mat pt 3 ppt and notes (neonate) Flashcards
foci of nursing care for infant
Respirations and Extrauterine Circulation Temperature Fluids and Electrolytes Nutrition and Waste Preventing Infection Bonding and Attachment
nursing Dx for high risk infant
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
what info will you look for in the chart to tell you about the neonate
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
what is GBS and why is it such concern for infant
how are women screened for it
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
symptoms in neonate of GBS infect
Early onset symp: tachypnea, apnea, paleness, hOtn, hypotonia, dec urine output from hypotension
in relation to TORCH what would be an indication for c section
TORCH-did mum come into contact with any of these? Does she have hx of herpes with active ulcers? If yes thenc section
if woman is smoker what is the concern
Smokingtiny placenta and tiny baby. Young women are smoking less. The baby and labour has very unusual odour.. The placenta might be fx at 50%
when are Apgars done
what is the ideal score
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
when assessing the birth history what does this entail
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
when would babies get blood gases and lytes done
aside from assessing the labs what ould you look at
it is important to assess the fontanel-sunken is dehydrated, bulging…
what could cause fluid or lyte imbal for neonate
how much BL is concern for them
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
what can be consequence of too much IV fluid
can babe get fluids easily if sick
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
why are neonates given IM vit K and when
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
normal vitals for term babe
normal BG
VS Respirations 30-60 Temperature 36.5-37.4 C axilla Pulse 110-160 (will be lower if overdue) Sugars 3.2-6
what resp signs are bad
We should not see ‘see-saw’ respirations, intercostal indrawing, xiphoid retractions, flared nares, or grunting!
gestational age and why it is imp?
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
what causes fetal circ to switch to normal circ
what can flip the babe back to fetal circ
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
names and fx of fetal circ
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
why is it so easy for babe to get acidotic
The baby has immature neurological system-cant shiver, cant change positionget coldacidotic
what puts babe at risk of resp distress
what helps the babe to breathe or clears airway that are very natural interventions
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
how is temp protected for newborn
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
what i opthalmia neonatorum when does it occur and how is it treated
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
if mum is hep B positive what precautions might be taken w newborn
- 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
how can herpes be transmitted
what are the concerns with herpes
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
what findings might indicate herpes in infant
- 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
how to prevent herpes infect of babe
- 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
how is HIV transmitted
can be via placenta or direct contact w maternal blood during birth
what condition might present as a preterm baby
what term is used to refer to macrosomic babies that desribes their health status
gestational diabetic
fragile giants
why might Preterm or sickly (GD, macrosomia) infants not get adequate nutrition
related to systems
Neuro-not able to coordinate sucking, swallow, breath
Resp-suck, swallow, breatheenergy and calories. Inc effort. Often must feed by tube feed
Bowels-may not be mature enough to absorbNecrotizing enterocolitis
how does breastmilk prevent abn things in blood
how does breastmilk change if preemie and how lon does this last
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.
how does neonate of gestational diabetic adjust to new env in r/t sugars
when must we intervene
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
what is the problem with babe having low sugars
whatre the best interventions for GD babes
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
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?
- 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
what syndrome can occur almost exclusively with infants of GD
• Caudal regression syndrome (hypoplasia of the lower extremities) is a syndrome that occurs almost exclusively in such infants
how does GD affect the delivery method
might need to have c/s to avoid cephalopelvic dysproportion
what makes macrosomic babes particularly unstable in terms of what they need to do after birth
whcih systems can be immature
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!!
what kind of care might macrosomic babe get
how big are these babes
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
principles of infection prevention from slides
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!
t or f it is dangerous to let parents touch tubes and wires their baby has
how does attachment/bonding affect babes condition
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.
why is it so important to know s/s of neonatal abstinence syndrome
what are they
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
which of the following is not an unstable infant
Preterm, postterm, macrosomia(LGA), SGA, neonatal infections
they all place babies in a high-risk category: unstable
how long does neonatal abstinence syndrome often last
• When the symp appear and fade depends on drug but on average it is 24-48 hours and lasts about 2 wk
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
f create a low stimulation, quiet dark env
tightly swaddling is better
what might infants exposed to cocaine in utero have trouble with after birth
have problem w suckling. Woman advised not to breastfeed
might not be able to use pacifier
now from little link not sure if imp?
are all babies of substance using mums taken to NICU right away and given naloxone
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)
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
breastfeeding
now from little link not sure if imp?
what is the aim of Tx with NAS
The aim of treatment is to control symptoms to allow oral feeding, tolerable irritability and adequate weight gain.
what is the med of choice for NAS
what is often used
whatever they are withdrawing from
• Common drugs used to counteract abstinence syp are morphine and phenobarbital. Others are methadone, chlorpromazine and diazepam
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
before wk 37
how can you figure out if the babe is preterm
• 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
