Newborn Complications Flashcards
What are some predictive risk factors associated with high risk infants?
Low socioeconomic level e.g.
Exposure to environmental dangers e.g. smoking
Pre-existing maternal conditions e.g. kidney failure, diabetes
Maternal factors e.g. low-socioeconomic status
Medical conditions related to pregnancy e.g. pregnancy-induced hypertension
Pregnancy complications e.g.
preterm labour
What are the parameters for “preterm”, “term”, and “postterm” infants?
Preterm = is <37 weeks gestation Term = is 37-40 weeks gestation Postterm = >42 weeks gestation
What is considered “appropriate for gestational age” in size? (AGA)
Between the 10th and the 90th percentile
What are the two types of small gestation age babies?
SGA symmetric
SGA asymmetric
What is symmetric small gestational age? (what causes it)
Chronic hypertension, severe malnutrition, chronic intrauterine viral infection, substance abuse, genetic anomalies
What is asymmetric small gestational age? (what causes it)
Placenta infarcts, preeclampsia, poor wt. gain in pregnancy
What is the difference between symmetric and asymmetric small gestational age babies?
Symmetric:
Long term maternal condition Noted early 2nd trimester Chronic, prolonged restriction Decrease # and size of cells Everything is small
Asymetric:
Assoc. with acute compromise
Noted in 3rd trimester
Restriction in 3rd trimester
Decrease size of cells
Wt decreased but head & length are not
What are some physical findings of small gestational age babies?
Small size, decreased fat & muscle mass
poor skin tugor, loss of vernix
Full term nails, dull hair, separate skull bones
Sunken abdomen, small liver
Developed creases & cartilage
Often a thin, meconium stained cord
Alert, wide eyed, developed reflexes
What is the appearance of large gestational age babies?
Increased body fat, macrosomic, ruddy, large placenta and cord
What are the reasons for large gestational size?
Poorly controlled diabetes, genetics, multiparity, male
What causes the IDM to typically be large? (What is going on inside with the glucose and the insulin)
Mother- high blood sugars (glucose)
Fetus has ↑glucose in blood, muscle & fat
Fetus converts fat to glycogen & stored
Fetus becomes large (macrosomic)
Fetus produces ↑ levels of insulin in utero
What causes hypoglycemia in IDM after delivery?
Fetus produces increased levels of insulin in utero.
Infant has minimal intake (colostrum) and is producing increased insulin = hypoglycemia
What are some common complications and potential nursing diagnoses for an IDM?
- Respiratory distress syndrome
Risk for impaired gas exchange (rt. Decreased surfactant, aspiration). - Hypoglycemia
Risk for unstable blood sugars (related to hyperinsulinemia (increased insulin)) - Hypocalcemia
Risk for imbalance in calcium homeostasis (related to hypoparathyroidism) - Hyperbilirubinemia
Risk for neonatal jaundice (related to increased RBC breakdown, trauma) - Birth trauma
Risk for injury related to LGA status - Congenital anomalies
Risk for anomalies related to IDM status
What level of blood glucose is considered normal/too low in a newborn?
Normal = above 2.6
What should be done for an infant with a blood glucose of 1.8 to 2.5? (nursing actions)
Feed small frequent feeds & check BS @ 1hr. Continue to monitor
What are the objective data that indicate hypoglycemia in a newborn? (Signs and symptoms)
Lethargy, apathy, hypotonia Poor feeding/sucking reflex, vomiting Pallor, cyanosis Hypothermia or temperature instability Apnea, irregular respirations, RDS (tachypnea) Tremors, jerkiness, seizure activity Weak or high-pitched cry
What is the typical behaviour of a postterm infant?
Wide eyed, alert
What is the appearance of the postterm infant?
long & thin, wasting (↓subcutaneous tissue)
Skin- loose, dry, cracking, parchment like, absence of lanugo & vernix
Fingernails long, hair profuse
Meconium stained nails, skin & cord
What are some potential nursing diagnoses for postterm infants?
- Impaired gas exchange related to in utero hypoxia or meconium aspiration
- Unstable blood sugar levels (hypoglycemia) related to deprived nutrition and limited glycogen stores in utero
- Hypothermia related to loss or poor development of subcutaneous fat
- Neonatal jaundice related to polycythemia in utero hypoxia
What is transient tachypnea of the newborn? (TTN)
Progressive respiratory distress
What is the etiology of TTN (transient tachypnea of the newborn)?
Infant fails to clear airway of lung fluids/mucous. May be caused by aspiration.
What is the incidence of TTN?
11/1000 live births
Which babies are at an increased risk for TTN (transient tachypnea of the newborn)?
C-section, LGA, late preterms, intrauterine or intrapartum asphyxia
What are the signs and symptoms of TTN?
