UNIT 5 HIGH RISK NEWBORN CHAPTER 25 Flashcards
What pre existing conditions can put new borns at risk
High-risk neonate-greater chance of morbidity & mortality
regardless of gestational age or birth weight; period of
viability (20 weeks gestation) to 28 days after birth
Conditions or circumstances impair adjustment to extra
uterine life
Prematurity
Birth trauma
Infection
Maternal substance abuse
Congenital anomalies
Family care for at risk patient
Assessment
Respiratory support
Thermoregulation
Thermal stability
Neutral thermal environment
Incubator or radiant warmer
Skin to skin (kangaroo care)
Should nurses be implementing Standard Precautions
YES
After birth should you minimize stimaltion for mom?
A. Yes
B. No
A. Yes
-Darken environment
-Quiet
-Rocking or limit handling with baby
What are risk factor for birth trauma?
Birth injuries often avoidable
Ultrasonography to diagnose macrosomia, gestation
anomalies, hydrocephalus, presentation,
Elective cesarean birth to prevent birth injury
Are precipitous labor avoidable?
Some significant birth injuries unavoidable
Difficult or prolonged labor
Abnormal presentation-caregiver error
Precipitous or “explosive” labor
What type of procedure can prevent birth injry>
Elective cesarean birth to prevent birth injury
Assessment of fractured clavicle
Feel crepitus @ fracture site.
Do not lay infant on affected side.
No other treatment needed
Assessment of Era-Duchenne paralysis
Erb-Duchenne paralysis (Erb’s Palsy)
Injury to brachial plexus.
Pulling head away from shoulder as with shoulder
dystocia. Moro reflex absent on affected side.
Neonatal infections
Sepsis/Septicemia: overwhelming infection; inability to clear
toxins of infection
Patterns
Early onset-congenital/prenatal exposure
Late onset-nosocomial infection
Pneumonia
Bacterial meningitis
Gastroenteritis is sporadic
Risk factor for Neonatal infections during the 3 stages of pregnancy
AntePartum maternal poor prenatal care, malnutrition,
substance abuse, limited resources, fever, UTI
Intrapartum: premature or prolonged rupture of
membranes, chorioamnionitis, prolonged labor
Neonatal: multiple gestation, male, birth asphyxia,
meconium aspiration, invasive procedures, galactosemia,
low birth weight
Toxoplasmosis
Other
Hepatitis B
HIV
Parvovirus
West Nile
Rubella
Cytomegalovirus
Herpes simplex virus
Can the TORCH Complex cause death in fetus?
A. Yes
B. No
A. Yes
Signs of Neonatal Sepsis
Respiratory: apnea, distress, decreased
SaO2
Cardiovascular: decreased perfusion, heart
rate changes, hypotension
Central nervous: lethargy or irritability,
hypotonic, temperature instability
Gastrointestinal: poor feed, vomiting,
diarrhea
Integument: jaundice, pallor, petechiae,
mottling
Can HERPES
SIMPLEX VIRUS
(HSV)
cause hearing loss and is It life threatening for neonate?
Yes
No
Yes
HERPES
SIMPLEX VIRUS
(HSV)
Newborn HSV possibly life threatening.
Can cause hearing loss
What type of Drugs are Drug exposed infants exposed too?
Drug addiction
Narcotics
Heroin
Methadone
Other drugs/illicit substances
Smoking
Alcohol abuse
NURSING CARE MANAGEMENT of Drug Exposed Infants
Neonatal abstinence scoring system
Finnegan tool
Neonatal intensive care unit network neurobehavioral scale
(NNNS)
Treatment modalities FOR WITHDRAWAL
Swaddle, rock or limit handling
Low stimuli environment, NO LOUD NOISES, NO LIGHTS
MEDICATIONS TO HELP WITH BABY WITHDRAWALS
Methadone, phenobarbital, morphine
What are the facial features of an infant with fetal alcohol syndrome/FETAL
ALCOHOL
SYNDROME
FETAL
ALCOHOL
SYNDROME
(FAS)
Microcephaly-a condition where a baby’s head is much smaller than expected.
