Test #4 Flashcards
what are ways to help the parents respond to perinatal loss
- inform them as soon as possible
- provide privacy
- keep same nursing staff
- prepare them for the appearance of the child
- allow unlimited time with infant
- dress the infant
- take pictures and offer them to the parents
- support cultural practices
- send anniversary cards
What classifies SGA
Birth weight less than the 10th percentile. Typically less than 5 lbs. 8 oz. at birth
What does the SGA infant look like
Loose dry skin(indicates loss of weight) Little fat or muscle(malnourishment) Sunken abd Thin cord Wide skull sutures Weak cry Hypoglycemia Development delay
What classifies LGA
Hey newborn with the weight above the 90th percentile. Greater than 9 pounds at birth
Can result from LGA
Difficult vaginal birth, shoulder dystocia, clavicle fractures, and facial palsies
What is LGA related to
Maternal diabetes, post date, large parents
What physiological problems may you see in an LGA infant
Hypoglycemia caused from maternal diabetes because the fetus sucks up the maternal extra glucose in utero so they produce excess insulin and when they’re born the glucose supply has diminished so they become hypoglycemic
Respiratory distress
Birth trauma
Signs of hypoglycemia in an infant
Lethargy, apathy, drowsiness, irritability, tachypnea, weak cry, temperature and stability, jitteriness, seizures, apnea, bradycardia, cyanosis or pallor, weak suck and poor feeding
When is an infant postterm
After 42 weeks
they may be SGA, LGA, or AGA
What may a post term infant look like
- wasted appearance due to the placenta not functioning optimally,
- lack of vernix because it is getting absorbed while the baby is in utero —lack of subcutaneous fat due to placenta declining and function.
- dry cracked skin
What are complications of a post term infant
-Asphyxia caused from placental aging
-Hypoglycemia
Meconium aspiration
Birth trauma
Hypothermia
Polycythemia caused by an increase production of RBC to compensate for reduced oxygen environment
When is preterm birth and what causes it
- infection
- ATOD
- trauma
- preeclampsia
- malnutrition
- diabetes
- multiple pregnancy
What characteristics do you see in preterm
Lack of subcutaneous fat, lack of surfactant, weak lungs, weak suck, weak gag, fragile capillaries Weak muscle tone poorly formed pinna of ear fused eyelids matted hair absent/few creases is soles and palms lax posture barely visible nipple At risk for respiratory distress
What Care do we want to provide for preterm infant
Mimic the uterine environment by keeping them flexed in a quiet dark warm nest
Avoid overstimulation
Supply nutrition
What type of feeding is provided for preterm infant care
TPN
Gavage -tube inserted to stomach to stimulate gi on no effort of the fetus
Nipple supplementation
What do we assess for in a preterm infant
- Cerebral bleed d/t the thin skin and fragile capillaries
- hypothermia
- hypoglycemia
- retinopathy
- respiratory distress
- cerebral palsy
what is necrotizing enterocolitis
an inflammatory disease of the bowel that can cause ischemic and necrotic injury
abx, parenteral fluids, human milk corticosteroids and probiotics help this condition
when and what symptoms will we see with respiratory distress
about 1-2 hours after birth s/s tachypnea, retractions nasal flaring grunting crackles diminished breath sounds decreased O2 cyanosis tachycardia
what can we do to help an infant in respiratory distress
- intratracheal surfactant replacement
- supply O2 by bubble, CPAP oscillator, Ventilator, hood or NC
- suction as needed- when mucous secretions blocking the airway
- monitor O2 sats and ABGs
when would you not give an infant a feeding
if they are in respiratory distress and their Respiratory rate is greater than 60 because they are now at an increased risk for respiration
what is kangaroo care & benefits
when the infant is placed chest to chest with parent over the heart. the parent is encouraged to rock the infant.
Benefits-increase sleep time for infant
regulates HR
decreased O2 demands
mothers body temp senses what infant needs and regulates temp for infant.
better weight gain
nurse better
what can happen to the infant of a diabetic mother
- the baby gets too big d/t all the extra glucose and can have birth trauma
- the babys pancreas produces excess insulin to meet the demands of the excess glucose and then when the baby is born the glucose diminishes but the pancreas still secretes a bunch of insulin to hypoglycemia results
- also resulting in hyperinsulinemia
- Resp distress d/t the hyperglycemic environment- delays the maturation of fetal lungs so therefore surfactant is not as quickly made.
- cardiac or spinal anomalies
- polycythemia- causes baby to have a red appearance
what interventions are performed for an infant of a diabetic mother
-check glucose @ 30 minutes, 1,2,4,6,9,12,24 hours
treat hypoglycemia
what is the neonatal hypoglycemia level
anything less than <40mg/dL
what do we do to treat hypoglycemia in infants
assess glucose before feedings
<40 we give them breast milk
<20 we give IV D10W
what is the issue with meconium aspiration
creates an emphysema like action
once meconium is inhaled it stops the alveoli from being able to exhale. -it blocks the airway
s/s of meconium aspiration syndrome
APGAR score of <6
respiratory distress(grunting, retractions etc)
barrel shaped chest
diminished breath sounds
meconium staining- the water may have a golden yellow/greenish color- worry some when there are chunks in the fluid
cord may be yellow/green
what can meconium aspiration lead to
aspirational pneumonia
what interventions do we do when an infant has meconium aspriation
suction the mouth and nose after head is born
-if the airway seems to be obstructed the baby will be intubated and the trachea will be suctioned
when does ABO incompatibility occur and what happens
when mom is type O and has a type A or B fetus
the mom develops antibodies against A and B that can cross the placenta
this will cause mild neonatal hemolysis and jaundice
when does jaundice begin to appear and bilirubin level
approx 24 hours after birth
< or equal to 15
what are the causes of jaundice
the result of increased RBC level and an immature liver that cannot filter out the excess RBC breakdown
and
the Rh or ABO incompatibility of mother and fetus
or infection
what can be complications of hyperbilirubinemia
-Kernicterus-unconjugated bilirubin deposited into the brain tissue causing neurological damage
(motor function, developmental delay, vision, hearing issues, -permanent conditions)
-Rh isoimmunization & erythroblastosis details- the moms antibodies are breaking down the infants RBC resulting in anemia and jaundice and the baby is producing immature RBCs to try to compensate
-Hydrops fetalis- severe anemia
so severe will develop while fetus is still in utero- causes multi-organ system failure, edema, ascites, hypoxia and fetal death
