mat pt 3 ppt and notes (neonate)

Question 1

foci of nursing care for infant

Answer 1

Respirations and Extrauterine Circulation
Temperature
Fluids and Electrolytes
Nutrition and Waste
Preventing Infection
Bonding and Attachment

Question 2

nursing Dx for high risk infant

Answer 2

Ineffective airway clearance r/t the presence of mucous or amniotic fluid in the airway
Ineffective tissue oxygenation r/t breathing difficulty
Ineffective thermoregulation r/t immature status
Risk for deficient fluid volume r/t insensible water loss
Risk for imbalanced nutrition, less than body requirements r/t the lack of strength for effective sucking
Risk for infection r/t lowered immune response due prematurity
Risk for impaired parenting r/t illness in newborn at birth
Deficient diversional activity (lack of stimulation) r/t to illness at birth
Readiness for developmental care to decrease overstimulation easily caused by necessary lifesaving procedures

Question 3

what info will you look for in the chart to tell you about the neonate

Answer 3

Review maternal history for illnesses, bloodwork, risk factors (GBS, TORCH infections, smoking, substance use, HIV, Hepatitis B, gestational diabetes).
Review the APGAR.
Know the gestational age as it has different implications if pre and post term
Look at how much they are pooping and peeing and feeding

Question 4

what is GBS and why is it such concern for infant

how are women screened for it

Answer 4

group B streptococcus (GBS) organism, a natural inhabitant of the female genital tract. It may spread from baby to baby if good handwashing is not used. If a women is found to be positive later in pregnancy, ampicillin administered IV during preg and again during labour to reduce risk
If the baby picks it up on the way out it runs the risk of dev meningitis.
Every woman is screened for GBS at around 35wks. As soon as labour happens then use Abx. Penicillin and if allergic then clindamycin. Baby isnt put on them unless symptomatic

Question 5

symptoms in neonate of GBS infect

Answer 5

Early onset symp: tachypnea, apnea, paleness, hOtn, hypotonia, dec urine output from hypotension

Question 6

in relation to TORCH what would be an indication for c section

Answer 6

TORCH-did mum come into contact with any of these? Does she have hx of herpes with active ulcers? If yes thenc section

Question 7

if woman is smoker what is the concern

Answer 7

Smokingtiny placenta and tiny baby. Young women are smoking less. The baby and labour has very unusual odour.. The placenta might be fx at 50%

Question 8

when are Apgars done

what is the ideal score

Answer 8

APGAR-1min, 5min, 10min. It is then scored as 0, 1, or 2.
HR
Tone-they should be flexed
Reflex irritabilty-does it get mad at suction etc
Colour-how much cyanosis or pink
Respiratory effort-lusty cry, no noise

At 1 minute if it has a score of less than 5 its in trouble. If it has a score of less than 7 at 5mins that’s not good.
Do you look at the APGAR to make resuscitation decision-NO! Decide right away! In the first 5 secodns of its life

best score is 10 but this is unusual as most babes have blue hands or feet

Question 9

when assessing the birth history what does this entail

Answer 9

C/S vs. Vaginal
The negative pressure fromt he vaginal delivery has a vacuum effect that helps with initial respirations. The vaginal flora also helps set people up with proper bacterial health.
Prolonged delivery-the baby is tired
Too fast-difficult adjustment
The neurological checks must happen! Esp with forceps! or vacuum
Postterm-the babys head might have trauma-birth is more difficult as it was fused
Environment? Where were they born. It may have been exposed to a lot of chilling
Did they have to be resuscitated

Question 10

when would babies get blood gases and lytes done

aside from assessing the labs what ould you look at

Answer 10

it is important to assess the fontanel-sunken is dehydrated, bulging…

Question 11

what could cause fluid or lyte imbal for neonate

how much BL is concern for them

Answer 11

Query blood loss from placenta previa or abruptio?
Insensible losses from increased respiratory efforts (RR)
Consider the impact of radiant warmers, incubators, skin to skin and overbundling

