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NCM 214 A > Unit 5: NURSING CARE OF THE HIGH RISK NEWBORN > Flashcards

Unit 5: NURSING CARE OF THE HIGH RISK NEWBORN Flashcards

1
Q

What phenomenon gives more plantar creases?

A

Fluid loss

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2
Q

It is a common condition for newborn who are small for gestational age which is usually characterized by limited glycogen stores.

A

Hypoglycemia

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3
Q

It is a common issue of large for gestational age newborn, this is present behind the shoulder blades.

A

excessive brown fat

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4
Q

What is the primary goal of healthy people 2030?

A

to keep infants safe and healthy through the first year of life

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5
Q

What are the important measures that will be carried out by healthy people 2030 to achieve their goal?

A
  • women get high quality care during pregnancy
  • focus on increasing breast feeding, vaccination and developmental screenings
  • encourage safe sleep practices and correct use of car seats
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6
Q

What can lead to high risk infants?

A
  • younger/older average maternal age
  • concurrent disease condition (DM, HIV infection
  • Pregnancy complication (placenta previa)
  • At risk lifestyle (substance abuse)
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7
Q

It is a black tarry mucoid and non smelling stool of the newborn which is usually eliminated 24 hours after birth?

A

Meconium

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8
Q

It refers to the birthweight being inappropriately low for gestational age.

A

Dysmature

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9
Q

What are included in the assessment of the newborn?

A
  • Assess for obvious congenital anomalies
  • Gestational (number weeks)
  • oxygen saturation
  • bp monitoring
  • close observation
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10
Q

Assessment should be performed under ______ to prevent heat loss?

A

prewarmed radiant heat

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11
Q

Give 3 nursing diagnosis for High Risk Newborns.

A
  • ineffective airway clearance
  • ineffective tissue perfusion
  • ineffective thermoregulation
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12
Q

What are the 9 Newborn Priorities?

A
  1. Initiation and maintenance of respiration
  2. Establishing extrauterine circulation
  3. Maintenance of F and E balance
  4. Regulating Temperature
  5. Adequate Nutrition
  6. Establish Waste Elimination
  7. Prevention of Infection
  8. Establish Newborn-Parent Bonding
  9. Institute Developmental care
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13
Q

This score indicates a difficulty in transitioning from intrauterine to extrauterine life.

A

Low Apgar Score

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14
Q

What Apgar ratings indicate that the baby is in good health?

A

7, 8 and 9

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15
Q

What is the most common cause of infant death for the first 48 hours after birth?

A

Inadequate Respiration

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16
Q

What are the common cause of asphyxia in utero?

A
  • cord compression
  • maternal anesthesia
  • placenta previa
  • intrauterine growth restriction
  • premature separation of placenta
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17
Q

What are the factors predisposing Infants to Respiratory Difficulty?

A
  • Low Birth Weight
  • Intrauterine Growth Restriction
  • Meconium Staining
  • Maternal Use of Barbiturates
  • Low Apgar Score (<7) @ 1/5 minutes
  • Small for gestational age
  • Multiple birth
  • Maternal rupture of DM
  • Premature rupture of membrane
  • Irregular FHB during labor
  • Cord Collapse
  • Post mature
  • Breech Birth
  • Chest, heart or respiratory anomalies
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18
Q

What procedure is performed when there is a neonatal arrest?

A
  • Neonatal Resuscitation
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19
Q

During a Neonatal Resuscitation, what is the best position to facilitate the airway without the risk for cervical spine injury?

A

Sniffing Position

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20
Q

How do you demonstrate a sniffing position?

A

15 degrees elevating head and 35 degrees extending the neck

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21
Q

What is the science behind the sniffing position?

A

It allows for the optimal exposure of the glottis, by aligning the oral, pharyngeal and larynx area.

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22
Q

This results from a lack of immediate action to respiration problems.

A

lack of cardiac function

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23
Q

What is the cardiac rate to be considered lacking for infants?

A

lesser than 60 bpm

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24
Q

How many times of chest compression per minute is needed for resuscitation?

A

100

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25
Q

What is the ratio of compression to ventilation?

A

3:1

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26
Q

When will you stop compression?

A

bpm is greater than 100

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27
Q

What are the nursing intervention for problems with extrauterine circulation?

A
  • monitor pulse oximeter ratio
  • ensure respiratory function and cardiac efficiency
  • transfer to NICU for continuous cardiopulmonary observation and care
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28
Q

This issue develops after resuscitation.

