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NURS 2156 OB 2 > Test 2: High Risk Newborn Complications Associated With GA > Flashcards

Test 2: High Risk Newborn Complications Associated With GA Flashcards

1
Q

Late preterm infants describe GA

Describe needs…

Health problems…

A

34 - 36 weeks (8% of infants)

Needs similar to preterm

Hypo thermia/glycemia
Feeding difficulties
Hyperbillrubinemia
Resp distress
Sepsis

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2
Q

Describe bilirubin in later preterm infants…

A

Hyperbilrubin

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3
Q

Interventions to prevent preterm birth. (4)

A

Folic acid
Prevent infection
Recognize signs of labor early
Dehydration

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4
Q

Reason why a baby maybe born preterm….

A

Elective / medical CS
Preterm labor / ROM

preE
Multiples
Obesity
ART
AMA
Inaccurate EDC

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5
Q

Define date for preterm infants

A

<36.6 weeks

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6
Q

Birth weights for any GA

LBW low birth weight….

VLBW Very low birth weight….

ELBW Extremely Low birth weight…

A

LBW low birth weight
<2500 g 5lbs 8oz

VLBW Very low birth weight
<1500 3lb 5 oz

ELBW Extremely Low birth weight
<1000 g 2lbs 3oz

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7
Q

Percent of babies who weight 500 - 600g that survive

A

85 - 90%

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8
Q

1500 - 2499g baby has this many times increase of dying…

<1500 this many times risk of dying…

A

1500 - 2499 = 5x

<1500 = 92x

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9
Q

Causes of Prematurity

A

Poor
No prenatal care
<18 or >40 years old
Smoker / Coccaine
Unmarried
Stress
Multiple gestation/ Over distention of uterus
Frequent, closely spaced pregnancies
Poor nutrition

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10
Q

Describe major features of a preterm babies appearance

A

Frail / weak
Limp
Large head
Small nipples
Lots of Vernix / lanugo
Pinna is soft
PLANTAR CREASES ABSENT
Large clit & labia minora Uncovered
Undescended testes, smooth sac

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11
Q

Preterm have immature lungs due to lack of surfactant (Keeps alveoli from collapsing)

Describe difference between Periodic & Apneic breathing…

A

Periodic = Stops for 5 -10 secs WITHOUT OTHER CHANGES followed by 10 - 15 secs of rapid breathing

Apneic = >15 seconds Accompanied by Cyanosis/ Bradycardia- prevalence increases woth level of prematurity

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12
Q

What are retractions the result of …

A

Excessive compliance (Elasticity) of the chest cage, bone are pliable

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13
Q

Apenic breathing baby

First intervention / Following intervention…

A

Stimulation

Bag mask breathing

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14
Q

Silverman-Anderson Index

Chest movements….
Intercostal Retraction…
Xyphoid Retraction…
Nasal Flaring…
Expiratory Grunting…

A

Chest movements
0 Equal, 1 Respiratory lag, 2 Seesaw

Intercostal Retraction
0 None, 1 Minimal, 2 Marked

Xyphoid Retraction
0 None, 1 Minimal, 2 Marked

Nasal Flaring
0 None, 1 Minimal, 2 Marked

Expiratory Grunting
0 None (With /Without Stethoscope),
1 (Audible with Stethoscope),
2 (Audible without Stethoscope)

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15
Q

Respiratory equipment in order of severity

A

Canual
Oxygen hood
Intubation/ Ventilador

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16
Q

To promote respiration use these posistion in a preterm baby…

A

Side lying & prone

Avoid in full term babies

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17
Q

Teach mom to use prone posistion upon discharge to help baby with respiratory issues

T F

A

F

Only use in hospital with monitoring

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18
Q

Babies fluid needs are increased with supplemental oxygen use.

A

T

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19
Q

Ambubag can cause this problem in an infant…

A

Pneumothorax

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20
Q

Reason for thermoregulation problems in preterm infants. (5)

A

Thin skin
Blood vessels near the surface
Lack of subQ fat <Brown Fat
Extended limp posistion allows more heat loss
Underdeveloped brain center for thermoregulation

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21
Q

Skin probe on abdomen? (Ask)

Normal temp for preterm…

A

36.3 - 36.9

97.3 - 98.6

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22
Q

Normal temp for preterm is 36.3 - 36.9
Normal temp for term 36.5 - 37.5

What are signs of inadequate thermoregulation

A

Poor feeding
Lethargy
Irritability
Poor muscle tone
Cool skin
Mottled skin (lacy or net-like pattern of discoloration under the skin)
Hypoglycemia
Resp difficulty

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23
Q

Describe mottled skin.

