High risk newborn (unit 3) Flashcards
caput succedaneum
- soft tissue injury sustained during birth
- FLUID edema of scalp
- benign
- DOES cross suture line
cephalhematoma
- soft tissue injury sustained during birth
- collection of BLOOD b/t skull bone and periosteum
- does NOT cross suture line
- usually after vert delivery
- benign
subconjunctival & retinal hemorrhages
- soft tissue injury sustained during birth
- d/t increased ICP
- benign
lacerations during birth
- soft tissue injury sustained during birth
- scalpel from C/S
- episiotomy on scalp, butt, thigh
skeletal injuries during birth
- skull (linear/depressed)
- clavicle- most common
- humerus/femur
Erb-Duchenne
•paralysis of upper portion of arm d/t upper plexus injury during birth
Klumphke
•paralysis of lower portion of arm d/t lower plexus injury during birth
phrenic nerve injury during birth
- diaphragmatic paralysis
- cyanosis, irregular thoracic movements
- vent support for 1st few days
- may spontaneously resolve or need surgery
subarachnoid hemorrhage during birth
- most common intracranial hemorrhage
- causes seizures
- vent support, IV, monitor ICP, minimal stim
infants of diabetic mothers r/o
- congenital anomalies
- IUGR
- heart anomalies (cardiomyopathy)
- respiratory distress
- hypoglycemia
- hypocalcemia
- hypomagnesemia
- polycythemia
hypoglycemia onset
•BS < 40 mg/dl (term) •BS < 25 (preterm) •jittery •RDS •apnea •lethargy •poor suck •seizures *w/in 1-3 hrs after birth -d/t inc. insulin production in utero
hypertrophic cardiomyopathy (HCM)
- hypercontractile
* thickened myocardium (-> LHF)
nonhypertrophic cardiomyopathy (non-HCM)
- poorly contractile
- over stretched
- tx w/ digoxin
polycythemia
- Hct > 65%
- inc. blood viscocity
- impaired circulation/oxygenation
- inc. RBC to be hemolized
- additional birth trauma if macrosomia (inc. cephalhematoma/bruising)
neonatal sepsis
- microorganisms/toxins (bacteria, virual, fungi) in blood/tissues
- perinatal- HSV, CMV
- during birth- GBS
- postnatally
bacterial neonatal infection
•early onset -congenital -rapid progression (24-72 hr) -hypothermia common •late onset -acquired -slow progression (1-2 wk)
neonatal group beta strep bacterial infection
- most common
- early onset indicates vertical transmission
- RDS, pneumonia, sepsis
neonatal e. coli bacterial infection
•amp resistant strain contracted during labor
neonatal listeriosis bacterial infection
- detected in meconium in amniotic fld < 37 wks
- granulomas, liver dz, meningitis (late onset)
- mom may not have s/sx, but newborn will
- found in dirt, water, unpaturized, uncooked, and ready-made
neonatal clamydia bacterial infection
- opthalmia neonatorum
- conjunctivitis
- reason for erythromycin in eyes at birth
neonatal fungal infections
- candidiasis (thrush)
* mouth/diaper most common site
heroin/methadone neonatal effects
- IUGR
- LBW
- SGA
- w/d
- risk of SIDS 5-10x higher
marijuana neonatal effects
- lowered response to light sim
- tremors
- high pitched cry
- small head
- hyperactive
- impulsive
- delinquency
cocaine neonatal effects
- pre-term
- LBW
- short
- small head
- piercing cry
- low Apgar
- irritable/hypersensitive
- poor feeding/sleeping
- high HR/RR
- tremors/startling
- dec. verbal reasoning/attention
methamphetamine neonatal effects
- poor growth
- LBW
- small head
- PTB
- placental problems
- w/d s/sx
tobacco neonatal effects
- UPI (vasoconstriction)
- SAb
- placental separation
- LBW
- PTL
- intellectual disabilities (ADHD)
fetal alcohol syndrome (FAS)
- poor habituation
- irritability/jittery
- feeding/sleep difficulties
- poor muscle tone
- sensitive to light/sound
- excessive crying
physiologic jaundice
- hyperbilirubinemia
- appears after 1st 24 hrs
- benign- not normal, but common
- s/sx 2nd-3rd day of life
- usually resolves by day 4
- bili < 12 (unless PT or BF)
pathologic jaundice
- hyperbilirubinemia
- appear w/in 1st 24 hrs
- r/t abnormalities that cause excessive RBC destruction (ABO/Rh incompatibility)
- bili levels higher and remain high
Kernicterus
- hyperbili (>25)
- long term neurological damage
- ½ infants survive
- never present at birth
choreoathetoid cerebral palsy
- extrapyramidal movement disorder resulting from kernicterus
- s/sx: jerking, tick twitch, slow writing
- tx: phototherapy; exchange transfusion
encephalocele
- rare neural tube defect characterized by sac-like protrusions of brain and meninges
- caused by failure of neural tube to close completely
- developmental delay, vision problems, mental/growth retardation
choanal atresia
•septum b/t nose and pharynx
omphalocele
- intestine or other abdominal organs stick out of the navel and are covered only by a thin layer of tissue and can be easily seen
- type of hernia.