A

Hypoglycemia

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29
Q

It increases insensible loss caused by rapid breathing.

A

Dehydration

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30
Q

What is the nursing management in order to maintain f and e balance?

A
  • monitor rate of fluid conscientiously
  • monitor input and output
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31
Q

What should be the specific gravity of a urine?

A

< 2 ml/kg/hour of specimen

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32
Q

What specific gravity indicates inadequate fluid intake?

A

> 1.015 - 1.020

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33
Q

What are the most common cause of difficulty in maintaining temperature in high risk infants?

A
  • stress from an illness or immaturity
  • exposure to long procedures
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34
Q

What are the appropriate nursing care in order to regulate temperature?

A
  • Keeping the patient in neutral heat
  • Cover newborn head with a cap
  • Dry the body and the head with a towel or blanket
  • Place the infant on a radiant warmer or a prewarmed incubator
  • Skin to skin contact with one of the parents if the newborn is stable
  • Maintain temperature between 36.5 and 37.5
  • Warmed mattresses
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35
Q

What does the hot environment do to the metabolic rate of an infant?

A

Decreases

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36
Q

What does the cold environment do to the metabolic rate of an infant?

A

Increases (warm body cells and increased oxygen demand)

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37
Q

What should initially be done if a newborn suffers from asphyxia at birth?

A

IV

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38
Q

If the rr of the infant remains rapid, the infant can’t initiate sucking effectively. What is the alternative method for feeding?

A

gavage feeding

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39
Q

What are the different hunger signs?

A

Rooting, Crying and Sucking Motions

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40
Q

All neonates who are gavage or gastrostomy fed should receive oral stimulation from nonnutritive sucking which is?

A

Pacifier

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41
Q

Can impressed breast milk be used as gavage? Yes or No

A

Yes

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42
Q

What are the exceptions to pacifier?

A
  • Immature neonates to have sucking reflex
  • with tracheoesophageal fistula, must not swallow air
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43
Q

When is the usual time in which the baby voids?

A

within 24 hours of birth

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44
Q

Why is the stool passed later in term than post term neonates

A

Because meconium has not reach the end of intestine

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45
Q

What are the common viruses to be present in Neonates?

A
  • Cytomegalovirus
  • Toxoplasmosis virus
  • Herpes Simplex
  • Hepatitis B
  • Escherichia cola
  • Klebsiella
  • Staphylococcus aureus
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46
Q

How many percent of kids have possible cytomegalovirus?

A

75%

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47
Q

What virus causes pneumonia?

A

Klebsiella

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48
Q

It is the most common cause of hospital acquired infection.

A

Staphylococcus aureus

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49
Q

How do you establish newborn-patient bonding?

A
  • Offer a tour of NICU
  • quickly move to playing age appropriate toys
  • look forward at the next developmental stop
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50
Q

This assessment of well-being involve observation of newborn for 1 minutes and 5 minutes which is use as a standard newborn evaluation after birth.

A

Apgar Scoring

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51
Q

What examinations are used to determine gestational age?

A

Dubowitz and Ballard Exam`

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52
Q

What aspects are involved in the Dubowitz and Ballard Exam?

A
  • Posture
  • Square window
  • Arm recoil
  • Popliteal Angle
  • Scarf Sign
  • Heel to ear
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53
Q

These neonates are born after the beginning of week 38 and before week 42 of pregnancy (calculated from first day of last menses).

A

Term

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54
Q

Neonates born before the beginning of 38 week.

A

Preterm

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55
Q

Neonates born after the end of week 41

A

Post-term or postmature

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56
Q

Falls between the 10th and 90th percentile of weight.

A

Appropriate for Gestational Age

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57
Q

Falls below the 10th percentile of weight

A

Small for Gestational Age

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58
Q

Falls above 90th percentile of weight

A

Large for Gestational Age

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59
Q

What are the classifications for SGAs?

A

Low birth weight: < 2500 g
very low: < 1500 g
extremely low: 1000 g

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60
Q

They are born before the end of the week 37 of gestational age.

A

Preterm Infant

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61
Q

Late preterm infant

A

between 34 and 37

62
Q

Early preterm infant

A

between 24 - 34 weeks

63
Q

What are the needed considerations for preterm infant?

A
  • need intensive care
  • prone to hypoglycemia, infection, and intracranial hemorrhage
  • lack of lung surfactant and vulnerable to Respiratory Distress Syndrome
64
Q

What are the potential complications of preterm infants?

A
  • Anemia of Prematurity
  • Acute Bilirubin Encephalopathy
  • Persistent Ductus Arteriosus
65
Q

It refers to the excessive withdrawal of the blood.

