Reproduction: Complicated Newborn Flashcards
What places a newborn at risk for complications?
- low socioeconomic level of the mother
- limited access to health care
- no prenatal care
- Exposure to environmental dangers
- Preexisting maternal conditions
- Maternal factors
- Medical conditions, complications
- complications of pregnancy
Birth of at-risk newborn may be anticipated by:
- the course of labor, birth unpredictable
- newborn classification, mortality risk tool
- Potential birth injuries
- Previous identification of congenital anomalies
When is an infant considered preterm?
When it is born less than 37 completed weeks
What are some growth-related complications?
- small for gestational age
- very small for gestational age
- Large for gestational age
- Intrauterine growth restriction
What are some birth-related complications?
- asphyxia
- respiratory distress
- transient tachypnea
- Meconium aspiration
- cold stress
- Hypoglycemia
- Polycythemia
What are some conditions at birth that can cause complications?
- mother with diabetes
- Post-term newborn
- Prenatal substance abuse
- Mother with HIV/AIDS
- Congenital heart defects
- Phenylketonuria
- Prematurity
- Galactosemia
- homocystinuria
- choanal atresia
- trachoesophagela fistula
- diaphragmatic hernia
- omphalocele and myelomeningocele
- gastroschisis
- prune belly syndrome
- imperforate anus
- congenital hydrocephalus
- maple syrup urine disease
What is Choanal Atresia?
Congenital narrowing of the back of the nasal cavity that causes difficulty breathing
What nursing assessments are needed for Choanal Atresia?
- Look for signs of respiratory distress (cyanosis and restrictions at rest)
- Noisy respirations
- Difficulty breathing during feeding (obligatory nose breathers)
- Obstruction by thick mucous
What are the goals and interventions for choanal atresia?
- Assess patency of nares
- listen for breath sounds while holding baby’s mouth closed and alternately compressing each nostril
- Assist with passing a catheter through each naris to confirm diagnosis
- Obtain ENT consult
- Maintain Respiratory Function
- Assist with taping airway in mouth to prevent respiratory distress
- Position with head elevated to improve air exchange
What is a Tracheoesophageal Fistula?
an abnormal connection between the esophagus and the trachea
What are the nursing assessments needed for Tracheoesophageal Fistula?
- hx of maternal polyhydramnios
- Excessive oral secretions
- constant drooling
- Abdominal distention beginning soon after birth
- Periodic chocking and cyanotic episodes
- Immediate regurgitation when feeding
- Aspiration of pharyngeal contents into the trachea
- Reflux of gastric contents into trachea leading to aspiration pneumonia
- Inability to pass NG tube
- S/S: Tachypnea, retractions, rhonchi, decreased breath sounds, cyanotic spells
What are the nursing goals and interventions for Tracheoesophageal Fistula?
- maintain respiratory status and prevent aspiration
- Elevate HOB 20-40 degrees (to prevent the reflux of GI contents)
- Keep baby calm (crying causes air to pass through fistula and to distend intestines)
- Maintain fluid and electrolyte balance
- begin broad-spectrum abx (secondary to risk of aspiration pneumonia)
- Provide parent education
- Keep parents informed
What is a Diaphragmatic Hernia?
A birth defect in which there is an abnormal opening in the diaphragm
What are the nursing assessments for a Diaphragmatic Hernia?
- difficulty initiating respirations secondary to hypoplastic lung on the affected side
- gasping respiration
- Nasal flaring and chest retractions
- Barrel chest and Asymmetric chest expansion
- Breath sounds may be diminished or absent, usually on the affected side
- Heart sounds displaced to the contralateral side
- Scaphoid abdomen (Abdomen is squeezed or depressed inward, bowel sounds may be heard in the thoracic cavity)
What are the goals and interventions for a Diaphragmatic Hernia?
- Do not ventilate with bag and mask (stomach and intestines will become air-filled and distended, further compressing the lungs)
- Maintain respiratory status (Give O2, prepare for intubation and ventilation, Considered a respiratory emergency)
- Initiate gastric decompression
- Place in high Semi-Fowler position (to use gravity to keep abdominal organs’ pressure off diaphragm)
- Turn onto the affected side (to allow unaffected lung expansion)
- Carry out interventions to alleviate respiratory and metabolic acidosis
What is Omphalocele?
A birth defect in which an infant’s intestine or other abdominal organs are outside of the body
What are the nursing assessments needed for Omphalocele?
- intestine or other abdominal organs are outside of the body because of a hole in the belly button (navel) area
- Encased in a protective transparent membrane
What are the nursing goals and interventions needed for Omphalocele?
