Newborn at risk Flashcards
infants with diabetic mother
high levels of glucose crosses placenta increasing fetal insulin production
infants with diabetic mother assessment
-mother with diabetes
-full rosy cheeks, ruddy skin, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subq fat, hypoglycemia, birth trauma
infants with diabetic mother mgmt
-prevent hypoglycemia: oral feedings, neutral thermal environment, rest periods
-maintina fluid and electrolyte balance: monitor calcium levels, fluid therapy, monitor bilirubin
hyperbilirubinemia risk factors
-polycythemia
-bruising, cephalohematoma
-birth trauma
-prematurity
-ABO incompatibility, Rh isoimmunization
-macrosomia
-delayed cord clamping
-siblings with hx of jaundice
-inadequate breastfeeding
-male
hyperbilirubinemia assessment
-skin, mucous membranes, sclera, bodily fluids
-signs of Rh incompatibility
-bilirubin levels
-tc bili
-total serum
-COOMBs/DAT: + result, risk for jaundice
hyperbilirubinemia mgmt
-prevention/early detection
-reduction of bilirubin levels
-early feeding, exposure to natural sunlight, phototherapy
-monitor hydration status, stools, skin color, bili levels
phototherapy
-monitor temp, I&O, hydration status, elimination characteristics
-change positions q2hrs
-monitor skin integrity
-eye and genital protection
-encourage parents to participate in care
-only remove infant for feedings
-maintain neutral thermal environment
respiratory distress syndrome
-lung immaturity and lack of alveolar surfactant, preemie baby
respiratory distress syndrome risk factors
-preterm birth
-c/s delivery
-male
-cold stress
-maternal diabetes
-perinatal asphyxia
respiratory distress syndrome assessment
-can occur at birth or w/ in a few hours, will worsen after 72 hours
-s/s resp. distress
-tachycardia (>150-180)
-generalized cyanosis
-tachypnea (<60)
respiratory distress syndrome tx
-supportive o2 (mechanical ventilation, CPAP, PEEP)
-surfactant
-thermoregulation
-cardiovascular and nutritional support
-glucose maintenance
meconium aspiration syndrome
inhalation of particulate meconium with amniotic fluid into lungs, secondary to hypoxic stress
meconium aspiration syndrome assessment
-risk factors
-staining of amniotic fluid, nails, skin, or umbilical cord
-prolonged or increasing resp. distress
-chest x-ray & ABGs- metabolic acidosis
meconium aspiration syndrome mgmt
-suction at birth when head is delivered
-adequate tissue perfusion
-decrease in o2 demand and energy use
-neutral thermal enviornment
necrotizing enterocolitis (NEC)
-inflammatory disease of the bowel which can cause ischemic and necrotic injury in the gastrointestinal tract
-preterm babies, especially with enteral feedings
NEC assessment
-s/s resp. distress
-lethargy
-feeding intolerance
-diarrhea
-bloody stools
-increase in abd. circumference
-determine residuals prior to next feeding, if high suspect NEC
NEC mgmt
-immediately stop feeding
-ivd
-measure abd. circumference
-monitor stools, gastric contents
-antibiotic therapy
-may need surgery
-can lead to sepsis
congenital neonatal sepsis
-intrauterine
-“vertical transmission”
-onset before birth
-CMV, rubella, toxoplasmosis, herpes, HIV, syphillis
early onset neonatal sepsis
-perinatal, <72 hrs
-GBS, E. Coli, staph, listeria
late onset neonatal sepsis
-“horizontal transmission”
->72 hours after delivery
-hospital/caregiver aquired
-more common w/ invasive procedures
-staph, e. coli, klebsiells, pseudonomal, enterobacter, candida, anaerobas
-HIV/CMV- breastfeeding or direct contact
neonatal sepsis risk factors
-prolonged labor
-antepartum/intrapartum infections
-preterm birth
-maternal substance abuse
-meconium aspiration
-chorioamnionitis
-low birth weight
-prolonged hospital stay
neonatal sepsis s/s
-poor feedings
-resp. distress
-bradycardia
-gi problems
-increased o2 demands
-lethargy
-hypotension
-decreased or elevated temp
-irritability
neonatal sepsis labs
-CBC: anemia, leukocytosis, leukopenia
-elevated c-reactive protein, indicates inflammation
-chest x-ray & blood cultures
neonatal sepsis mgmt
-early recognition/dx is key!!
-broad spectrum abx
-medical & surgical asepsis at all times
-monitor vs, comfort/pain, nutrition, positioning, oral care, invasive sights for s/s infection
-watch for organ system dysfuction
fetal alcohol spectrum disorders
-most common: fetal alcohol syndrome
-physical and mental disorders appear at birth and remain problematic throughout life
-main findings: growth restriction, craniofacial abnormalities, cns dysfunction- delayed fine motors, learning disabilities
withdrawal sx
-W = Wakefulness: sleep duration less than 3 hours after feeding
-I = Irritability
-T = Temperature variation, tachycardia, tremors
-H = Hyperactivity, high-pitched persistent cry, hyperreflexia, hypertonus
-D = Diarrhea, diaphoresis, disorganized suck
-R = Respiratory distress, rub marks, rhinorrhea
-A = Apneic attacks, autonomic dysfunction
-W = Weight loss or failure to gain weight
-A = Alkalosis (respiratory)
-L = Lacrimation
