New born complications vice over Flashcards
The nursing goals for NB?
Pink
Warm
Sweet (not hypoglycemia)
Blood glucose > 45mg/d
Infants of Diabetic Mothers (IDM)
If the mother’s blood glucose is NOT well controlled….
She may produce a baby who is
The abrupt discontinuation of the high glucose leaves cause?
LGA- Large for Gestational Age
baby increases insulin d/t cover the high level of BG from the mother.
The abrupt discontinuation of the high glucose leaves the infant with too much-circulating insulin and can result in life-threatening drops in BG
Infants of Diabetic Mothers (IDM)
If the mother’s diabetes has caused arterial damage and hypertension, the baby may be
SGA due to poor perfusion to the placenta.
IUGR?
The baby is not as big as would be expected for the stage of the mother’s pregnancy.
The placenta ages, what is happening?
Commonly?
The baby begins to deplete his subcutaneous fat 使い果たす
glycogen reserves to make up for the placenta deficit
Commonly postpartum
Hypoglycemia
a) risk baby
b)solution
a)
IDM
SGA
Preterm babies
b)
Feeding the baby
Skin-to-skin with the mother
risk of the baby should feed within the first 30-60 minutes of life
Hyperbilirubinemia
a) abnormal level
b) when it occurs?
a) unconjugated bilirubin levels > 5mg/dL
b) n the first 7 days of life
usually 2nd to 3rd day
If the bilirubin is not passed quickly through the bowels, it can be reabsorbed, converted back to the unconjugated state, and further overwhelm the liver.
Pain management in newborns
Breastfeeding or
skin-to-skin during the procedure
a pacifier
Phototherapy
Unconjugated bilirubin levels > 5mg/dL
Occurs in up to 80% of healthy newborns in the first 7 days of life
Phototherapy
considerations
Protect eyes with eye mask
Expose as much skin(only diaper to wear)
Assess for dehydration and diarrhea
LGA from IDM and SGA from poor perfusion
Which jaundice is at high risk?
physiologic jaundice r/t polycythemia.
physiologic jaundice
A newborn’s immature liver often can’t remove bilirubin quickly enough
due to these normal newborn conditions
typically appears on the second or third day of life
How jaundice develop?
bilirubin in the blood (yellow pigment) increased
Old RBCs recycle pattern, mom placenta do this for the baby but now the baby have to this his own (usually, poo out)
Why jaundice so common at NB?
High number of RMCs
Shorter RBCs lifespan
Slower liver conjugation
If preterm delivery anticipated?
Magnesium sulfate given
-decrease uterine contractions and stop cervical dilation
Betamethazone IM for fetal lung maturity
preterm infants
#1 urgent health problem?
What are the causes?
Respiratory
Lungs are not fully mature
Respiratory distress
What do we see?
Nursing considerations?
Cyanosis or pallor
tachypnea, retractions
flaring, grunting
Respiratory Assessment
Ability of infant to breathe
Maintain respiratory function
Energy consumption
Risk for aspiration
DO NOT bottle feed a baby in respiratory distress!
RDS
What causes it?
Who is at risk?
Lack of sufficient surfactant causes the NB to work harder to breathe
Premature newborns and infants of diabetic mothers (IDM)
RDS
Interventions
Need some O2 mechanical assistance
The longer oxygen and respiratory support is required, the greater the risk that the infant will develop Bronchopulmonary Dysplasia or Retinopathy of Prematurity=blind
Transient Tachypnea of the Newborn
TTN?
A failure of the lungs to clear the amniotic fluid
resolves quickly thus decreasing the chance of the complications that go with long-term respiratory support
TTN
Who is at risk?
Nursing considerations?
LGA and late preterm
IDM
c-section NB
Initiating oxygen therapy
IV fluids
Restricting oral feedings until respiratory status improves
An immature gut
Problem?
What can we encourage?
Poor sucking, small stomach capacity
BREASTFEEDING!
broken down easier
Premature newborns have
a) less what? 2
b) decreased what?
c) skin?
a) subcutaneous fat
less brown fat
b) glycogen stores
c) Thinner
Premature newborns
cold stress sets up?
Hypoglycemia
Pulmonary vasoconstriction
Hyperbilirubinemia
Respiratory distress
Metabolic acidosis
Neonatal Sepsis
Findings
cool, clammy skin
Hypothermia
1 causes of Neonatal Sepsis
What to do?
Group B strep
Ampicillin IV during labor every 4 hr until delivery
What are common antibiotics for NB? 2
Ampicillin and Gentamycin
Be sure all cultures are collected before antibiotics are started if possible.
NAS baby?
Neonatal abstinence syndrome
NAS babies care?
A lot of time just to comfort and control their agitated behaviors
Offer a pacifier
Encourage the parents in the plan of care(they have poor coping skill)
Avoid judgmental actions and comments
Position on right side or semi-Fowler to avoid aspiration with regurgitation or vomiting