- maintain hydration and temperature
- Place newborn in a sterile bag up to and covering the defect
- Obtain surgical consult
- Initiate decompression
- Position to prevent trauma to defect
- Administer broad spectrum antibiotics to prevent infection
What is Gastroschisis?
A birth defect in which an infant’s intestine are outside of the body
What are the nursing assessments needed for Gastroschisis?
- recognize that there is no protective covering around the intestines
- Intestines exposed to the caustic amniotic fluid
- Associated with intestinal atresia
- associated with malrotation (the intestines can become irritated, causing them to shorten, twist, or swell)
- Large amounts of evaporative fluid losses from the exposed bowel
What are the nursing goals and interventions for Gastroschisis?
- Maintain hydration and temp
- provide normal saline (for hypovolemia/fluid resuscitation)
- Place newborn in sterile bag up to the axilla in a side-lying position (to prevent trauma of the bowel)
- DO NOT COVER DEFECT WITH A WET SALINE GAUZE
- obtain surgical consult
- Initiate gastric decompression
- administer a broad-spectrum abx (to prevent infection of exposed bowel)
What is Prune Belly Syndrome?
a rare disorder characterized by partial or complete absence of the stomach (abdominal) muscles
What are the nursing assessments needed for Prune Belly Syndrome?
- recognize that there is a deficiency of the abdominal wall musculature
- abdomen is shapeless
- skin hangs loosely and is wrinkled in appearance
- Associated with urinary abnormalities
- Associated with Undescended testes (cryptorchidism)
What are the nursing goals and interventions for Prune Belly Syndrome?
- maintain respiratory status (may need to be immediately intubated and ventilated)
- Obtain surgical and urology consult
- Prevent trauma and infection
- Place a urinary catheter and monitor output
- Carry out interventions to alleviate respiratory and metabolic acidosis
- Keep parents updated and informed about prognosis
What is Myelomeningocele?
A defect of the backbone (spine) and spinal cord
What nursing assessments are needed for Myelomeningocele?
- Myelomeningocele directly connects to the subarachnoid space
- hydrocephalus often associated
- No response or varying response to sensation below the level of the defect
- May have constant dribbling of urine
- Incontinent or retention of stool
- Anal wink may or may not be present
What are the nursing goals and interventions for Myelomeningocele?
- prevent trauma and infection (position on abdomen or on side and restrain- prevents pressure and trauma to sac; administer broad-spectrum abx)
- Meticulously clean buttocks and genitals
- Cover with protective plastic wrap over sac (observe sac for oozing of fluid; DO NOT cover defect with wet saline gauze)
- Crede bladder to prevent urinary stasis
- Assess amount of sensation and movement below defect
- Obtain baseline occipital-frontal circumference measurements then measure head circumference daily
- check fontanelle for fullness and bulging
What is Imperforate Anus?
A defect that is present from birth. The opening to the anus is missing or blocked
What are the nursing assessments needed for Imperforate Anus?
- look for the inability to visualize rectal opening
- See that no meconium is passed
- Meconium is passed through a fistula or a malpositioned anus
- Gradual abdominal distension if no fistula present
What are the nursing goals and interventions for Imperforate Anus?
- inspect the perineal area for the presence of a fistula
- Initiate gastric decompression
- maintain fluid balance
- No rectal temperature
What is congenital Hydrocephalus?
A buildup of excess cerebrospinal fluid in the brain at birth
What are the nursing assessments for Hydrocephalus?
- enlarged or full fontanelles
- split or widened sutures
- “Setting sun” eyes
- Head circumference greater than 90% on growth chart
- Visibly distended scalp veins
- Behavioral stat changes: may become increasingly irritable or lethargic
What are the nursing goals and interventions needed for Hydrocephalus?
- assess presence of hydrocephalus
- Check fontanelle for bulging and sutures widening
- Obtain neurosurgery consult
- Assist with imaging studies: cranial ultrasound, CT scan, MRI
- Maintain skin integrity
- Change position frequently
- Use gel pillow under the head
What is Fetal Alcohol Syndrome?
a condition that results from alcohol exposure during the mother’s pregnancy
What assessments are needed for Fetal Alcohol Syndrome?
- abnormal structural development and CNS dysfunction (irritability, hypotonia, microcephaly and hyperactivity, and cognitive disability in childhood
- Growth deficiencies (restricted in regard to weight, length, and head circumferences)
- Distinctive facial abnormalities
- Associated anomalies
What distinctive facial abnormalities does a baby with Fetal Alcohol Syndrome have?
- epicanthal folds
- broad nasal bridge
- flattened midfacies
- short
- upturned or beaklike nose
- Abnormally small lower jaw
- thin upper lip and smooth groove on upper lip