Newborn at risk

Question 1

infants with diabetic mother

Answer 1

high levels of glucose crosses placenta increasing fetal insulin production

Question 2

infants with diabetic mother assessment

Answer 2

-mother with diabetes
-full rosy cheeks, ruddy skin, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subq fat, hypoglycemia, birth trauma

Question 3

infants with diabetic mother mgmt

Answer 3

-prevent hypoglycemia: oral feedings, neutral thermal environment, rest periods
-maintina fluid and electrolyte balance: monitor calcium levels, fluid therapy, monitor bilirubin

Question 4

hyperbilirubinemia risk factors

Answer 4

-polycythemia
-bruising, cephalohematoma
-birth trauma
-prematurity
-ABO incompatibility, Rh isoimmunization
-macrosomia
-delayed cord clamping
-siblings with hx of jaundice
-inadequate breastfeeding
-male

Question 5

hyperbilirubinemia assessment

Answer 5

-skin, mucous membranes, sclera, bodily fluids
-signs of Rh incompatibility
-bilirubin levels
-tc bili
-total serum
-COOMBs/DAT: + result, risk for jaundice

Question 6

hyperbilirubinemia mgmt

Answer 6

-prevention/early detection
-reduction of bilirubin levels
-early feeding, exposure to natural sunlight, phototherapy
-monitor hydration status, stools, skin color, bili levels

Question 7

phototherapy

Answer 7

-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

Question 8

respiratory distress syndrome

Answer 8

-lung immaturity and lack of alveolar surfactant, preemie baby

Question 9

respiratory distress syndrome risk factors

Answer 9

-preterm birth
-c/s delivery
-male
-cold stress
-maternal diabetes
-perinatal asphyxia

Question 10

respiratory distress syndrome assessment

Answer 10

-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)

Question 11

respiratory distress syndrome tx

Answer 11

-supportive o2 (mechanical ventilation, CPAP, PEEP)
-surfactant
-thermoregulation
-cardiovascular and nutritional support
-glucose maintenance

Question 12

meconium aspiration syndrome

Answer 12

inhalation of particulate meconium with amniotic fluid into lungs, secondary to hypoxic stress

Question 13

meconium aspiration syndrome assessment

Answer 13

-risk factors
-staining of amniotic fluid, nails, skin, or umbilical cord
-prolonged or increasing resp. distress
-chest x-ray & ABGs- metabolic acidosis

Question 14

meconium aspiration syndrome mgmt

Answer 14

-suction at birth when head is delivered
-adequate tissue perfusion
-decrease in o2 demand and energy use
-neutral thermal enviornment

Question 15

necrotizing enterocolitis (NEC)

Answer 15

-inflammatory disease of the bowel which can cause ischemic and necrotic injury in the gastrointestinal tract
-preterm babies, especially with enteral feedings

Question 16

NEC assessment

Answer 16

-s/s resp. distress
-lethargy
-feeding intolerance
-diarrhea
-bloody stools
-increase in abd. circumference
-determine residuals prior to next feeding, if high suspect NEC

Question 17

NEC mgmt

Answer 17

-immediately stop feeding
-ivd
-measure abd. circumference
-monitor stools, gastric contents
-antibiotic therapy
-may need surgery
-can lead to sepsis

Question 18

congenital neonatal sepsis

Answer 18

-intrauterine
-“vertical transmission”
-onset before birth
-CMV, rubella, toxoplasmosis, herpes, HIV, syphillis

Question 19

early onset neonatal sepsis

Answer 19

-perinatal, <72 hrs
-GBS, E. Coli, staph, listeria

Question 20

late onset neonatal sepsis

Answer 20

-“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

Question 21

neonatal sepsis risk factors

Answer 21

-prolonged labor
-antepartum/intrapartum infections
-preterm birth
-maternal substance abuse
-meconium aspiration
-chorioamnionitis
-low birth weight
-prolonged hospital stay

Question 22

neonatal sepsis s/s

Answer 22

-poor feedings
-resp. distress
-bradycardia
-gi problems
-increased o2 demands
-lethargy
-hypotension
-decreased or elevated temp
-irritability

Question 23

neonatal sepsis labs

Answer 23

-CBC: anemia, leukocytosis, leukopenia
-elevated c-reactive protein, indicates inflammation
-chest x-ray & blood cultures

Question 24

neonatal sepsis mgmt

Answer 24

-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

Question 25

fetal alcohol spectrum disorders

Answer 25

-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

Question 26

withdrawal sx

Answer 26

-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