Shortly after birth - grunting (expiratory), nasal flaring, mild cyanosis after birth
Tachypnea usually within 6 hours
Rate >60-120 per min
How long does mild TTS last?
PErsists usually 12-24 hours
How long does mod/severe TTS last?
May last 48-72 hours
What is the treatment for TTS?
O2, IV (fluids and electrolytes)
What is the definition of Meconium Aspiration Syndrome (MAS)?
Meconium aspirated into the tracheobroncial tree during labour/delivery
What is the etiology of Meconium Aspiration Syndrome (MAS)?
Asphyxia -> increased peristalsis and relaxation of anal sphincter -> aspiration at birth
What is the incidence of Meconium Aspiration Syndrome (MAS)?
10% of all mec. stained amniotic fluid (MSAF) births
What are the data assocated with meconium aspiration syndrome? (MAS)
Low apgar, respiratory distress, depression, bradycardia, pallor/cyanosis, retractions
How is Meconium Aspiration Syndrome diagnosed?
X-ray
What is the treatment for Meconium Aspiration Syndrome?
O2, High pressure ventilation.
What is considered late preterm?
34-36+6 weeks gestation
What is considered moderately preterm?
32-33+6 weeks gestation
What is considered very preterm?
28-31+6 weeks gestation
What is considered extremely preterm?
<28 weeks gestation
what are some of the signs and symptoms (objective data) of preterm babies?
Less flexion of extremities Less square window ability (wrist) Less recoil of extremities Scarf sign (elbow past midline) Less cartilage, few rugae Amount of lanugo varies Labia maj. does not cover labia minora Nipple & areola barely visable Heel can touch the ear Less creases on plantar surface
What are some potential nursing diagnoses for a preterm infant?
Impaired gas exchange related to immature respiratory system
Imbalanced nutrition, less than body requirements related to weak suck and swallow reflex and decreased ability to absorb nutrients
Ineffective thermoregulation related to hypothermia (secondary to decreased glycogen stores and brown fat stores)
Infection related to immature immune system
Fluid volume deficit related to immature kidneys and insensible fluid loss
What are some nursing actions for risk for impaired gas exchange related to: aspiration, asphyxia, MAS, TTS, premature status
Assess characteristics of respirations Q1H until stable Q6h then Q shift
Assess LOC, colorand behaviour Q interaction/Q1h until stable
Limit or decrease stimulation Q interaction
Teach mom re “back to sleep” and how to deal with a choking baby
Report abnormalities to RN/MD stat
RN to provide O2 and notify MD and NICU if ongoing problems
What are some nursing actions for risk for unstable blood sugar levels (hypoglycemia)?
Discuss plan of care with RN
RN to implement algorithm as per hospital policy (blood sugar and feeds)
Anticipate and assess for signs of hypoglycemia
Ensure infant has small frequent feeds and mother aware of the plan
Limit infant activity (eg. bath) until stable blood sugars
What are some nursing actions for risk for hypothermia/temperature instability?
Assess temp Q1h until stable
Encourage skin to skin x1 hour then re-evaluate temp
If unable to perform skin to skin, bundle babe in warm shirt, flannel and hat
Maintain a thermal neutral environmental Q shift
Teach mom and partner re temp control and how to dress her baby
Once stable ensure a warm environment during bath. F/U temp 1 hour post bath
Ensure frequent feeds and STS
What are some nursing actions for risk for injury (fracture/palsy) related to LGA/preterm status?
Assess for bruising, fractured clavicle/skull, paralysis (facial/brachial plexus), prominent caput/cephalhematoma/intracranial bleed every shift
Assess behaviour, wake sleep & feeding pattern, I&O Q shift
Refer to MD/pediatrician if problems
Teach parents about “what to expect and how to care for problem prior to discharge”
Refer to PHN on discharge PRN
What are some nursing actions for risk for neonatal jaundice (hpyerbilirubinemia)?
Assess circulation (color, pressure over bony areas) every shift
Assess behaviour (wake-sleep pattern) q shift
Assess I&O Q3h
Assess for signs of dehydration (decrease skin turgor, fontanelles, eyes) Q3h
Teach parents re signs of jaundice, when to seek out help and community resources prior to discharge
What are some nursing actions for risk for impaired parenting related to delayed attachment/anomalies?
Assess maternal-child/parental attachment q interaction
Assess maternal affect q interaction
Assess social support initially
Explore situation and feelings re:infant and hospitalization
Refer to professional resources (social worker, public health nurse) prior to discharge
What are signs of newborn distress?
Increased resp rate Sternal retraction Nasal flaring Grunting Excessive mucus Cyanosis (central) Abdominal distention Vomiting of bile-stained material Absence of Meconium or urine within 24 hours Jaundice within 24 hours Temperature instability Jitteriness
