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
