Fetal Infections Rubella CMV Congenital/chromosomal anomalies Maternal morbidity Preeclampsia Lifestyle choices Tabacco, ETOH, Illicit drugs Severe malnutrition Sub-optimal placental function

Module 12 (Final) Flashcards by Kelly vara

Whatfor Gestational Age ( is meant by Small SGA)?

Infants below the 10th percentile
Usually a result of intrauterine growth restriction (IUGR)

How well did you know this?

Not at all

Perfectly

What is meant by Appropriate for Gestational Age (AGA)?

Infants between 10th and 90th percentile
- Generally AGA term infants are 2500-4000G (5lb. 8oz-8lb. 13oz)

How well did you know this?

Not at all

Perfectly

What is meant by Large for Gestational Age (LGA)?

Infants are above the 90th percentile

How well did you know this?

Not at all

Perfectly

SGA/IUGR Etiologies

Fetal Infections
- Rubella
- CMV
Congenital/chromosomal anomalies
Maternal morbidity
- Preeclampsia
Lifestyle choices
- Tabacco, ETOH, Illicit drugs
Severe malnutrition
Sub-optimal placental function

How well did you know this?

Not at all

Perfectly

What nursing considerations should be in place for small for gestational age neonates?

Impaired transition to extrauterine life
- Evidenced by APGAR scores
Hypothermia
Hypoglycemia
- Caloric needs are proportionately increased in the SGA/IUGR neonate than in the AGA infant

How well did you know this?

Not at all

Perfectly

What are the reasons for large for gestation (LGA) age neonates?

Diabetes
Multiparity
Genetic predisposition
- Macrosomia

How well did you know this?

Not at all

Perfectly

What nursing considerations should be in place for a neonate that is large for gestational age (LGA)?

Infant of diabetic mother
- Hypoglycemia
- Impaired respiratory effort
  - Delayed surfactant production (due to increased insulin production)
Risk of birth related injuries
- Dystonic labor/ operative delivery
- Assisted delivery
  - Cephalohematoma
- Shoulder dystocia
  - Clavicular fracture
  - Bracial plexus injury

How well did you know this?

Not at all

Perfectly

Define preterm

Birth occurs prior to the beginning of the 38th gestational week

Ex.

birth at 36 weeks and 6 days is preterm (37th week is not complete)

birth at 36 weeks and 7 days = 37 weeks = term because the baby is now beginning the 38th week

How well did you know this?

Not at all

Perfectly

What nursing considerations should be in place for the preterm neonate?

Preterm infants are “unfinished”
Respiratory function/RDS
Thermoregulation (no brown fat)
Neurologic immaturity
- Weak reflexes
- Impaired regulation of behavioral states
  - Risk for impaired parenting (do not feed/cue as well as term neonates)

How well did you know this?

Not at all

Perfectly

What is the etiology of respiratory distress syndrome (RDS)?

Insufficient surfactant production
Birth prior to 34-36 weeks’ gestation = impaired alvelolar function

How well did you know this?

Not at all

Perfectly

Risk factors of respiratory distress syndrome

Prematurity
Infant of Diabetic Mother (IDM)
Hypoxia/Asphyxia = acidosis

How well did you know this?

Not at all

Perfectly

How would respiratory distress syndrome be managed?

Indications evident shortly after birth: tachypnea/tachycardia, GFR (grunting, flaring, retracting), cyanosis, heart murmur (increased risk of patent ductus arteriosis (PDA) )

How well did you know this?

Not at all

Perfectly

Discuss transient tachypnea of the neonate (TTN)

Delayed/inadequate absorption of lung fluids after birth

Occurs early in transition to extrauterine life, generally resolves unassisted

Common in precipate births and c-sections

How well did you know this?

Not at all

Perfectly

Discuss meconium aspiration syndrome (MAS)

Secondary to intrapartal hypoxia

Correlates with severe respiratory distress syndrome (RDS)

How well did you know this?

Not at all

Perfectly

Discuss Retinopathy of Prematurity (ROP)

Retinal damage in premature infants

Proposed etiologies: oxygen therapy, prolonged ventilatory assistance, sepsis, acidosis
Nursing management: monitor oxygen levels, maintain oxygen at lower level (in the 80s), facilitate ophthalmic exams

How well did you know this?

Not at all

Perfectly

Discuss necrotizing enterocolitis

Inflammation of gastrointestinal mucosa

Proposed etiologies: immaturity of neonatal gut, perinatal hypoxia/asphyxia

Nursing management: provision of colostrum/breast milk, abdominal girth measurements, IVF/perenteral nutrition

How well did you know this?

Not at all

Perfectly

Defining criteria for Postterm Neonate

Postterm: Birth occurs after completion of the 42nd gestational week

Ex.

Birth at 41 weeks and 6 days = term

Birth at 41 weeks and 7 days = 42 weeks = postterm (infant is now beginning the 43rd week)

How well did you know this?

Not at all

Perfectly

What nursing considerations should be in place for the postterm neonate?

Study These Flashcards

Intrapartal Hypoxia: decreased placental function (diminished fetal reserves)
Hypothermia/Cold Stress: Brown fat stores are depleted as a result of decreased placental function and needing to use it for enegy
Hypoglycemia: Depleted glycogen stores

What are the priorities of care for preterm and postterm neonates?

Study These Flashcards

Thermoneutral environment
Vital sign stability
Fluid and nutrient intake
Infection control
Behavioral state: environmental modifications to support need for rest, quiet
Parental/Neonatal attachment and bonding: kangaroo care

How is pathological jaundice defined?

