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Unit 4 > HR Newborn > Flashcards

HR Newborn Flashcards

1
Q

What is a late preterm infant?

A

Born between start of 34 weeks and end of week 37

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2
Q

What is kangaroo care?

A

Using skin to skin (of mom or dad) to help regulate baby’s temp

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3
Q

What is considered a preterm infant?

A

Before start of 38 weeks

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4
Q

What is considered a low birth weight baby? (LBW)

A

<2500 grams or
5lb 8 oz

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5
Q

What is a very low birth weight baby?
(VLBW)

A

<1500 grams or
3lb 5 oz

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6
Q

What is an extremely low birth weight baby? (ELBW)

A

<1000 grams or 2lb 3 oz

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7
Q

What is a car seat challenge?

A

How well does baby tolerate car seat?
Watch for bradycardia, apnea, decrease in O2 sat
—Common in PT infants—

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8
Q

What should we teach parents of preterm infants about?

A

Signs of jaundice, dehydration, adequate output, overstimulation.
How to dress preemie–one extra layer than is comfortable for adult.
Safe sleep practices and SIDS info.

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9
Q

What is difference between normal periodic breathing and apneic spells?

A

Periodic lasts 5-10 seconds of cessation of breathing followed by rapid breathing for 15-20 seconds.
Apneic spells last 15-20 seconds and they will show signs of inadequate oxygenation.

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10
Q

What is grunting?

A

Possible early sign of RDS.
Baby is closing glottis to increase pressure in chest to keep alveoli open.

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11
Q

What position is best for preemie?

A

Prone. Increases oxygenation, respiratory control, lung volume and reduces energy expenditure.

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12
Q

What should abdominal temp probe reading be?

A

96.8—–97.7

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13
Q

What should axillary temp for preemie be?

A

97.3—–98.4

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14
Q

What are signs of inadequate thermoregulation?

A

Poor feeding
Irritability to lethargy
Weak cry or suck
Decreased muscle tone
Skin pale, mottled, acrocyanotic
Hypoglycemic
Respiratory distress
Poor weight gain (if chronic)

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15
Q

What is considered LGA (large for gestational age)?

A

Greater than 90th percentile

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16
Q

What is considered SGA (small for gestational age)?

A

Less than 10th percentile

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17
Q

What are common signs of pain in NBs?

A

Change in HR, RR, Pox, BP
Eyes squeezed shut, grimacing
Brow changes
Muscle tension/flaccidity
Sleep/wake pattern changes
Rigidity of extremities
—Assessment tool is PIPP or Premature infant pain profile–

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18
Q

What is normal urinary output for preterm infant?

A

2ml/kg/hour
–less than 1ml/kg/hour is oliguria–
Earliest sign of fluid imbalance

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19
Q

What are signs of fluid imbalance in newborn?

A

Early: Oliguria=<1ml/kg/hr
urine specific gravity of >1.01
Weight loss
Dry skin/mucous membranes (late sign)
Sunken fontanelles (late sign)
Poor turgor (late sign)
Elevated sodium, protein, hematocrit in labs

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20
Q

What are signs of over hydration in NBs?

A

Urine output of >5ml/kg/hour
Urine specific gravity of <1.002
Edema
Weight gain
Bulging fontanels
Moist breath sounds
Dyspnea
Decreased sodium, protein, hematocrit

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21
Q

Nursing interventions for pain in NB.

A

Touch
Sweet-ease
Swaddling (but let one hand stay at mouth)
Pacifier
Kangaroo care
Breastfeeding
Morphine, fentanyl, acetaminophen

22
Q

Signs of overstimulation in NB.

A

BP, HR, RR unstable
Signs of hypoxia
Flaring nares
Decrease in O2 Sats
Sneezing, coughing, yawning
Stiffness
Fisting or splaying of hands
Arching
Alert, worried expression
Gaze aversion
Regurgitation, gagging, hiccuping

23
Q

What are some signs infant is not ready for nipple feedings?

A

RR of >60
No rooting/sucking
No gag reflex
Excessive gastric residuals

24
Q

What position is best to feed a premature infant with bottle?

A

Upright, head flexed, angle of 45-60 degrees. (allows him control over flow)

25
Q

What is RDS (respiratory distress syndrome)? When does it peak?