15ml can be enough for FVD

Question 12

what can be consequence of too much IV fluid

can babe get fluids easily if sick

Answer 12

return to fetal circ (opening of ductus arteriosus)

Frail or sickly infants are not able to restore fluid losses through eating, kidneys are very immature and have difficulty concentrating urine

Question 13

why are neonates given IM vit K and when

Answer 13

Vitamin K-the precursors to vit K are made in liver. Livers dont mature until exposure to daylight
All babies are given vit K within 6hrs of birth

to combat risk of bleeds

Question 14

normal vitals for term babe

normal BG

Answer 14

VS
Respirations 30-60
Temperature 36.5-37.4 C axilla
Pulse 110-160 (will be lower if overdue)
Sugars
3.2-6

Question 15

what resp signs are bad

Answer 15

We should not see ‘see-saw’ respirations, intercostal indrawing, xiphoid retractions, flared nares, or grunting!

Question 16

gestational age and why it is imp?

Answer 16

it affects the following..sorry I didnt write how

Resting Posture
Recoil of Extremities
Extremities
Sole (Plantar) Creases--gets more wrinkly with age. preemies dont have sole creases
Breast Tissue
Genitalia

Question 17

what causes fetal circ to switch to normal circ

what can flip the babe back to fetal circ

Answer 17

When born we are usually just tiny bit acidotic. The changes in P-neg P change cause the ducts to shut. From the first breath we start with neonatal circulation

Things that get int he way of this:
Lack of surfactant
Significant acidosis
Cold

You need the baby warm and dry. If you dont, they might get cold and then get acidotic and then the ducts open again and theyre back in fetal circ

Question 18

names and fx of fetal circ

Answer 18

Ductus arteriosus-allows blood back into main circulation
Foramen ovale-bet the R and L atriums
Ductus venosus–from wikipedia..shunts a portion of the left umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver
When inside the mum the ducts allow the blood to ome from placenta and get to the heart and bypass the lung

Question 19

why is it so easy for babe to get acidotic

Answer 19

The baby has immature neurological system-cant shiver, cant change positionget coldacidotic

Question 20

what puts babe at risk of resp distress

what helps the babe to breathe or clears airway that are very natural interventions

Answer 20

Decreased surfactant and lung maturity
Susceptibility to cold stress and metabolic disturbances
Immature organ development
Immature CNS
Decreased fat deposits and no “brown fat”
Decreased ability to eat and absorb nutrition

The breathing motion of mum helps babe to breathe
colostrum helps to clear the airways
colostrum helps to clear the airwaywhat

Question 21

how is temp protected for newborn

Answer 21

Remove wet linens, and place Skin to Skin if healthy
Incubators, dry linen, plastic wrap, warmed stethoscopes, warmed beds

The preemie is wrapped in plastic, stethoscope must be warmed, hands must be warm

Question 22

what i opthalmia neonatorum when does it occur and how is it treated

Answer 22

eye infection that occurs at birth during first month of life. Generally bilateral, conjuctivae become fiery red and covered witht hick us and eyelids are edematous
• Occurs on day 1-4 of life.
• IV ceftriaxone and penicillin
• Sterile saline in eyes using dropper or bulb syringe

Question 23

if mum is hep B positive what precautions might be taken w newborn

Answer 23

• Asked if they would like their infant vaccinated atbirth
• Should be bathed as soon as possible to remove blood and secretions from mom
• Gentle suctioning to avoid trauma to mucous membrane
• Infant administered serum immne globulin (HBIG) in addition to HBV cavvination

Question 24

how can herpes be transmitted

what are the concerns with herpes

Answer 24

by fetus across placenta if mom has primary infect during pregnancy. gen it is from vaginal secretions at birth though
The long term prognosis of the child is guarded bc severe neurological damage may have occurred simultaneously frm the development of the lesions.
• Between 25-70% of newborns that survive have permanent CNS damage

