Newborns w/ Special Needs

Question 1

What are some factors that will affect fetal growth?

Answer 1

maternal nutrition
genetics
placental functions
environmental factors

Question 2

What are the common classifications of birth weight and term gestational age?

Answer 2

Appropriate for Gestational Age
Small for Gestational Age
Large for Gestational Age

Question 3

AGA

Answer 3

Appropriate for gestational age

-normal

Question 4

SGA

Answer 4

Small for gestational age

• weight < 2500 g (5 lb 8 oz) at term
• below 10th percentile

Question 5

LGA

Answer 5

Large for gestational age

• weight > 4000 g (8 lb 13 oz) at term
• weight > 90th percentile

Question 6

What are other terms used for marginal weight but ANY gestational age?

Answer 6

Low birth weight
Very low birth weight
Extremely low birth weight

Question 7

LBW

Answer 7

Low birth weight

< 2500 g or 5.5 lb

Question 8

VLBW

Answer 8

Very low birth weight

< 1500 g or 3 lb 5 oz

Question 9

ELBW

Answer 9

Extremely low birth weight

< 1000 g or 2 lb 3 oz

Question 10

SGA newborns are considered to have what?

Answer 10

Fetal Growth Restriction

Question 11

Fetal Growth Restriction (FGR)

Answer 11

the rate of growth does not meet the expected growth pattern?

Question 12

FGR can result from what?

Answer 12

Aneuploidy
Congenital malformations
Infections
Uteroplacental Insufficiency

Question 13

FGR restriction is usually categorized as what?

Answer 13

Asymmetric or Symmetric

Question 14

Symmetric FGR

Answer 14

Fetuses w/ equally poor growth rates of the brain, the abdomen, and the long bones and is thought to result from an early global insult

Question 15

Symmetric FGR is thought to result from what?

Answer 15

An early global insult

Question 16

Asymmetric FGR

Answer 16

infants whose brain growth is spared compared to their abdomen and internal organs

Question 17

Typical Characteristics of SGA Newborns

Answer 17

• head disproportionately large
• wasted appearance
• reduced fat
• decreased breast tissue
• scaphoid abdomen (sunken appearance)
• wide skull sutures
• poor muscle tone
• thin umbilical cord

Question 18

Common problems for SGA Newborns

Answer 18

perinatal asphyxia
difficulty w/ thermoregulation 
hypoglycemia 
polycythemia 
meconium aspiration 
hyperbilirubinemia 
birth trauma

Question 19

Nursing Management for SGA

Answer 19

• weight, length, and head circumference measurements
• serial BG monitoring
• vitals
• early/frequent oral feedings; IV infusions
• S/S of polycythemia
• anticipatory guidance

Question 20

Polycythemia

Answer 20

venous hematocrit > 65% and hemoglobin > 20 grams

Question 21

What are the clinical signs to watch for w/ Polycythemia?

Answer 21

respiratory distress
cyanosis 
jitteriness 
jaundice 
ruddy skin color
lethargy

Question 22

Risk Factors for LGA Newborns

Answer 22

Maternal Diabetes 
Multiparity 
History of macrosomnic infant 
Postdates gestation 
Maternal obesity 
Male fetus 
Genetics

Question 23

What fetal birth trauma can result for LGA newborns?

Answer 23

Shoulder dystocia
Clavicular fractures
Facial palsies

Question 24

LGA Newborn Common Characteristics

Answer 24

large body, plump, full faced
proportional increase in body size
poor motor skills
difficulty regulating behavioral states

Question 25

Common birth problems for LGA newborns are?

Answer 25

Birth trauma Hypoglycemia Polycythemia Hyperbilirubinemia

Question 26

Hypoglycemia

Answer 26

blood glucose value < 40 mg/dL

Question 27

Nursing Management for LGA

Answer 27

- Vitals/BG monitoring - Oral feedings w/ IV glucose prn - Monitor for S/S polycythemia/hypoglycemia - Hydration - Phototherapy for increased bilirubin levels

Question 28

Term

Answer 28

born from the first day of 38th week through 42 weeks

Question 29

Preterm

Answer 29

born before completion of 37 weeks

Question 30

Late Preterm

Answer 30

Born b/t 34 weeks/7 days and 36 weeks/6-7 days

Question 31

Postterm

Answer 31

born beyond 42 completed weeks

Question 32

What happens to the placenta after 42 weeks?

Answer 32

unable to provide adequate oxygen and nutrients

Question 33

Postterm Newborn Characteristics

Answer 33

-dry, cracked, wrinkled skin/possible meconium -long, thin extremities; long nails; creases cover feet -wide eyed, alert expression -abundant hair on scalp -thin umbilical cord limited vernix/lanugo

Question 34

Common Problems for Postterm newborns are?

Answer 34

``` perinatal asphyxia hypoglycemia hypothermia polycythemia meconium aspiration ```

Question 35

Postterm Newborn Nursing Management

Answer 35

``` Resuscitation BG monitoring Initiation of feeding; IV Dextrose Prevent heat loss Evaluation of polycythemia Parental support ```

Question 36

What problems can lead to preterm birth?

Answer 36

infection/inflammation maternal/fetal distress bleeding stretching

Question 37

Common Problems for Preterm Newborn

Answer 37

``` respiratory distress hemorrhage bronchopulmonary dysplasia retinopathy hyperbilirubinemia anemia necrotizing entercolitis hypoglycemia infection/septicemia mental/motor delays ```

Question 38

What problems affect the preterm newborn's respiratory system?

Answer 38

- Surfactant deficiency - unstable chest wall - immature respiratory control centers - small respiratory passageways - inability to clear fluids

Question 39

What is the main problem faced by the preterm newborns cardiovascular system?

Answer 39

changing from fetal to newborn circulation pattern

Question 40

What places the newborn at risk for malnutrition and weight loss if preterm?

Answer 40

Combination of shunting, ischemia, damage to intestinal wall, and poor sucking ability

Question 41

What will place the preterm newborn at risk for growth and developmental delays?

Answer 41

``` Small stomach capacity weak abdominal muscles compromised metabolic function limited ability to digest proteins/absorb nutrients weak/absent suck and gag reflexes ```

Question 42

Renal System problems of the preterm infant are?

Answer 42

reduced ability to concentrate urine and slow glomerular filtration rate

Question 43

What are the risks from the preterm newborns immature renal system?

Answer 43

Fluid retention Fluid/electrolyte disturbances/increases Increased risk drug toxicity

Question 44

Common Preterm Characteristics

Answer 44

``` Weight < 5.5 lb Scrawny/poor muscle tone/minimal fat Undescended testes/Prominent labia and clitoris Plentiful lanugo/vernix Poorly formed ear pinna/Fused eyelids Thin skin; absent/few creases ```

Question 45

Preterm Newborn Common Problems

Answer 45

Hypothermia Hypoglycemia Hyperbilirubinemia Problems w/ immature body systems

Question 46

Nursing Management for Preterm Newborns

Answer 46

``` oxygenation thermal regulation nutrition/fluid balance infection prevention stimulation pain management growth/development parental support ```

Question 47

Perinatal Greif/Loss Management

Answer 47

``` Effect on childbearing fams Parent/newborn interaction Interventions Sit quietly/observe Cultural differences ```