HR Newborn Flashcards by Brandy Wilson

What is a late preterm infant?

Born between start of 34 weeks and end of week 37

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What is kangaroo care?

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

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What is considered a preterm infant?

Before start of 38 weeks

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

<2500 grams or
5lb 8 oz

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

<1500 grams or
3lb 5 oz

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

<1000 grams or 2lb 3 oz

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What is a car seat challenge?

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

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What should we teach parents of preterm infants about?

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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What is difference between normal periodic breathing and apneic spells?

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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What is grunting?

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

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What position is best for preemie?

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

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What should abdominal temp probe reading be?

96.8—–97.7

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What should axillary temp for preemie be?

97.3—–98.4

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What are signs of inadequate thermoregulation?

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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What is considered LGA (large for gestational age)?

Greater than 90th percentile

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What is considered SGA (small for gestational age)?

Less than 10th percentile

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What are common signs of pain in NBs?

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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What is normal urinary output for preterm infant?

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

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What are signs of fluid imbalance in newborn?

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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What are signs of over hydration in NBs?

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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Nursing interventions for pain in NB.

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

Signs of overstimulation in NB.

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

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

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

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

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

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

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

S/Sx of RDS.

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

What are some of the effects of RDS?

Atelectasis Hypoxia Hypercapnia Pulmonary HTN Ductus arteriosus can open

Treatment for RDS.

Surfactant replacement therapy in trachea O2 Vent CPAP Nitric oxide therapy

What is intraventricular hemorrhage? (IVH)

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

S/Sx of IVH.

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

What is treatment of IVH?

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

Nursing considerations of IVH.

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

What is necrotizing enterocolitis? (NEC)

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

What decreases risk of NEC?

Breast milk

S/sx of NEC.

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)

Treatment for NEC.

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

What are risks involved in post maturity syndrome?

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

What will a post mature baby look like?

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

What is polycythemia?

Too many RBCs

What is thrombocytopenia?

Too little platelets

What is transient tachypnea of the newborn? (TTN)

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

What is meconium aspiration syndrome? (MAS)

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

When is suctioning needed in meconium exposed baby?

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

What is persistent pulmonary hypertension of NB?

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

What is erythroblastosis fetalis?

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

What is most common cause of sepsis in NB?

GBS

What are signs of sepsis in NB?

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

What will labs show in sepsis in NB?

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

What will labs show in polycythemia?

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

What are signs of hypocalcemia in NB?

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