A

Insufficient surfactant
Lungs non compliant (stiff)
Usually less than 34 weeks gestation
Peaks at day 3 after birth

26
Q

S/Sx of RDS.

A

Tachypnea
Nasal flaring
Retractions
Cyanosis
Grunting on expiration
Decreased breath sounds/rales

27
Q

What are some of the effects of RDS?

A

Atelectasis
Hypoxia
Hypercapnia
Pulmonary HTN
Ductus arteriosus can open

28
Q

Treatment for RDS.

A

Surfactant replacement therapy in trachea
O2
Vent
CPAP
Nitric oxide therapy

29
Q

What is intraventricular hemorrhage? (IVH)

A

Brain bleed that is common in very LBW preemies. Fragile vessels in brain
Graded 1-3 depending on amount of blood loss.

30
Q

S/Sx of IVH.

A

These greatly depend on the severity;
Lethary
Poor muscle tone
Decrease in respiratory status
Drop in hematocrit
Acidosis
Hyperglycemia
Decreased reflexes
Tense fontanel
Seizures

31
Q

What is treatment of IVH?

A

Supportive.
Treat complications.
A shunt can be placed in extreme situation.

32
Q

Nursing considerations of IVH.

A

Try to prevent by decreasing stress on baby.
Risk factors:
Suctioning, Vent, Excessive handling, anything that increases BP and stress
Monitor head circumference carefully

33
Q

What is necrotizing enterocolitis?
(NEC)

A

Inflammation of intestines that leads to necrosis.
Intestines of preemies are immature.
If intestines are stressed before ready increases risk.

34
Q

What decreases risk of NEC?

A

Breast milk

35
Q

S/sx of NEC.

A

Feeding intolerance
Increased abdominal girth
Increased gastric residuals
Decreased BMs
Vomiting
Abdominal tenderness
Blood in stools
Signs of infection
Respiratory distress (distended abdomen decreases space for lungs to expand)

36
Q

Treatment for NEC.

A

Early recognition of feeding intolerance
D/C oral feeding and go to parenteral nutrition
Intestines rested and monitored

37
Q

What are risks involved in post maturity syndrome?

A

Meconium
Placental insufficiency leads to decrease in weight gain or growth
LGA
Still born

38
Q

What will a post mature baby look like?

A

Dry cracked skin
Long fingernails
No vernix
No lanugo
Long, thin, little SQ fat

39
Q

What is polycythemia?

A

Too many RBCs

40
Q

What is thrombocytopenia?

A

Too little platelets

41
Q

What is transient tachypnea of the newborn? (TTN)

A

Very rapid breathing (60-120) starts shortly after birth
Fetal lung fluid not being re-absorbed so lungs stay wet
Resolves on own in 24-72 hours

42
Q

What is meconium aspiration syndrome? (MAS)

A

Respiratory distress from meconium exposure
Air becomes trapped in lungs (can present as a barrel shaped chest)

43
Q

When is suctioning needed in meconium exposed baby?

A

Only if baby has low APGARs
If breathing, heart rate ok-may not need vigorous suctioning

44
Q

What is persistent pulmonary hypertension of NB?

A

Holes in heart slow to close. Increased vascular resistance in pulmonary vessels.
Means blood bypasses lungs, leads to hypoxia and metabolic acidosis
Presents in first 24 hours

45
Q

What is erythroblastosis fetalis?

A

Mom and baby’s blood not compatible. Mom’s immune system destroys baby’s blood. Least to anemia in baby

46
Q

What is most common cause of sepsis in NB?

A

GBS

47
Q

What are signs of sepsis in NB?

A

Temp instability (usually low)
Respiratory distress
Tachycardia
Low BP
Poor feedings
Hypoglycemia
Abdominal distress
Decreased muscle tone
Lethargy
Jaundice (advanced)

48
Q

What will labs show in sepsis in NB?

A

CBC with differentials will show:
Decreased total neutrophils
Increased bands (immature neutrophils)
Decreased platelets

49
Q

What will labs show in polycythemia?

A

Hematocrit high (>65%)
Hemoglobin high (>22g/dL)

50
Q

What are signs of hypocalcemia in NB?

A

Jittery
Irritable
Muscle twitching
Poor feeding
High pitched cry
Seizures
—But often asymptomatic—

Unit 4 (4 decks)

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