Study These Flashcards

Any clinically evident jaundice prior to 24 hours of age is considered pathologic. Bilirubin levels rising at greater than 5mg/dL per 24 hours also suggests pathology. Any jaundice persisting greater than 6 days in a term infant OR greater than 14 days in a preterm infant is considered pathologic.

What are the etiologies of pathological jaundice?

Study These Flashcards

Rh or ABO incompatibility: Hemolytic disease of the neonate
Prematurity
Cephalohematoma (birth trauma)
Nutritional/Fluid Deficits
Sepsis

How does pathological jaundice present itself in the neonate? (neonatal morbidity)

Study These Flashcards

Lethargy
Poor feeding: excessive weight loss, diminished output
Kernicterus: encephalopathy caused by deposition of bilirubin in brain cells, potential for neurologic compromise of varying degrees

What nursing considerations should be in place for a neonate with pathological jaundice?

Study These Flashcards

Identify any risk factors: maternal blood type and Rh, antepartal RhoGAM if indicated, perinatal course, gestational age
Determine neonate’s blood type, Rh, Direct Coombs
Draw bilirubin levels per protocol/order
Initiate phototherapy protocol per order

Discuss the conjugation of bilirubin

Study These Flashcards

Indirect Bilirubin: Unconjugated bilirubin is fat soluable. It attaches to binding sites on plasma albumin and is transported to the liver. It is converted to conjugated bilirubin (glurcuronyl transferase).

Direct Bilirubin: Conjugated bilirubin is water soluable. It is excreted VIA stool and urine.

The indirect bilirubin level plus the direct bilirubin level equals the total bilirubin level

Discuss phototherapy treatment for jaundiced neonates

The neonate is exposed to high-intensity fluorescent light which facilitates the excretion of unconjugated bilirubin and bypasses the hepatic conjugation. Nursing diagnoses: Fluid Volume Deficit R/T insensible water loss and inadequate oral intake, Impaired Skin Integrity R/T frequent loose stools, Risk for Altered Parenting

Discuss the reasons for pathological jaundice in the fetus (prenatal)

* Erythroblastosis Fetalis: Rh incompatibility only. Transplacental passage of maternal antibodies leads to hemolysis of fetal RBCs * Hydrops Fetalis: Most severe form of erythroblastosis fetalis. Severe anemia and multiorgan system failure (intrauterine blood transfusion is treatment)

Discuss sepsis neonatorum

Systemic infection during the neonatal period (6 weeks after birth). Early onset sepsis is acquired perinatally, through prolonged labor, chorioamnioitis, or PROM; it is evident through the first hours after birth and has a high mortality rate. Late onset sepsis develops during the first week of the neonate's life and is more specific and localized, therefore, it has a lower mortality rate than early onset sepsis.

What is proper nursing managment of sepsis neonatorum?

* Know that early signs and symptoms are often subtle: temperature instability (generally hypothermic) * Impaired respiratory function * Cardiovascular indicators: tachycardia/color changes * Gastrointestinal Indicators: feeding intolerance leads to hypoglycemia * Neurological indicators: lethargy/irritability/high-pitched cry

Discuss Neonatal Abstinence Syndrome (NAS)

* Prenatal chemical exposure: opiates, tranquilizers, sedatives, ETOH * Onset for ETOH is 3-12 hours * Onset for opiates is 48-72 hours (often after discharge) * Observable indicators: tremors/hypertonicity, irritability/high-pitched cry, excessive sucking with uncoordinated suck/swallow reflexes

What are the nursing responsbilities associated with neonatal abstinence syndrome (NAS)?

* Collect first urine for chemical dependency * Administer medical withdrawal regimen: NAS scoring per protocol * Feeding: minimize distractions/ guard against aspiration * Environment: containment/controlled stimulation * Parent/child attachment

Discuss Phenylketonuria (DKU)

CNS damage due to toxic level of phenylalanine and a deficiency of phenylalanine hydroxylase which leads to autosomal recessive disorder. Nursing responsiblities include facilitating the mandated NYS screening (make sure screening is done before discharge). Management for PKU is lifelong low-phenylalnine diet and low protein foods.

Discuss Trisomy 21

Down syndrome. Each cell contains an "extra" chromosome #21 that causes delayed attainment of developmental milestones. The characteristic physical findings are small low-set ears, hypotonia, palmar crease (just one), flattened facial profile. Diagnoses are VIA karyotyping.

Define intrauterine growth restriction (IUGR)

Impaired fetal growth due to any etiology

Define macrosomia

Large fetal body size and weight

Define polycythemia

Abnormal increase in the number of red blood cells in circulation

Define tansient tachpnea of the neonate (TTN)

Tachypnea clinically evident by six hours of age, caused by excessive fluid or mucous in the lungs

Define meconium aspiration syndrome (MAS)

Inhalation of meconium or meconium-stained fluid, characterized by respiratory distress

Define respiratory distress syndrome (RDS)

Impaired ventilation at the alveolar level (membrane disease)

Define hyperbilirubinemia

Excessive bilirubin in the blood, indicative of hemolytric process

Define Kernicterus

Encephalopathy caused by deposition of unconjugated bilirubin in brain cells

Define Erythroblastosis Fetalis

Hemolytric disease of the neonate characterized by anemia, jaundice, hepatomegaly, and generalized edema

Define sepsis neonatorum

Generalized infection that spreads rapidly through the bloodstream during the neonatal period (first 28 days of life)

Identify maternal data indicative of the need for a neonatal toxicology screen

Reported substance use/abuse an/or absence of prenatal care

Module 12 (Final) Flashcards

(43 cards)