Small eyes, thin upper
lip, flat mid-face
Growth restriction
Neurodevelopmental
deficits (fine motor, IQ,
speech
Hemolytic Disorders
Blood incompatibility
(isoimmunization)
Rh incompatibility
Rh- mom Rh+ baby
must need program with 72 hours of delivery
What is ABO imcompatibility
Occurs if fetal blood type is A, B, or AB, &
maternal type is O
Incompatibility arises because naturally
occurring anti-A & anti-B antibodies are
transferred across placenta to fetus
Jaundice
Exchange transfusions rare
Do diabetic mothers normally produce macrosomic babies?
A. Yes
B. No
A. Yes
Characteristic appearance
Macrosomia
Increased risk for birth injuries
Increase in congenital anomalies
Nursing care management
Adequate thermoregulation
Carbohydrate feedings as appropriate
Serum glucose level
What are the characteristics of Large for Gestational Age babies?
Respiratory distress
Hypoglycemia (< 40 mg/dL)
Hypocalcemia
Polycythemia
Neurological deficits
(seizures, jitteriness, lethargy)
less vernix
CHARACTERISTICS OF A PRETERM INFANT
- Small, lack brown fat
- Large head, soft poorly shaped ears
- Thin, translucent skin
- Lanugo; copious vernix
- Genital development
?Are late preterm babies at risk for sepsis?
Born between 34 and 36 6/7 weeks of
gestation
Termed preterm rather than near term
Higher risk for problems related to:
Respiratory function
Thermoregulation
Hypoglycemia
Hyperbilirubinemia
Sepsis
Complications of Preterm birth
Respiratory distress syndrome
“Hyaline membrane” disease
Surfactant insufficient
Absence of alveolar stability
Prolonged hypoxemia
Oxygen therapy
Endotracheal tube
Continuous positive airway pressure (CPAP
What is Kangaroo care?
skin to skin, mom and baby
Encourage bonding & relationships
Touch/skin to skin contact
Post Term Baby cOmplications
Gestation that extends beyond 42 weeks
3.5 -15% of pregnancies
Cause of delayed labor is unknown
Placental dysfunction
Significant increase fetal & neonatal mortality
Fetal distress; placental insufficiency
Increased risk for birth injuries(DYSTOCIA)
Hypospadias and Epispadias
Hypospadias- urethral
opening located behind glands
penis or anywhere along
ventral surface of penile shaft.
Epispadias- Meatal opening is
located on dorsal surface of
the penis.
Management: requires
surgical repair
Assessment of Post TermBaby
Dry, cracked, peeling skin,
Well formed ears with instant recoil
Loss of subcutaneous tissue
Well developed genitalia
High incidence of meconium release prior to
delivery
S/S of respiratory distress
- Tachypnea
(60breaths/min)initially - Dyspnea
*Pronounced intercostal or substernal retractions - Fine inspiratory crackles
- Audible expiratory grunt
- Flaring of the external nares
- Cyanosis or pallor
- Apnea
- With progression of condition, deteriorating vital signs including blood
pressure, apnea, body temperature instability - hypotension
You have acknowledged that during your patient’s pregnancy, She has been using illicit drugs consistently. What would you anticipate for Health Care Provider to prescribe for the newborn?
A. Naloxone
B. Phenobarbital
C. Methylphenidate
D. Lithium
B. Phenobarbital
At 3 hours of age, a term newborn seems jittery and has a weak and high-pitched cry and irregular resp The nurse suspects that the infant may have which of the following?