A

Anemia of Prematurity

66
Q

This is a type of anemia where n cells are few in numbers.

A

Normocytic Anemia

67
Q

Destruction of brain cells by invasion of direct and unconjugated bilirubin.

A

Acute Bilirubin Encephalopathy

68
Q

When indirect bilirubin rise, what condition occurs?

A

Jaundice

69
Q

This condition refers to noncompliant lungs, where more opening for blood to move to lung artery causing pulmonary artery hypertension.

A

Persistent Ductus Arteriosus

70
Q

Persisting Ductus Arteriosus is secondary to what condition?

A

Inadequate surfactant

71
Q

Is a type of pregnancy that lasts 42 weeks or more

A

Post term Newborn

72
Q

What happens to the placenta during post maturity?

A

Placenta is no longer able to provide enough nutrients to the newborn

73
Q

What are the symptoms of Post maturity?

A
  • Dry, loose, peeling skin
  • Overgrown nails
  • Abundant Scalp hair
  • visible creases on palms and soles of feet
  • minimal fat deposits
  • green, brown or yellow color skin
  • more alert “wide-eyed”
74
Q

What are the nursing management for post maturity?

A
  • provide care individually according to newborn needs
  • observe respiratory distress
  • take temperature
  • monitor serum glucose
  • monitor serum calcium
  • Oral calcium, give with enteral feeding
  • Obvious sign and symptoms of hypoglycemia because of limited glycogen stores.
75
Q

What are the common conditions of high risk infants?

A
  • Respiratory distress
  • Infection
  • Jaundice
  • Thermal instability
  • Neuro disorder
  • Hypoglycemia
  • Feeding problems
76
Q

This type of condition is uncontrolled during pregnancy which results into a bigger newborn also known as macrosomia,

A

Maternal Diabetes Mellitus

77
Q

It is teratogenic to a rapidly growing fetus.

A

Hyperglycemia

78
Q

Maternal Diabetes can result in to fat and puffy appearance called ______.

A

Cushingoid

79
Q

This type of newborn is characterized by greater chance of birth injuries and severe hypoglycemia.

A

Macrosomic Newborn

80
Q

What is the value for severe Hypoglycemia?

A

Glucose < 45 mg/dl

81
Q

What are the managements for a macrosomic newborn?

A
  1. Need to be feed early with formula
  2. Continuous infusion of glucose if unable to suck
  3. Careful monitoring for bowel movements
82
Q

How many insulin dependent mothers have macrosomic newborn?

A

1/4th

83
Q

In macrosomia, in what trimester does excessive growth happen?

A

3rd trimester

84
Q

Why are newborns susceptible to develop infections?

A

because of their immature ability to produce antibodies

85
Q

How does newborns contract infections?

A

Exposure to vaginal secretions at birth

86
Q

What are the major causes of infection in newborn?

A

B-Hemolytic, Group B Streptococcal Infection`

87
Q

When do signs of infection usually appear in newborn?

A

first 24 hours after birth

88
Q

What are the signs of infection in newborn?

A
  • Being fussy
  • very sleepy
  • having breathing problems (sign of sepsis)
  • breathing fast
  • making grunting noises (signs of pneumonia)
89
Q

What are the managements for B-Hemolytic, Group B Streptococcal infection?

A
  • Antibiotics
  • Parent Education
  • Immunization of all woman of childbearing age against strep B organism
90
Q

Give 3 examples of antibiotic that can be used to treat infection?

A
  • Gentamycin
  • Ampicillin
  • Penicillin
91
Q

An eye infection that occurs at birth or during the first month.

A

Opthalmia Neonatorum

92
Q

What causes opthalmia neonatorum?

A

Neisseria Gonorrhea or Chlamydia Trachomatis

93
Q

What is the mode of transmission of opthalmia neonatrum?

A

Birth from vaginal secretions

94
Q

Serious form of conjunctivitis may lead to?

A

Corneal destruction and severe visual impairment

95
Q

What are the nursing management for opthalmia neonatorum?

A
  • Prophylactic instillation of erythromycin ointment on both eyes of the newborn.
  • Rocephin (Ceftriaxone and penicillin) IVTT
  • Infection Precaution
  • Irrigate eyes with sterile saline solution @ room temperature using bulb syringe or medicine dropper
96
Q

What is the mode of transmission of hepatitis B infection?

A

Infected vaginal blood at birth

97
Q

What are the nursing management for infant who contracted Hepa B infection?

