UNIT 2 COMPLICATIONS OF THE NEWBORN Flashcards
What are some nonmodifiable risk factors that put a newborn at risk?
- Previous preterm delievery
- Multiple abortions
- Race/Ethnic group
- Uterine/cervical anomaly: Cervix trying to dialate to quickly
- Multple gestation
- pregnancy induced hypertenion- terminating pregnancy is the only way to resolve.
- Short interval between pregnancies
- Bleeding in the 1st trimester
What are some modifiable factors that put newborns at risk?
- Age at pregnancy <17 or >34 years of age
- Unplanned pregnancy: prenantal care not in place
- Domestic violence: Stress and trauma to mom and baby
- Low pre-pregnancy weight: Malnutrition can play a factor on unborn baby
- Obesity: can lead to type 2 DM
- Infection: Mom and/or baby
- Substance abuse/alcohol abuse: Mom and baby connected so anything mom ingest baby gets
- Cigarette smoking: Causes babies to be smaller
- Late or no prenatal care
Define a very premature baby?
Neonates born at less than 32 weeks gestation
Define a premature baby?
Neonates born between 32-34 weeks gestation
Define a late premature baby?
Neonates born between 34-37 weeks
In our assessment of a preterm baby what might there color be like?
Usually pink or ruddy; may be acrocyanotic– Not as common in preterm babbies.
In our assessment of a preterm baby what might their skin look like?
- Reddened, translucent, blood vessels apparent; lack of subq fat.
- 23-24 weeks old skin is very thin and delicate
How does lanugo on a preterm babies present?
Plentiful, widley distrubuted
How does the head of a preterm baby present?
Appears large in relation to the body
How does the skull present in a preterm baby?
Bones pliable, fontanels smooth and flat, sutures approximated and overriding
How do ears present on our assessment on a preterm baby?
Minimal cartilage, pliable, folded over
Important during care to reshape the ear
On assessment of a preterm baby what might there nails look like?
Soft; short
On assessment of a preterm babys genitals what might we see?
Males: nonrugated, small scrotum; testes may or may not be descended.
Females: prominent clitoris and labia minora, not as much psudomenstration
On assessment of a preterm baby what might we notice about their posture.
- Flaccid, froglike position
On assessment what might we notice about a preterm babies cry?
Weak, Feeble
On assessment of a preterm baby what might reflexes look like?
Poor suck, swallow and gag making them poor eaters
Not able to safely eat before 34 weeks
On assessment of a preterm baby what might we notice about their activity?
Jerky, generalized movements
True or false: Determining gestational age in preterm newborns requires knowledge and experience in adminstering gestational assessment tools?
True
What physiologic data might we monitor in a preterm infant?
- Hr
- Respirations
- Pulse ox
- Bp if they have an arterial line
Nursing care for the high-risk newborn includes?
1.Establish and maintain respiration
2.Apply external warmth
- Radiant warmers… not able to thermoregulate on their own.. brain can only do so much at a time..
- 1800G is when we might start weaning off of external warmth.
3.Administer fluids and meds
4.Enteral feeding (nipple, breast, gavage)
- under 34 weeks we gavage feed
5. Skin Care
- Do not give baths right away due to issues with thermoregulations might do spot baths.
6. Developmental and family-centered care.
Whar are 5 physiologic and anatomic factors that increase heat loss in the preterm infant?
- Preterm baby has a high ratio of body surface to body weight
- Preterm baby has very little Sub Q fat
- Preterm baby has thinner, more permeable skin
- The posture of the preterm baby influences heat loss
- The preterm baby has a decreased ability to vasoconstrict superficial blood vessels and conserve heat in the body core (they cant shiver)
True or False: Providing a neutral thermal environment minimizes the oxygen consumption required to maintain a normal core temp; it also prevents cold stress and facilitates growth by minimizing caloric expenditure to maintain body temp.
True
What are some nursing interventions to minimize heat loss?
- Allow skin to skin between mother and newborn
- Moms have a natural hormanal response when they fill baby and will warm up to meet babies needs.
- Warm and humidify oxygen to minimize evaporative heat loss and decrease oxygen consumption
- Place baby in double-walled incubator; use plexiglass heat shield over preemie in single-walled incubator; use radiant warmer and pipe in humidity
- Avoid placing infant on cold surfaces. Use warmers during procedures; pre-warm mattresses; warm hands and stethoscopes
What are special characteristics of the preterm renal system?
- The preterm infants kidneys are limited in their ability to concentrate urine or to excrete exccess amounts of fluid
- Renal immaturity affects ability to excrete drugs.