Newborns w/ Special Needs Flashcards
What are some factors that will affect fetal growth?
maternal nutrition
genetics
placental functions
environmental factors
What are the common classifications of birth weight and term gestational age?
Appropriate for Gestational Age
Small for Gestational Age
Large for Gestational Age
AGA
Appropriate for gestational age
-normal
SGA
Small for gestational age
- weight < 2500 g (5 lb 8 oz) at term
- below 10th percentile
LGA
Large for gestational age
- weight > 4000 g (8 lb 13 oz) at term
- weight > 90th percentile
What are other terms used for marginal weight but ANY gestational age?
Low birth weight
Very low birth weight
Extremely low birth weight
LBW
Low birth weight
< 2500 g or 5.5 lb
VLBW
Very low birth weight
< 1500 g or 3 lb 5 oz
ELBW
Extremely low birth weight
< 1000 g or 2 lb 3 oz
SGA newborns are considered to have what?
Fetal Growth Restriction
Fetal Growth Restriction (FGR)
the rate of growth does not meet the expected growth pattern?
FGR can result from what?
Aneuploidy
Congenital malformations
Infections
Uteroplacental Insufficiency
FGR restriction is usually categorized as what?
Asymmetric or Symmetric
Symmetric FGR
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
Symmetric FGR is thought to result from what?
An early global insult
Asymmetric FGR
infants whose brain growth is spared compared to their abdomen and internal organs
Typical Characteristics of SGA Newborns
- head disproportionately large
- wasted appearance
- reduced fat
- decreased breast tissue
- scaphoid abdomen (sunken appearance)
- wide skull sutures
- poor muscle tone
- thin umbilical cord
Common problems for SGA Newborns
perinatal asphyxia difficulty w/ thermoregulation hypoglycemia polycythemia meconium aspiration hyperbilirubinemia birth trauma
Nursing Management for SGA
- weight, length, and head circumference measurements
- serial BG monitoring
- vitals
- early/frequent oral feedings; IV infusions
- S/S of polycythemia
- anticipatory guidance
Polycythemia
venous hematocrit > 65% and hemoglobin > 20 grams
What are the clinical signs to watch for w/ Polycythemia?
respiratory distress cyanosis jitteriness jaundice ruddy skin color lethargy
Risk Factors for LGA Newborns
Maternal Diabetes Multiparity History of macrosomnic infant Postdates gestation Maternal obesity Male fetus Genetics
What fetal birth trauma can result for LGA newborns?
Shoulder dystocia
Clavicular fractures
Facial palsies
LGA Newborn Common Characteristics
large body, plump, full faced
proportional increase in body size
poor motor skills
difficulty regulating behavioral states
Common birth problems for LGA newborns are?
Birth trauma
Hypoglycemia
Polycythemia
Hyperbilirubinemia
Hypoglycemia
blood glucose value < 40 mg/dL
Nursing Management for LGA
- Vitals/BG monitoring
- Oral feedings w/ IV glucose prn
- Monitor for S/S polycythemia/hypoglycemia
- Hydration
- Phototherapy for increased bilirubin levels
Term
born from the first day of 38th week through 42 weeks
Preterm
born before completion of 37 weeks
Late Preterm
Born b/t 34 weeks/7 days and 36 weeks/6-7 days
Postterm
born beyond 42 completed weeks
What happens to the placenta after 42 weeks?
unable to provide adequate oxygen and nutrients
Postterm Newborn Characteristics
-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
Common Problems for Postterm newborns are?
perinatal asphyxia hypoglycemia hypothermia polycythemia meconium aspiration
Postterm Newborn Nursing Management
Resuscitation BG monitoring Initiation of feeding; IV Dextrose Prevent heat loss Evaluation of polycythemia Parental support
What problems can lead to preterm birth?
infection/inflammation
maternal/fetal distress
bleeding
stretching
Common Problems for Preterm Newborn
respiratory distress hemorrhage bronchopulmonary dysplasia retinopathy hyperbilirubinemia anemia necrotizing entercolitis hypoglycemia infection/septicemia mental/motor delays
What problems affect the preterm newborn’s respiratory system?
- Surfactant deficiency
- unstable chest wall
- immature respiratory control centers
- small respiratory passageways
- inability to clear fluids
What is the main problem faced by the preterm newborns cardiovascular system?
changing from fetal to newborn circulation pattern
What places the newborn at risk for malnutrition and weight loss if preterm?
Combination of shunting, ischemia, damage to intestinal wall, and poor sucking ability
What will place the preterm newborn at risk for growth and developmental delays?
Small stomach capacity weak abdominal muscles compromised metabolic function limited ability to digest proteins/absorb nutrients weak/absent suck and gag reflexes
Renal System problems of the preterm infant are?
reduced ability to concentrate urine and slow glomerular filtration rate
What are the risks from the preterm newborns immature renal system?
Fluid retention
Fluid/electrolyte disturbances/increases
Increased risk drug toxicity
Common Preterm Characteristics
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
Preterm Newborn Common Problems
Hypothermia
Hypoglycemia
Hyperbilirubinemia
Problems w/ immature body systems
Nursing Management for Preterm Newborns
oxygenation thermal regulation nutrition/fluid balance infection prevention stimulation pain management growth/development parental support
Perinatal Greif/Loss Management
Effect on childbearing fams Parent/newborn interaction Interventions Sit quietly/observe Cultural differences
