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