gastroschisis
•birth defect in which an infant’s intestines stick out of the body through a defect on one side of the umbilical cord
imperforate anus
•opening to the anus is missing or blocked
teratoma
- embryonal tumor
- may be solid, cystic, or mixed
- 80% benign
- if not resected before 1-2 months more likely to become malignant
preterm infant appearance
- disproportionately large head
- dec. muscle tome
- little fat
- skin thin w/ visible blood vessels (-> fld loss/dec. thermo)
- abundant lanugo/vernix
- absent plantar creases if < 32 wks
respiratory issues of preterm
- surfactant deficiency
- periodic resp./apnea
- RD (tachy, retractions, flaring, grunting)
- cyanosis
nutritional issues of preterm
- miss all/part of 3rd trimester transfer of nutrients, glycogen, Fe
- fat stores minimal
- glucose reserved used quickly
- smaller stomach capacity
- GI immaturity
preterm nutritional needs
- 150 kcal/kg/day
- more protein, Fe, Ca, P
- can’t suck-swallow-breathe until 34 wks and 1500g
signs of readiness to PO feed
•rooting •sucking •+ gag •RR < 60 •tolerate being held *start PO feed slow
assessing tolerance of enteral feeds
- residuals
- vomiting
- abd distention
- stools
- suck-swallow-breathe coordination
- fatigue
- VS
preterm renal issues
- insensible fld. loss (warmer, RR rate)
- kidney can’t concentrate, dilute, or conserve electrolytes
- more immature -> need more fld.
preterm expected UOP
- 1-3 mL/kg/her
* 1 g= 1cc (diaper)
assessing preterm renal fxn
- UPO
- urine specific (1.005-1.015)
- weight
- turgor/edema
- anterior fontanelle
- Na, hct, BUN
preterm hematologic issues
- inc. cap friability
- inc. clotting time (bleed)
- dec. erythropoiesis
- dec. blood vol.