Question 25

what findings might indicate herpes in infant

Answer 25

• Infant maybe born with vesicles covering the skin.
• If infant don’t acquire the infection until birth, by day 4 -7 they show loss of appetite, low grade fever, and lethargy. Stomatitis (ulcers of mouth) appear
• After vesicles appear- infant very ill. Develop dyspnea, jaundice, purpura, convulsions, hotn
• Death may occur within hours or days

Question 26

how to prevent herpes infect of babe

Answer 26

• Therapy- antiviral drug such as acyclovir (zovirax) a drug that inhibits DNA synthesis is effective in combating overwhelming infection
• Prevention is best form of protection. Antenatal antiviral prophylaxis reduces viral shedding and recurrences at birth and reduces the need for caesarian birth.
• Advised to have c/s w active herpetic vulvar lesions
• Infants should be separated from other infants in nursery
• Herpes simplex 1 aka cold sores should be assessed on mom

Question 27

how is HIV transmitted

Answer 27

can be via placenta or direct contact w maternal blood during birth

Question 28

what condition might present as a preterm baby

what term is used to refer to macrosomic babies that desribes their health status

Answer 28

gestational diabetic

fragile giants

Question 29

why might Preterm or sickly (GD, macrosomia) infants not get adequate nutrition

related to systems

Answer 29

Neuro-not able to coordinate sucking, swallow, breath
Resp-suck, swallow, breatheenergy and calories. Inc effort. Often must feed by tube feed
Bowels-may not be mature enough to absorbNecrotizing enterocolitis

Question 30

how does breastmilk prevent abn things in blood

how does breastmilk change if preemie and how lon does this last

Answer 30

it causes the loose cells of the gut to come closer together and prevents proteins etc from drifting into bloodstream

The milk you make has a high level of protein in it and high EFA, more immune booting substances if delivered premature. This only lasts 2wks. Specially formulated food for preterm infant.

Question 31

how does neonate of gestational diabetic adjust to new env in r/t sugars

when must we intervene

Answer 31

Babies born to GD mothers are used to a high level of glucose coming to them
The baby produces high levels of insulin to cope with the high sugars
After birth the sugar “supply” is cut off, but insulin persists in the body for several hours, causing neonatal blood sugars to drop to low levels

The sugars can go below 3.2. once sugars are below 2.8 must intervene

Question 32

what is the problem with babe having low sugars

whatre the best interventions for GD babes

Answer 32

With low sugars it cant stay warm and generate heat. It also get acidotic. Might reurn to fetal circ. Also see: sluggish neurologically if left too long.
Will test sugars often for GD, and for large babys

Nursing care of these babies centres on frequent BS checks and ensuring adequate intake. Supplementation with formula is usually necessary until breastmilk supply is established
Often, these babies are cared for in the SCN due to their unstable status (tendency to low blood sugars and respiratory distress)

Lots of skin to skin and feeding. Can be with dad as well

Question 33

GD babes

have inc risk of...
what effect does insulin have on gen growth?
how does it affect birth?
how does it affect lungs?
GI?
fluid status?

Answer 33

• Typically weigh more than other babies (macrosomia)
• Baby has a greater chance of having a congential anomaly such as cardiac anomaly bc hyperglycemia is teratogenic to rapid growing fetus

greater chance of birth injury espshulder and neck
• RDS occurs at a higher rate bc premature or if at term, lecithin pathways may not be mature
• High fetal insulin bc hyperglycemia can inferfere with cortisol release (this can block formation of lecithin and prevent lung maturity)
• Some have smaller than usual colon-
• loses a greater proportion of wt in first few days of life than normal bc loss of extra fluid- make sure dehydration is not occurring

Question 34

what syndrome can occur almost exclusively with infants of GD

Answer 34

• Caudal regression syndrome (hypoplasia of the lower extremities) is a syndrome that occurs almost exclusively in such infants

Question 35

how does GD affect the delivery method

Answer 35

might need to have c/s to avoid cephalopelvic dysproportion

Question 36

what makes macrosomic babes particularly unstable in terms of what they need to do after birth

whcih systems can be immature

Answer 36

The workload of supplying a large body mass with oxygenated blood is can prove too much for baby’s lungs and heart.
Additionally, a newborn may not feed well in the first hours of life, worsening the risk for low sugars. Low BS contribute to acidosis and impede his respiratory function.
Tend to be neuro, resp immature. Really at risk of low sugars and acidosis!!

