T4: Nursing Care for High Risk Newborn

Question 1

S/S of illness in infants

Answer 1

• Poor perfusion
• Hypotension
• Brady or tachycardia
• Tachypnea, apnea, retractions, nasal flaring, grunting, metabolic acidosis
• Temperature instability
• Lethargy
• Hypotonia
• Irritability, seizures
• Cyanosis, pallor
• Jaundice, petechiae, mottling

Question 2

what is the first sign of illness in a newborn

Answer 2

poor feeding (not being able to eat)

Question 3

maternal infections

Answer 3

TORCH
Toxoplasmosis
Other (HBV, syphilis, HBV)
Rubella
Cytomegalovirus
Herpes

Question 4

Toxoplasmosis

Answer 4

caused by infection with protozoan parasite Toxoplasma gondii
o Produces rash and symptoms of acute, flu-like infection in mother
o Transmitted through ingestion of raw meat or handling cat litter of infected cats
o Transmitted to fetus across placenta and can cause miscarriage in the first trimester

Question 5

Rubella

Answer 5

German measles
o Teratogenic in the first trimester; transmitted across the placenta
o Causes congenital defects of the eyes, heart, ears, and brain

Question 6

If not immune to rubella client should be vaccinated

Answer 6

in POSTPARTUM period; the client must wait 1-3 months before becoming pregnant

Question 7

Cytomegalovirus

Answer 7

o Causes low birth weight, intrauterine growth restriction, enlarged liver and spleen, jaundice, blindness, hearing loss, and seizures
o Antiviral medications may need to be prescribed for severe infection in mother, but these medications are toxic
o Maintain CONTACT PRECAUTIONS

Question 8

herpes

Answer 8

affects external genitalia, vagina, and cervix and causes draining, painful vesicles
o Acyclovir may be prescribed to treat recurrent outbreaks during pregnancy
o Transmitted to fetus during birth through infected vagina

Question 9

mom with herpes usually delivers

Answer 9

c-section

Question 10

uterine drug screen

Answer 10

Do drug screen, if it comes back positive then she is randomly checked throughout prenatal visit

Question 11

after baby is born what is checked for drugs

Answer 11

1st stool (meconium) is tested and sent to the lab and do a drug test on the baby

Question 12

Neonatal Abstinence Scoring System

Answer 12

assess baby and tell us if baby is going through withdrawals or if they are getting better

Question 13

interventions for a baby going through withdrawal

Answer 13

o Wrap baby tight, snuggle them because it helps with the tremors
o Morphine is also ordered

Question 14

Facial features of FAS

Answer 14

thin upper lip, flat midface, indistinct philtrum, low nose bridge, short, upturned nose

Question 15

Rh incompatibility

Answer 15

antibodies from Rh+ baby will be exposed to the mother, during second pregnancy the body will think the fetus is a foreign body and can cause miscarriage

Question 16

When is Rhogam administered?

Answer 16

o At 28 weeks Rhogam is given if mom is Rh negative
o Also given after birth
o If both parents are Rh- then Rhogam does not need to be given

Question 17

clinical manifestations of babied born to diabetic mothers

Answer 17

o LGA: large gestational age
o Very plump/full faced (edema/puffiness of cheeks)
o Abundant vernix
o Plethora
o Listless and lethargic
o Possible meconium stained
o Hypotonia

Question 18

why does blood glucose need to be controlled in diabetic mothers during pregnancy

Answer 18

otherwise preterm baby (<36.6) will be VERY BIG

Question 19

preterm babies stay in the NICU until

Answer 19

they are term

Question 20

what is the first action for a newborn born to a diabetic mother

Answer 20

FEED

Question 21

for preterm infants we Need to make sure they are gaining weight and can keep their O2 saturations up, so

Answer 21

o Car seat challenge needs to be done before discharge

Question 22

common problem with preterm infants

Answer 22

• May be on CPAP
• Respirations are irregular with periods of apnea
  o Maintaining body temperature
• No brown fat to maintain body temperature (use warming device)

Question 23

MAS

Answer 23

Meconium Aspiration Syndrome

Question 24

meconium staining of amniotic fluid can cause

Answer 24

baby to aspirate, pneumonia, and even sepsis

Question 25

Respiratory Distress Syndrome (RDS)

Answer 25

serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxemia and acidosis

Question 26

S/S Respiratory Distress Syndrome (RDS)

Answer 26

tachypnea, nasal flaring, grunting, retractions, see-saw respirations, decreased breath sounds, pallor, cyanosis

Question 27

what baby is most at risk for Respiratory Distress Syndrome (RDS

Answer 27

Preterm more susceptible because they do not have the SURFACTANT that line the alveoli to keep them open

Question 28

interventions for Respiratory Distress Syndrome (RDS)

Answer 28

o Betamethasone can be given
o Surfactant replacement can be provided to newborn through an endotracheal tube

Question 29

How is betamethasone given?

Answer 29

IM to mom befofre delivery
o First dose given 12mg IM, the repeated 24 hours after 12mg

Question 30

Retinopathy of Prematurity (ROP):

Answer 30

vascular disorder involving gradual replacement of retina by fibrous tissue and blood vessels

Question 31

retinopathy of Prematurity (ROP) is caused by

Answer 31

by prematurity and TOO MUCH USE OF SUPPLEMENTAL O2 (<30 days)

Question 32

Bronchopulmonary Dysplasia (BPD):

Answer 32

chronic pulmonary condition affects newborns who have experienced respiratory failure or have been oxygen-depended for more than 28 days

Question 33

Patent Ductus Arteriosus (PDA)

Answer 33

passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth

Question 34

Intraventricular Hemorrhage (IVH)

Answer 34

bleeding within the ventricles of the brain

Question 35

Necrotizing Enterocolitis (NEC)

Answer 35

acute inflammatory disease of the GI tract