A
  • infections are routinely vaccinated at birth
  • administration of immune serum globulin within 12 hours after birth
  • gentle suction
98
Q

This type of herpesvirus infection is most prevalent among woman with multiple sexual partners.

A

Herpes simplex virus type 2

99
Q

What is the common manifestation of infants with mothers who have herpesvirus infection?

A

Skin vesicles

100
Q

What are the signs and symptoms of infants with herpesvirus?

A
  • loss of appetite
  • low-grade fever
  • lethargy
  • stomatitis
101
Q

What are the management for herpesvirus infection?

A
  • Antiviral drug: Acyclovir (zovirax)
  • Cesarean birth (to minimize newborn’s exposure)
  • separated from other infants
102
Q

What are the most common fate of drug-dependent birthing parents?

A
  • tend to be SGA
  • will show withdrawal syndrome (neonatal abstinence syndrome)
  • irritability and convulsions
  • disturbed sleep pattern
  • constant movement
  • Tremors, tachypnea
  • Frequent sneezing
  • Shrill, high pitched cry
  • vomiting and diarrhea
103
Q

When do signs of drug-dependent birthing parents usually appear?

A

begins at 24-48 hours after birth and last approximately 2 weeks and mild signs may appear for up to 6 months

104
Q

In neonates who are born after the beginning of 38 weeks and before week 42 of pregnancy, signs begin within the first _____ weeks of life with an average onset of _____ hours.

A

2; 72

105
Q

In ______ addicted newborns, withdrawal begins later and lasts longer than heroin withdrawal.

A

Methadone

106
Q

What are the specimens taken for infants with mothers who are cocaine addicted

A

urine, meconium and hair

107
Q

Infants exposed to drugs in utero may have long term neurologic problems. True or False

A

True

108
Q

What are the nursing care for infants with drug dependent birthing parents?

A
  • environment free from excessive stimuli
  • Darkened Room
  • give pacifier (heroin-addicted newborn suck vigorously)
  • gavage feeding (methadone and cocaine addicted newborns) (extremely poor sucking)
  • maintain f and e balance activity
  • not best to breastfeed if using narcotics
  • mother needs treatment for withdrawal
109
Q

Alcohol crosses the placenta in the same concentration as in the maternal bloodstream causing what specific condition?

A

Fetal Alcohol Syndrome

110
Q

What are the dysmorphic features of fetal alcohol syndrome?

A
  • small palpebral features
  • smooth philtrum
  • thin upper lip
  • micrognathia
  • epicanthal folds
  • low nasal bridge
111
Q

What are the other manifestations of micrognathia?

A
  • prenatal and postnatal growth restriction
  • CNS involvement: cognitive challenge
  • Cerebral palsy
  • Weak suckling reflex
  • Always awake or always asleep
112
Q

What are the common illness that appear in newborn?

A
  1. Respiratory distress syndrome
  2. Meconium Aspiration Syndrome
  3. Apnea
  4. Sudden Infant Death Syndrome
  5. Hemolytic Disease
  6. Hemorrhagic Disease
113
Q

What is the most common indication of a preterm newborn?

A

Low levels of surfactant

114
Q

What does ABG stands for?

A

Arterial Blood Gas

115
Q

What does RDS stands for

A

Respiratory Distress Syndrome

116
Q

What is the other term for RDS?

A

Hyaline Membrane Disease

117
Q

Respiratory Distress Syndrome occurs in what specific conditions?

A
  • Preterm Birth
  • Infant with Diabetes Mellitus
  • Cesarean Birth
  • Decrease Blood Perfusion of Lungs
  • Low or Absence of Surfactant
  • Low Body Temperature
  • Nasal Flaring
  • Pale Gray Skin
  • Diminished Breath Sounds
  • Tachypnea
  • Subcostal Retraction
  • Delayed or Decrease Air Entry
  • Cyanosis
  • Desaturation
118
Q

What are the specific management for Respiratory Distress Syndrome?

A
  • administration of surfactant
    -via endotracheal tube at birth and attached to ventilator, refrain from suctioning for 1 hour
  • Use of muscle relaxant: Pancuronium (Parulon) IVTT
  • Maintain Abg
  • Maintain Maternal Neutral Temperature
119
Q

It is termed for belly breathing.

A

Subcostal Retraction

120
Q

It is a dark green, sterile fecal matter that baby’s produce in the intestines while in the womb.

A

Meconium

121
Q

Who discovered and termed the word Meconium?