- dec. RBC life
transient tachypnea of newborn (TTN)
•delay in abs. of fetal lung fld
•risk if C/S, maternal GDM, smoker, SGA
•s/sx: RR > 60; grunt; flare; retraction; circumoral cyanosis
*resolves 24-72 hr
meconium aspiration syndrome (MAS)
- caused by vagal stimulation or hypoxia, resulting in meconium passage before birth
- can lead to pneumonia, obstruction of airway, and air trapping
- s/sx: RD, cyanosis, coarse sounds, barrel chest
- tx: O2 vent
hyaline membrane disease (HMD)/respiratory distress syndrome (RDS)
•most common cause is IDM •inc. incidence/severity w/ dec. GA •surfactant deficiency causes atelectasis •onset w/in 1st hour of life -Nasal flaring -Cyanosis -↓ breath sounds -grunting -Opaque “ground glass” X-ray
HMD/RDS tx
•surfactant •O2 -hood or NC -CPAP -mechanical/high freq vent -ECMO
when to use hood O2 therapy
•if baby can breathe on its own
went use CPAP O2 therapy
•can breathe on own, but have apnea > 15 sec
•forces breath
*nose breathers
when to use mechanical ventilator O2 therapy
- baby can’t breathe on own
* placed in trachea and set at specific breath/min
when to use high freq. ventilator
- extremely preterm
- frequent, small puff of air
- no pressure to lungs (passive diffusion of O2)
- vibrating chest movement
extracorporeal membrane oxygenation therapy (ECMO)
•artificial heart/lung machine that oxygenates blood and returns it to the heart
•allows lungs to rest
*only available @ level II hospitals
bronchopulmonary dysplasia
- O2 still required 28 days after birth or 36 wks post-conceptual age
- scarring of lungs, decreasing elasticity and causing chronic lung dz
persistent pulmonary hypertension of newborn
- increased pulmonary vascular resistance causes RHF
- caused by intrauterine hypoxia and birth asphyxia
- can also be caused by ASA or NSAIDs in 3rd trimester
persistent pulmonary hypertension of newborn s/sx and tx
- onset w/in 24 hrs
- RDS (w/o retrations)
- cyanosis
- tachypnea that worsens with handling
- O2, NO vent.
periventricular-intraventricular hemorrhage
- s/sx: lethargy, hypotonia, resp distress, ↓hct, full or bulging fontanels, seizure
- tx: shunts
- long term issues: neurologic abnormalities, developmental delay, cerebral palsy, hydrocephalus
retinopathy of prematurity
- blood vessels form where they shouldn’t, leading to retinal detachment, glaucoma, blindness
- tx w/ laser surgery or cryotherapy
patent ductus arteriosus (PDA)
- closing failure of ductus arteriosus b/t L pulm artery and descending aorta
- s/sx: cyanosis, murmur, bounding peripheral pulse, tachy, crackles, CHF
- tx: PDA ligation; time
necrotizing enterocolitis (NEC)
•accumulation of gas in the submucosal layers of the bowel wall→necrosis & bowel perforation & sepsis •S/S: Onset approx 2 weeks after birth -Abdominal distension -Blood in stool -Retention of feeds •Treatment -antibiotics -NPO with parenteral nutrition -gastric decompression and serial -X-rays -Surgery
postmature maturity syndrome
- aging placenta causes dec. O2 and malnutrition
- s/sx: ↓fetal growth; meconium staining; polycythemia; little subQ fat; little lanugo or vernix; abundant hair; long nails; dry, cracked, peeling skin
small for gestational age (SGA)
•BW < 10% (5.5# lb for term)
asymmetric growth restriction
- head and length unaffected, but weight is (disproportional)
- recover w/ adequate postnatal nourishment
- d/t MID PG complications
symmetric growth restriction
- weight, length, and head circumference affected
- may have long-term growth issues
- d/t EARLY PG complications
large for gestational age (LGA)
- BW > 90%
- risk for: longer labor, birth injury, shoulder dystocia, clavicle fracture, brachial plexus injury, facial nerve palsy, bruising, hypoglycemia, polycythemia, C/S
infants response to pain
- increase in levels of stress hormones (cortisol, catecholamines)
- affects growth, won healing, complications, length of stay
infant pain assessment
•HR -inc. in normal -dec. in compromised •BP •RR •Skin- pallor, redness, cyanosis •palmar sweating •dilated pupils •hyperglycemia
NIPS
- neonatal infant pain scale
- facial expression
- crying
- arm movement
- leg movement
- state arousal
CRIES
*neonatal pain scale •crying •requires •oxygen to maintain O2 stat >95% •increased VS •Expression •sleepless
FLACC
•UAMS pain scale
•5 criteria worth 2 puts each
*0 is pain free
infant nonpharmacologic pain management
- dec. stim
- position like in uterus
- swaddle/frogs
- non-nutritive suctin
- Sweet-ease
- rocking
- kangaroo care
infant pharmacologic pain management
- acetaminophen
- morphine, fentanyl (narcan ready)
- sedatives (chloral hydrate, midazolam)
