HIGH RISK NEWBORN - FINAL EXAM Flashcards
preterm infants
born less than 37 wks with immature organ systems and lack of nutrients
high risk infants are classified according to
birth wt, gestational age, pathophysiologic problems
extremely lbw
1000 g/2.2 lbs or less
very lbw
less than 1500 g/ 3.3 lbs
lbw
2500/5.5 lbs
very premature
less than 32 wks
late premature
born btw 34-37 wks
premature
born btw 32-34 wks
tone and flexion assessment
increases with gestation, hypotonic and extended tone and posture
skin assessment
translucent, transparent, red
subcut fat assessment
decreased fat leading to thermoregulation issues
lanugo assessment
present btw 20-28 wks and then will disappear
foot creases assessment
not present until 28-30 wks
eye assessment
eyelids fused in very preterm and open btw 26-30wks
overriding sutures assessment
common among prematures, lbw
pina assessment
thin, soft, flat, folded
respiratory and cardiovascular support for neonate
maintain patent airway and thermal environment, assess vitals, labs I/O
nursing action for preterm neonates
NTE, nutrition, fluid/electrolytes, test
cardiovascular support includes evaluation of
HR, rhythm, skin, murmurs, pulses, cap refill, BP, hemoglobin/hematocrit, blood transfusions
maintain fluid and electrolyte imbalances
monitor I/O, IV fluids, determine hydration, add humidity
nutrition needs for preterm
monitor blood glucose, breastfeeding, bonding, feedings
respiratory distress synddrome
alveoli underdeveloped and lifethreatening
L/S ration
determines lung maturity with 2 phospholipids detected in liver
PG test
synthesized from mature alveoli to determine lung maturity
S/S or resp distress
grunting, flaring, retractions, decreased breath sounds, tachypnea, hypotonic, tachycardia, gray skin
nursing actions of resp distress
maintain patent airway, admin O2, low flow or high flow cannula, maintain NTE
bronchopulmonary dysplasia
chronic lung problem form those that have been treated with mechanical ventilation/O2
risk factors
neonates that have been on O2 for more than 28 days
S/S of BPD
low lung compliance, atelectasis, pulmonary resistance, overdistened lungs
intraventricular hemorrhage
bleeding around brain ventricles common in lbw babies
nursing actions of intraventricular hemorrhage
supine position, keep hips below head, NTE, minimize crying
sudden change in condition with intraventricular hemorrhage
bradycardia, hypotonia, low hematocrit, shock, metabolic acidosis, hyperglycemia, full/tense anterior fontanel
signs that bleeding worsened for intraventricular hemorrhage
apnea, low bp, acidosis, seizures, full or tense anterior fontanel, decreased LOC
NEC
gastrointestinal disease causing necrosis and inflammation of bowels
cause of NEC
prolonged ROM w infection, hypoxia, SGA, congential heart disease, anemia
prevention of NEC
breastmilk
S/S of NEC
apnea, bradycardia, blood in stool, shock, low UO, abdomen distention, vomit
nursing actions of NEC
withhold feedings, monitor I/O and blood vol, hydration and prep for surgery
retinopathy of prematurity
retina is not completely vascularized and susceptible to stress/injury causing blindness
risks of retinopathy
high O2, prematurity, lbw, sepsis, infection, sterioids
decreasing risk of ROP
monitor oxygen using pulse ox
post term infant
infant born after 41 wks
risk factors of post term
anencephaly, hx of post, 1st preg, grand multiparous
s/s of post term
dry peeling skin, long nails, thick blood, pronounced creases, green/yellow skin, placental insufficiency
complications of post term
meconium, hypoxia, hypoglycemia, polycythemia, cold stress, seizures, cephalohematoma
cephalohematoma
doesnt cross suture line and involves bone with no skin color change that slowly resolves
caput succedaneum
crosses suture line with ecchymosis and jaundice that resolves spontaneously
meconium aspiration
aspiration of meconium causing obstruction, low O2, resp failure
s/s of meconium
low apgar, grunt, flare, retraction, barrel chest, decreased breath sounds
complications of meconium
pneumothorax, infection, PPHN
interventions for meconium aspiration
assess resp distress, admin o2, monitor blood glucose, suction/resuscitation
patent ductus arteriosus
heart murmur from hole in heart that shunts blood away from lungs not allowing them to breath outside utero
s/s of PDA
bounding/widened pulse, tachycardia, tachypnea, apnea, active precordium
PPHN
norm vasodilation and relaxation of pulmonary vascular bed doesnt happen leading to hypertension
risk factors of PPHN
hypoxia, asphyxia, low apgar, RDS, MEC, sepsis, congenital issues
s/s of PPHN
hypoxia, low CO, hypotension, metabolic acidosis, grunting, cyanosis
SGA
below the 10th percentile for gestational age
symmetric IUGR
generalized reduction of parts of infant
asymmetric IUGR
disproportional reduction of parts of infant
risk factors for SGA
multi gestation, under 15, over 45, substance use, preeclampsia, hypertension, placental problems (previa, abruption, small)
interventions for SGA
assess meconium/temp/hypoglycemia, weigh daily, NTE, strict I/O
characteristics of IUGR baby
large head, little to no hair, weak cry, loose skin
complications of IUGR
hypothermia, polycythemia, hypoglycemia, asphyxia
nursing actions of IUGR/SGA
assess resp distress, NTE, early feeds, monitor vitals, weigh daily
LGA
weight above the 90th percentile for gestation age
macrosomia
above 4000g at birth
risk factors of LGA
diabetes, multiparity, hx of LGA, prolonged preg
LGA likely causes
c/s, OVD, shoulder dystocia, breech, birth trauma, hypoglycemia, hyperbilirubinemia
infants of diabetic mothers are at risk for
congenital abnl, skeletal defects, placental insufficiency, neuro probs, childhood obesity
assessment of infants from diabetic moms
macrosomia, fractured clavical, polycythemia, hypotonia, hypoglycemia
nursing actions for infants of diabetic moms
assess for symptoms of hypoglycemia and resp distress
neonatal infection
immune system immature placing infant at risk for infection
assessment for neonate infection findings
resp distress, hypothermia, hypotension, tremors, poor feeding, jaundice, hypoglycemia
neonatal abstinence syndrome
from maternal substance use
neonatal abstinence syndrome s/s
grunt, flair, tremors, frantic sucking, sneezing, yawning
nursing care of infant withdrawal
observe signs of distress, quiet dark room, feed frequently, bonding
omphalocele
defect in umbilical ring with peritoneal sac covering defect
nursing management of omphalocele
cover viscera, prone/side lying, prevent water loss
gastroschisis
hernation of bowel through defect in abdominal wall right of umbilicus leading to swelling/irritation
spina bifida
neural tube defect where spine doesnt form properly causing bulging sac of CSF and meninges
prevention of spina bifida
take folic acid
cryptorchidism
failure of one or both testes to descend
assist with grief
time w baby, memorabilia, refer by name
