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