1. Hypoglycemia
2. Hypercalcemia
3. Hypervolemia
4. Hypothyroidism
- Hypoglycemia
The mother of a newborn is breastfeeding her infant on the delivery table. How can the nurse best assist
1. Touch the infant’s cheek adjacent to the nipple to elicit the rooting reflex
2. Leave the mother and baby alone and allow the infant to nurse as long as desired
3. Position the infant to grasp the nipple so as to express milk
4. Give the infant a bottle first to evaluate the baby’s ability to suck
- Touch the infant’s cheek adjacent to the nipple to elicit the rooting reflex
Parents of a newborn note petechiae on the newborn’s face and neck. The nurse should tell them that this of which of the following?
1. Increased intravascular pressure during delivery
2. Decreased vitamin K level in the newborn infant
3. A rash called erythema toxicum
4. Excessive superficial capillaries
- Increased intravascular pressure during delivery
A newborn has a total body response to noise or movement that is distressing to her parents. What should tell the parents about this response?
1. It is a reflexive response that indicates normal development.
2. It is a voluntary response that indicates insecurity in a new environment.
3. It is an automatic response that may indicate that the baby is hungry.
4. It is an involuntary response that will remain for the first year of life.
- It is a reflexive response that indicates normal development.
When changing her newborn infant, a mother notices a reddened area on the infant’s buttocks. How shoul respond?
1. Have staff nurses instead of the mother change the infant
2. Use both lotion and powder to protect the area
3. Encourage the mother to cleanse and change the infant more frequently
4. Notify the physician and request an order for a topical ointment
- Encourage the mother to cleanse and change the infant more frequently
A woman, at 32 weeks gestation, delivers a 3-Ib, 8-oz baby boy two hours after arriving at the hospital.
What is the baby at risk for because of his gestational age?
1. Mental retardation and seizures
2. Hypothermia and respiratory distress
3. Acrocyanosis and decreased lanugo
4. Patent ductus arteriosus and pneumonia
- Hypothermia and respiratory distress
Orders for a premature infant are for nipple feedings or gavage. What assessment findings are necessary feedings are given?
1. The baby must have a respiratory rate of 20 to 30 and heart rate of 110 to 130.
2. The baby must be alert and rooting.
3. Sucking and gag reflexes must be present.
4. Weight and temperature must be stable.
- Sucking and gag reflexes must be present.
.The mother of a term newborn born two hours ago asks the nurse why the baby’s hands and feet are blu information should the nurse include when responding?
1. Blue hands and feet can indicate possible heart defects.
2. This is normal in newborns for the first 24 hours.
3. This pattern of coloration is more common in infants who will eventually have darker skin color.
4. Once the baby’s temperature is stabilized, the hands and feet will warm up and be less blue
- This is normal in newborns for the first 24 hours.
Risk factors for hyperbilirubia
*Preterm
* Breastfeeding: especially if exclusively breastfeeding and weight loss is
excessive
* Rh- or ABO incompatibility or other known hemolytic disease (e.g., G6PD
deficiency)
* Polycythemia
* Asian or Native American race
* Bruising related to birth trauma
* Previous sibling who received phototherapy
*Bruising can increase the risk for hyperbili- rubinemia.
Signs and symptoms of infection in Newborn
Lethargy, irritability, poor feeding, vomiting or diar- rhea, decreased reflexes, and pale or mottled skin color are some of the clinical signs that suggest infection. Respiratory symptoms such as apnea, tachypnea, grunting, or retracting can be associated with infec- tion such as pneumonia.
Characteristic of Post Term baby
*little if any vernix caseosa,
*absence of lanugo,
*abundant scalp hair,
*long fingernails.
*The skin is often cracked, parchment-like, and peeling.
*A common finding in postmature infants is a wasted physical appear-ance that reflects placental insufficiency.
*Depletion of subcutaneous fat gives them a thin, elongated appearance.
*The scant amounts of vernix caseosa that remain in the skinfolds may be stained deep yellow or green, which is usually an indication of meconium in the amniotic fluid.
HOW MANY DAYS SHOULD YOU DO A CIRCUMCISION ON JEWISH NEW BORN MALE
8 days