A sign of inadequate thermoregulation in preterm

A

lacy or net-like pattern of discoloration under the skin

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24
Q

Interventions for thermoregulation

A

Neutral thermal environment
Radiant warmer
Warmed oxygen
Open crib
Dressed
Doubled wrapped with warmed blankets

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25
Q

No blanket under radiant warmer

A

T

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26
Q

Describe reasons for electrolyte imbalances in preterm (3)

A

Large surface area in proportion to body weight (Big Head) - Epidermal water loss

Radiant heat & Bili lights

Immature kidneys - unable to balance fluid overload / dehydration

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27
Q

Electrolyte balance

Monitor I & O

Plastic bags secured to perineum = PUC peri urine collector (For Drug Screen)

Weigh diapers: 1 g = __ ml of urine

Weight daily

Measure specific gravity of urine - use cotton ball on perineum

A

1 g = 1 mL

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28
Q

Urine output associated with dehydration in a preterm

A

<1ml/kg per hr

29
Q

Dry skin
Sunken anterior fontanel
Poor tissue turgor
Tachycardia
Elevated sodium, protein, and hematocrit
Hypotension
Weight loss
Urine output <1ml /kg per hr

Are all assessments for…

A

Dehydration

30
Q

Edema
Bulging fontanel
Decreased sodium, protein, and hematocrit
Moist breath sounds / difficulty breathing
Urine output >3mL /kg/ hr

Nursing assessments for…

A

Over hydration

31
Q

Describe urine output for overhydration…

A

Urine output >3mL /kg/ hr

32
Q

Skin is fragile

Avoid Alcohol/Iodine

Use ___ water for bathing - avoid drying agents

Use ____ in incubators

A

Sterile

Humidity

33
Q

Why might a blanket be put over a babies basenet…

A

To block light and stimulation

Relaxation is needed for growth

Baby sleeps 90% of time inutero

34
Q

Over stimulation signs…

A

Increases / decrease pulse/ resp rates

Stiff extended limbs

No eye contact

Yawn, coughs, regurgitation

35
Q

Which GA can start to recieve oral feedings

A

Aprox 34 weeks

36
Q

RR of ____ may require gavage (Feeding Tube) feeding due to increased risk of aspiration

A

70 or above

37
Q

Feeding has a goal for preterm.

What happens if baby >34 weeks cannot meet their goal…

A

Gavage feeding the rest to meet goal

38
Q

Rooting
Sucking on gavage tube, finger, pacifier
Able to tolerate holding
RR <60
Presence of gag reflex

Signs of…

A

Readiness to nipple

Drink milk

39
Q

Adverse signs of feeding

Feeding time is…

A

> 25 - 30 mins

40
Q

Why is feeding longer than 25 - 30 mins contradicted…

A

Burns too many calories

41
Q

Premature babies need ___ support when feeding.

A

Jaw

42
Q

Leading cause of all premature deaths in US

A

RDS Respiratory distress syndrome

Or

Hyaline membrane disease

43
Q

Cause of RDS or hyaline membrane disease, #1 cause of infant death in US

A

Insufficient surfactant- causes collapse of alveoli upon exhalation

Atelectasis (collapse) / hypoxia occur

44
Q

Signs of RDS

TX…

A

Tachypnea
Nasal Flaring
Retraction
Cyanosis
Audible Grunting on expiration
Decreased breath sounds
Abnormal chest x-ray

Tx: Surfactant instilled into infants, O2, CPAP, Vent, IV, Antibiotics

45
Q

BPD

Bronchopulmonary Dysplasia

Major sign: infant cannot be weaned from ventilator

Prevention… (3)

May a child go home on a ventilation…

A

Maternal steroids to enhance lung maturity

Minimum exposure to O2 or ventilator

Avoid fluid overload.

Yes, a child can go home on ventilation

46
Q

Periventricular - Intraventricular Hemorrhage (PIVH)

BLOOD VESSELS LEAK INTO CARNIAL CAVITY

RISK factors (5)

4 grades…

A

Resuscitation
Infusion of hyperosmolar solutions
Apnea/ Bradycardia
Mechanical ventilation
Pneumothorax

1st is least severe

47
Q

Necrotizing Enterocolitis (NEC)

Usually in <1500 g

Breakdown of intestinal mucosa barrier - DUE TO BACTERIA

SS…

A

Feeding intolerante/ Bile colored vomiting
Abdominal distention
Septic or Hypovolemic shock
Blood in stool
Temp instability

48
Q

Necrotizing Enterocolitis (NEC)

Breakdown of mucosa barrier - DUE TO BACTERIA

SS:
Feeding intolerante/ Bile colored vomiting
Abdominal distention
Septic or Hypovolemic shock
Blood in stool
Temp instability

TX….