A

Aristotle

122
Q

In the olden times Aristotle theorized that meconium can _______.

A

induce sleep

123
Q

Infants first bowel movement.

A

Meconium

124
Q

What is meconium made of?

A

Proteins
Fats
Epithelial Cells
Lanugo
Mucus
Bile
Water
Intestinal Secretions and amino fluids

125
Q

What percent of meconium is water?

A

85-95%

126
Q

What percent of meconium is a combination of intestinal secretions and clumps of amino fluids?

A

5-15%

127
Q

When does meconium starts to develop?

A

10th week of gestation

128
Q

Is meconium a sterile product? Yes or No

A

Yes

129
Q

It is 5 to 10% of births leading cause of illness and death.

A

Meconium Aspiration Syndrome

130
Q

What is the nursing management for meconium aspiration syndrome?

A
  • Cesarean Birth
  • Assisted Ventilation
  • Antibiotic Therapy
  • Administration of Surfactant
  • Observe heart failure: increase HR/PR
  • maintain a temperature neutral environment
  • chest physiotherapy with clapping and vibration
131
Q

What may indicate a sleeping disorder?

A

Open mouth while sleeping

132
Q

It is a pause in inspiration longer than 20 seconds during sleep.

A

Apnea

133
Q

Who are at risk of Apnea?

A
  • Preterm infants
  • infection
  • hyperbilirubinemia
  • hypoglycemia
  • hypothermia
134
Q

What are the management for apnea?

A
  • Gentle handling to avoid excessive fatigue
  • Indwelling NGT rather than intermittent (reduces vagal stimulation that may lead to bradycardia)
  • Careful Burping
  • Never check temperature rectally to an infant prone of apnea
  • Apnea monitor
135
Q

What does SIDS stand for?

A

Sudden Infant Death Syndrome

136
Q

What are the risks for SIDS?

A
  • unexplained
  • infants of closely paced pregnancies
  • economically disadvantage
  • black infants, Alaskan native infants
  • Twins
  • Infants of Narcotic Dependent Mother
  • Peak age is 2-4 month age
  • Babies sleeping with blankets
137
Q

What are the post autopsy findings for SIDS?

A
  • Laryngospasm
  • Blood-streaked sputum and vomiting
  • Petechiae in the lungs
  • Inflammation of respiratory tract
138
Q

This diseases is caused by RH blood type incompatibility or ABO incompatibility which can lead to hyperbilirubinemia.

A

Hemolytic Disease of the Newborn

139
Q

This Hemolytic Disease have mild effects and can go away with time.

A

ABO incompatibiltiy

140
Q

This type of incompatibility has a serious effect including a baby born with severe jaundice due to the build up of bilirubin.

A

RH incompatibility

141
Q

What test is use to determine Hemolysis or Hemolytic Disease?

A

Coombs Test

142
Q

What are the management for Hemolytic Disease in infants?

A
  1. Early feeding - the sooner feeding starts the sooner the removal of bilirubin
  2. Phototherapy - speed conversion potential of the bilirubin to water soluble isomers
  3. Exchange Transfusion
143
Q

What considerations should be taken note when doing phototherapy?

A
  1. Lights are placed 12-30 inches above bassinet/incubator
  2. Do not undress diaper
  3. Eyes covered
144
Q

What are the steps of exchange transfusion?

A
  1. The baby’s stomach is aspirated (minimize risk of aspiration during manipulation)
  2. Umbilical Vein is catheterized
  3. Alternatively withdraw small amount of blood (2-10 mL) of the infant blood, then replace with the same amount of donor’s blood slowly
145
Q

This disease results from deficiency of vitamin K?

A

Hemorrhagic Disease of the Newborn

146
Q

Vitamin K is essential for the formation of _____ by the liver?

A

Prothrombin

147
Q

Hemorrhagic disease is also known as what?

A

Vitamin K deficiency bleeding

148
Q

In Hemorrhagic disease there is an impaired production of coagulation factors such as _________.

A

II, VII, IX, X

149
Q

What are the symptoms of Hemorrhagic Disease?

A
  • Petechiae from superficial bleeding
  • conjunctival mucus membrane or retinal hemorrhage
  • vomits fresh blood out
  • black tarry stool
  • occurs in day 2 of life
150
Q

What is the prevention for hemorrhagic disease?

A

injection of 1 mg vitamin K IM to allow membranes immediately after birth

151
Q

What is the care for infant with hemorrhagic disease?

A
  • handle infant gently
  • blood transfusion in severe bleeding

NCM 214 A (8 decks)

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