T4: Nursing Care for High Risk Newborn Flashcards
S/S of illness in infants
- 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
what is the first sign of illness in a newborn
poor feeding (not being able to eat)
maternal infections
TORCH
Toxoplasmosis
Other (HBV, syphilis, HBV)
Rubella
Cytomegalovirus
Herpes
Toxoplasmosis
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
Rubella
German measles
o Teratogenic in the first trimester; transmitted across the placenta
o Causes congenital defects of the eyes, heart, ears, and brain
If not immune to rubella client should be vaccinated
in POSTPARTUM period; the client must wait 1-3 months before becoming pregnant
Cytomegalovirus
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
herpes
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
mom with herpes usually delivers
c-section
uterine drug screen
Do drug screen, if it comes back positive then she is randomly checked throughout prenatal visit
after baby is born what is checked for drugs
1st stool (meconium) is tested and sent to the lab and do a drug test on the baby
Neonatal Abstinence Scoring System
assess baby and tell us if baby is going through withdrawals or if they are getting better
interventions for a baby going through withdrawal
o Wrap baby tight, snuggle them because it helps with the tremors
o Morphine is also ordered
Facial features of FAS
thin upper lip, flat midface, indistinct philtrum, low nose bridge, short, upturned nose
Rh incompatibility
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
When is Rhogam administered?
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
clinical manifestations of babied born to diabetic mothers
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
why does blood glucose need to be controlled in diabetic mothers during pregnancy
otherwise preterm baby (<36.6) will be VERY BIG
preterm babies stay in the NICU until
they are term
what is the first action for a newborn born to a diabetic mother
FEED
for preterm infants we Need to make sure they are gaining weight and can keep their O2 saturations up, so
o Car seat challenge needs to be done before discharge
common problem with preterm infants
- 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)
MAS
Meconium Aspiration Syndrome
meconium staining of amniotic fluid can cause
baby to aspirate, pneumonia, and even sepsis
Respiratory Distress Syndrome (RDS)
serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxemia and acidosis
S/S Respiratory Distress Syndrome (RDS)
tachypnea, nasal flaring, grunting, retractions, see-saw respirations, decreased breath sounds, pallor, cyanosis
what baby is most at risk for Respiratory Distress Syndrome (RDS
Preterm more susceptible because they do not have the SURFACTANT that line the alveoli to keep them open
interventions for Respiratory Distress Syndrome (RDS)
o Betamethasone can be given
o Surfactant replacement can be provided to newborn through an endotracheal tube
How is betamethasone given?
IM to mom befofre delivery
o First dose given 12mg IM, the repeated 24 hours after 12mg
Retinopathy of Prematurity (ROP):
vascular disorder involving gradual replacement of retina by fibrous tissue and blood vessels
retinopathy of Prematurity (ROP) is caused by
by prematurity and TOO MUCH USE OF SUPPLEMENTAL O2 (<30 days)
Bronchopulmonary Dysplasia (BPD):
chronic pulmonary condition affects newborns who have experienced respiratory failure or have been oxygen-depended for more than 28 days
Patent Ductus Arteriosus (PDA)
passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth
Intraventricular Hemorrhage (IVH)
bleeding within the ventricles of the brain
Necrotizing Enterocolitis (NEC)
acute inflammatory disease of the GI tract