A

Prebiotic
Breastfeeding
Antibiotics
Parental nutrition to allow bowels to rest
Ostomy

49
Q

Short Bowel Syndrome

Causes….

Problem Short Bowel Syndrome causes…

Common symptoms…

TX…

A

Congenital malformation
Surgical resection

Problem: Inadequate absorption due to Inadequate surface area

SS: Diarrea/ failure to thrive

TX: Balance fluid & Electrolytes
Possible TPN

50
Q

Retinopathy of Prematurity

Occurs in infants <1000g

Caused by damage to imature blood vessels in the retina, hemorrhage, permanet.

Results from (What causes the blood vessels in the retina to hemorrhage)….

Requires close monitoring of…

A

Too much oxygen- (Some rsh indicates from too much oxygen)

Acidosis
Prolonged mech vent
Sepsis and shock

Close monitoring of Pulse Ox

51
Q

Dev milestones and Prematurity

Explain when they meet their milestones…

A

If premature baby is born at 33 weeks (1 month early) they will be a month behind

52
Q

SGA is defined as…

A

<10th percentage

53
Q

Congenital malformation
Chromosomal abnormalities
Genetic
Multiple gestation
Fetal infection (Rubella / cytomegalovirus)
Poor placenta function
Maternal illness preE, DM
Smoking, drug, alcohol

Lead to…

A

SGA

54
Q

SGA

After birth monitor closely for…

A

Hypoglycemia

55
Q

Are LGA 90th Percentile babies always Macrosomia (>4,000g) babies…

A

No, if they are born preterm they can be in the 90th percentile but still under 4,000g

56
Q

LGA are most at risk for…

Other risk on the slide…

A

Increased birth trauma.

Non reassuring FHT during 2nd stage

Neonatal respiratory depression at delivery, require resuscitation

57
Q

Birth trauma is associated with LGA

A generalized swelling of the soft tissues of the scalp caused by pressure during vaginal delivery, particularly prolonged labor or vacuum-assisted delivery.

Key Features:

Location: Diffuse swelling that crosses suture lines.

Cause: Pressure from the uterus or vaginal walls during delivery, causing edema (fluid accumulation).

Appearance: Soft, boggy swelling that may have a bruised or discolored appearance.

Timeframe: Present at birth and usually resolves within a few days without intervention.

Complications: Rare, as it is generally benign.

A

Caput Succedaneum

58
Q

LGA may experience birth trauma

Definition:

A collection of blood between the periosteum (the membrane covering the skull) and the skull bone itself, caused by trauma during delivery.

Key Features:

Location: Localized swelling that does not cross suture lines, because the blood is confined to one bone (e.g., parietal or occipital).

Cause: Rupture of blood vessels due to pressure during delivery, often associated with the use of forceps or vacuum extractors.

Appearance: Firm, well-defined swelling that develops hours to days after birth.
Timeframe: Resolves gradually over weeks to months as the blood is reabsorbed.

Complications: Can lead to jaundice (due to breakdown of blood), anemia, or rarely calcification if severe.

A

Cephalohematoma

59
Q

Caput Succedaneum

Cephalohematoma

Facial nerve damage

Brachial plexus injury, over extension & torsion of the neck, damage to cervical nerves. (ERBS PALSAY, FRACTURE OF CLAVICAL / HUMERUS)

BESURE TO CHEXK CLAVICLE POST DELIVERY FOR FRACTURE

IMMOBILIZE BY PINNING INFANTS SLEVE TO SHIRT

Hypoglycemia/ Hypocalcemia

Resp distress

Associated with…

A

LGA

60
Q

LGA

Be prepared for resuscitation at delivery

T or F

A

T

61
Q

Monitor for Jaundice RT bruising / Trauma in…

A

LGA

62
Q

Higher risk in Post Term infants (2)

A

Meconium passage

Amniotic fluid decrease (Increased Variable Decelerations)

63
Q

Posterm skin care maybe needed why?

A

Lack of vernix / Lanugo and macerated skin

64
Q

Why might a posterm infant need help with thermoregulation…

A

Same reasons as SGA

Low fat stores, due to decreased placental function

65
Q

PRETERM

GA assessment should be done when…

A

ASPA <8 Hrs

66
Q

Silverman- Anderson Index

Give values

Severe Respiratory distress…

Impending Respiratory failure…

No Respiratory distress….

A

Severe Respiratory distress: 10

Impending Respiratory failure: 7 or below

No Respiratory distress: No Respiratory Distress

67
Q

Risk for altered growth and development rt stress from over stimulating environment

Does this make sense?

A

Yes

68
Q

Bradypnea is associated with RDS…

A

False

Tachypnea

Flaring
Retraction
Cyanosis
Decrease breath sounds
Ab norm x ray

NURS 2156 OB 2 (8 decks)

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