Module 12 (Final) Flashcards
Whatfor Gestational Age ( is meant by Small SGA)?
- Infants below the 10th percentile
- Usually a result of intrauterine growth restriction (IUGR)
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)
What is meant by Large for Gestational Age (LGA)?
Infants are above the 90th percentile
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
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
What are the reasons for large for gestation (LGA) age neonates?
- Diabetes
- Multiparity
- Genetic predisposition
- Macrosomia
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
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
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)
What is the etiology of respiratory distress syndrome (RDS)?
- Insufficient surfactant production
- Birth prior to 34-36 weeks’ gestation = impaired alvelolar function
Risk factors of respiratory distress syndrome
- Prematurity
- Infant of Diabetic Mother (IDM)
- Hypoxia/Asphyxia = acidosis
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) )
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
Discuss meconium aspiration syndrome (MAS)
Secondary to intrapartal hypoxia
Correlates with severe respiratory distress syndrome (RDS)
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
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
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)
What nursing considerations should be in place for the postterm neonate?
- 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?
- 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?
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?
- 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)
- 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?
- 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
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
