption
PPROM
Ectopic pregnancy
SIDS
```
206
Drinking while pregnant is associated with...
Cognitive impairment
Issues with juvenile delinquency
Cognitive anomalies
207
Using cocaine while pregnant is associated with...
```
Miscarriage
Preterm labor
Placental abruption
Stillbirth
Birth defects
```
208
Abusing opioids while pregnant is associated with...
Neonatal abstinence syndrome
209
Opioids rapidly...
cross the placenta
210
What are the symptoms of NAS?
Irritability, sleep disorders, feeding problems that persist for weeks
211
What are complications of NAS?
```
Respiratory distress
Jaundice
Congenital anomalies
IUGR
Behavioral abnormalities
Withdrawal
```
212
What is the modified Finnegan Neonatal Abstinence score sheet?
Assessment too that scores severity of withdrawal from opioids
213
What is included in the Finngan Neonatal Abstinence score sheet?
21 most frequently observed symptoms given a score
214
When should the nurse use the Finnegan Neonatal Abstinence score sheet?
Two hours after birth to establish a baseline then every 4 hours after each feeding until the infant is ad lib
215
If the infant scores an 8 or greater on the Finnegan Neonatal Abstinence score sheet, what should the nurse do?
Score every 2 hours until NAS medication started, then every 4 hours or after every feeding
216
When are ad lib infants scored using the neonatal abstinence score sheet?
After every feeding
217
What is the initial treatment of a baby born with NAS?
```
Supportive- skin to skin
Safe swaddling
Gentle waking
Quiet
minimal stimulation
Low lighting
Calm music
Massage therapy
```
218
What are nursing interventions for a baby born with NAS?
Supportive care
Cluster care
Encourage parental involvement
Continue breast feeding
219
Mothers on methadone or buprenorphine should be encourage to...
continue breastfeeding
220
Mothers who are still using opioids still continue to breast feed because...
It can delay the onset and decrease the severity of withdrawal symptoms as well as decrease the need for pharmacological treatment
221
What are the most common first line medications used to treat NAS?
Morphine and methadone
222
Which is better, oral or sublingual morphine?
SL, linked to shorter hospital stays
223
What is the discharge criteria for infants born with NAS?
Be off all NAS-related medications
| Continue to score for 72 hours
