Part 2 On Final (Newborn Risk) Flashcards
Soft tissue injuries
Ecchymosis & petechiae
Abrasions & lacerations
Edema
Scleral & retinal hemorrhages
Cephalhematoma
Forceps injury
Skeletal and nervous system injuries
Clavical : supportive care and pin arm to shirt
Brachial plexus injury: stimulate moro to test
Complications of infants w/ diabetic moms
Anomalies
Macrosomia
Birth trauma & asphyxia (bc so large)
RDS
Hypoglycemia (cause decrease surfactant = RDS)
Hyperbilirubinemia & polycythemia
Hypoglycemia
What number in the first how many hours of life
Risks
40 or less in 1st 72hrs of life
At risk:
-SGA
-LGA
-preterm
-infants of moms w/ diabetes
-Resp distress
-cold stress
Hypoglycemia manifestations
Jitteriness
Lethargy (not waking up for food)
Hypotonia
Hypothermia
Resp. Distress
Poor feeding
Hypoglycemia
Nursing management
Use facility protocol
-monitor blood sugar
-early and freq feedings
-administer glucose gel per protocol
Neonatal jaundice
Screen what 2 types
Screen how soon
Is transcutaneous level surpasses threshold then do what
TcB (transcutaneous)
TSB (serum)
Screened at minimum 24 hrs of life & prior to discharge
-unless showing signs of jaundice well do sooner
If transcutaneous levels surpass threshold for hours of life, serum bilirubin is collected
Types of jaundice
-physiological
After when
Increases what hours after birth
Levels decline by when and no greater than what
After 24 hours of age
Increases 72-120hrs after birth
Levels decline by 5-10 days, no greater than 10
Types of jaundice
Pathological
Before what hours
Persistent after what day
Rise how much per day
Gets to how much
Before 24 hrs of age
Persistent after day 14
Rise more than 5mg/dl per day
Rise to 15-20mg per day
Breast milk jaundice
Early vs late
What is happening
2-3 days of life (early)
5-7 days of life (late)
Enzyme in milk inhibits bilirubin conjugation
Breast milk jaundice tx
Continue breast feeding frequently
Supplement with formula until full supply is in and bilirubin levels drop
Phototherapy
Hemolytic disease of newborn
Destruction of what d/t what 2 things
Jaundice in 1st how many hours
2 lab findings
Destruction of RBCs from antigen-antibody reactions
1. RH incompatability
2. ABO:mom with O blood (anti A & B cross placenta)
Jaundice in 1st 24hrs
-hyperbilirubin
-anemia (rapid RBC destruction)
Hemolytic disease screenings
Direct coombs: positibe antibody coated RBCs
-from babies cord blood
Indirect coombs: presence of maternal antibodies
-from mom
ABO incompatibility
Fetal blood type
Moms blood type
Mom produces what
Cause what 2 things
Tx
Fetal A,B, AB
Mom O
Mom produces Anti A & B cross placenta
Causes:
-mild anemia
-hyperbilirubinemia
Tx: phototherapy
RH incompatibility
RH (?) mom produces what against babies RH(?) blood
Rhogam given what weeks and within how many hours of delivery
RH- mom produce antibodies against Rh + fetus
At 24-28 weeks within 72hours of delivery
If Rh- antibodies develop were worried about what 2 things
If left untreated can cause what
Can develop:
-erthroblastosis fetalis
-hydrops fetalis (anemia)
Untreated leads to :
Kernicterus=
High levels of bilirubin cross blood brain barrier and cause damage
Hyperbilirubinemia tx
Freq feedings (2-3 BF & 3-4hr formula)
Monitor I/O
Phototherapy (bili blanket and lights)
Exchange (blood) transfusion: if serious
Phtotherapy for jaundice
Nursing care
-expose all skin but genitalia (have diaper)
-eyes covered to protect retina
-monitor temp/I/O/hydration
-reposition Q2-3hrs
Neonatal sepsis
Name
Early vs late
Sepsis neonatorum
Early: acquired beofr or during birth
-comp labor
-prolonged ROM
-prolonged labor
-chorioamnionitis
Late: develops after 1st week of life
RF for infection
Prematurity
ROM >18hrs
Prolonged labor
Signs of infection in mom/GBS pos.
Invasive procedures
Neonatal infections s/s
Temperature instability (low or fever)
Resp problems (apnea)
Tachycardia
Poor feeding
Lethargy
Neonatal infection
Diagnostic testing
Cultures: blood, CSF (lumbar puncture), urine
CRP (inflammation if elevated)
CBC w/diff
Neonatal infection tx
Broad-spectrum abx (IV) - until culture results
-early infection are ampicillin
& aminoglycoside (gentamicin)
-strict I/O
-Feeding
-Resp support
Neonatal abstinence syndrome
-what is it
Test it how
Neonates w/ drug w/d from in utero drug exposure
Test:
Urine
Meconium
Cord blood (best option)
What we do if mother is on opiates
When we see w/d from baby
During pregnancy Switch to methadon or buprenorphine (dont want total cessation)
24-72hrs after birth = w/d
Neonatal abstinence syndrome scoring
What we want to do for tx
Scoring determine necessity of drug therapy to alleviate
w/d
-gradually taper off
Signs of w/d in newborn
High pitch cry
Hypertonic (stiff as a board)
Sleep disturbance
Sneezing, yawning
Diaphoresis
Tachypnea
Vomiting/diarrhea
Neonatal abstinence syndrome managment
Adminiter meds as ordered for tapering:
-morphine, clonidine, phenobarbital
Reduce stimulation
Monitor I/O
Pacifier for sucking
Monitor mother and infant interactions
Other substances
Marijuana s/s (4)
Irritability
Preterm
IUGR
Deficits in attention/cognition
Other substances
Tobacco s/s (6)
Irritability
Preterm
IUGR
Jitteriness
Increase risk of SIDs
Increased developmental delays
Other substances
Alcohol s/s
Irritability
Jitteriness
Increase muscle tone
FAS (fetal alcohol syndrome)
PKU (phenylketonuria) = tx
Galactosemia = tx
PKU:
-formula w/o phenylalanine
Galactosemia:
-no breastfeeding
-soy-based formula