Question 37

what kind of care might macrosomic babe get

how big are these babes

Answer 37

Macrosomic babies are supported with frequent BS monitoring, supplemental feeds, possible IV, and oxygen
Lots of skin to skin and feeding. Can be with dad as well

10-12lbs

Question 38

principles of infection prevention from slides

Answer 38

Compromised or immature immune systems
Moms with Group B Streptococci can infect neonates in utero-meningitis
Breastmilk has immunologic properties
Strict infection control and visiting policies

If sickly or come too soon cant prevnet
Breastfeeding is important for them!

Question 39

t or f it is dangerous to let parents touch tubes and wires their baby has

how does attachment/bonding affect babes condition

Answer 39

f
Nursing care supports bonding and attachment no matter what the circumstances.
Parents are enabled to be partners in care, no matter how complex the infant’s condition.
Babies are encouraged to be skin to skin and spend time with parents.
Babies in the nursery do suffer, but when we allow for attachment, bonding, and contact with the mother (parents), they do better.

Question 40

why is it so important to know s/s of neonatal abstinence syndrome

what are they

Answer 40

the mum often doesnt tell you for fear that it will be taken away

Irritability
Disturbed sleep pattern
Constant movement, tremors
Frequent sneezing
Shrill, high-pitched cry
Possible hyperreflexia and clonus
Convulsions
Tachypnea
Vomiting and diarrhea

Question 41

which of the following is not an unstable infant

Preterm, 
postterm,
 macrosomia(LGA), 
SGA, 
neonatal infections

Answer 41

they all place babies in a high-risk category: unstable

Question 42

how long does neonatal abstinence syndrome often last

Answer 42

• When the symp appear and fade depends on drug but on average it is 24-48 hours and lasts about 2 wk

Question 43

t or f

you should create a stimulating, lively env to distract the infant from its withdrawal

you should allow it to be loosely swaddled so it doesnt feel trapped

Answer 43

f create a low stimulation, quiet dark env

tightly swaddling is better

Question 44

what might infants exposed to cocaine in utero have trouble with after birth

Answer 44

have problem w suckling. Woman advised not to breastfeed

might not be able to use pacifier

Question 45

now from little link not sure if imp?

are all babies of substance using mums taken to NICU right away and given naloxone

Answer 45

no they would want the family to stay together NASyndrome wont automatically happen. it is just a possibility that must be monitored for

should not give naloxone as it has such a sudden onset and could put them right into withdrawal (unless theyre directly under influence of opioid)

Question 46

now from little link not sure if imp?

____ is associated with a 50% reduction in the risk of developing NAS requiring treatment and is strongly encouraged

Answer 46

breastfeeding

Question 47

now from little link not sure if imp?

what is the aim of Tx with NAS

Answer 47

The aim of treatment is to control symptoms to allow oral feeding, tolerable irritability and adequate weight gain.

Question 48

what is the med of choice for NAS

what is often used

Answer 48

whatever they are withdrawing from

• Common drugs used to counteract abstinence syp are morphine and phenobarbital. Others are methadone, chlorpromazine and diazepam

Question 49

Now considering what was on the ppt about homework focus Ill do a bit more on preemies

what is considered preterm and what are they at risk of

Answer 49

before wk 37

Question 50

how can you figure out if the babe is preterm

Answer 50

• Neonatal assessments- sole creases, skull firmness, ear cartilage, and neurological development (eg reflexes) plus moms last period help determine
gestational age

it will have a lg head in comparison to body
might have more verni caseosa
less active and doesnt cry often
small eyes…more more