Unit 5: NURSING CARE OF THE HIGH RISK NEWBORN Flashcards
1
Q
What phenomenon gives more plantar creases?
A
Fluid loss
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
3
Q
It is a common issue of large for gestational age newborn, this is present behind the shoulder blades.
A
excessive brown fat
4
Q
What is the primary goal of healthy people 2030?
A
to keep infants safe and healthy through the first year of life
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
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)
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
8
Q
It refers to the birthweight being inappropriately low for gestational age.
A
Dysmature
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
10
Q
Assessment should be performed under ______ to prevent heat loss?
A
prewarmed radiant heat
11
Q
Give 3 nursing diagnosis for High Risk Newborns.
A
- ineffective airway clearance
- ineffective tissue perfusion
- ineffective thermoregulation
12
Q
What are the 9 Newborn Priorities?
A
- Initiation and maintenance of respiration
- Establishing extrauterine circulation
- Maintenance of F and E balance
- Regulating Temperature
- Adequate Nutrition
- Establish Waste Elimination
- Prevention of Infection
- Establish Newborn-Parent Bonding
- Institute Developmental care
13
Q
This score indicates a difficulty in transitioning from intrauterine to extrauterine life.
A
Low Apgar Score
14
Q
What Apgar ratings indicate that the baby is in good health?
A
7, 8 and 9
15
Q
What is the most common cause of infant death for the first 48 hours after birth?
A
Inadequate Respiration
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
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
18
Q
What procedure is performed when there is a neonatal arrest?
A
- Neonatal Resuscitation
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
20
Q
How do you demonstrate a sniffing position?
A
15 degrees elevating head and 35 degrees extending the neck
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.
22
Q
This results from a lack of immediate action to respiration problems.
A
lack of cardiac function
23
Q
What is the cardiac rate to be considered lacking for infants?
A
lesser than 60 bpm
24
Q
How many times of chest compression per minute is needed for resuscitation?
A
100
25
What is the ratio of compression to ventilation?
3:1
26
When will you stop compression?
bpm is greater than 100
27
What are the nursing intervention for problems with extrauterine circulation?
- monitor pulse oximeter ratio
- ensure respiratory function and cardiac efficiency
- transfer to NICU for continuous cardiopulmonary observation and care
28
This issue develops after resuscitation.
Hypoglycemia
29
It increases insensible loss caused by rapid breathing.
Dehydration
30
What is the nursing management in order to maintain f and e balance?
- monitor rate of fluid conscientiously
- monitor input and output
31
What should be the specific gravity of a urine?
< 2 ml/kg/hour of specimen
32
What specific gravity indicates inadequate fluid intake?
> 1.015 - 1.020
33
What are the most common cause of difficulty in maintaining temperature in high risk infants?
- stress from an illness or immaturity
- exposure to long procedures
34
What are the appropriate nursing care in order to regulate temperature?
- 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
35
What does the hot environment do to the metabolic rate of an infant?
Decreases
36
What does the cold environment do to the metabolic rate of an infant?
Increases (warm body cells and increased oxygen demand)
37
What should initially be done if a newborn suffers from asphyxia at birth?
IV
38
If the rr of the infant remains rapid, the infant can't initiate sucking effectively. What is the alternative method for feeding?
gavage feeding
39
What are the different hunger signs?
Rooting, Crying and Sucking Motions
40
All neonates who are gavage or gastrostomy fed should receive oral stimulation from nonnutritive sucking which is?
Pacifier
41
Can impressed breast milk be used as gavage? Yes or No
Yes
42
What are the exceptions to pacifier?
- Immature neonates to have sucking reflex
- with tracheoesophageal fistula, must not swallow air
43
When is the usual time in which the baby voids?
within 24 hours of birth
44
Why is the stool passed later in term than post term neonates
Because meconium has not reach the end of intestine
45
What are the common viruses to be present in Neonates?
- Cytomegalovirus
- Toxoplasmosis virus
- Herpes Simplex
- Hepatitis B
- Escherichia cola
- Klebsiella
- Staphylococcus aureus
46
How many percent of kids have possible cytomegalovirus?
75%
47
What virus causes pneumonia?
Klebsiella
48
It is the most common cause of hospital acquired infection.
Staphylococcus aureus
49
How do you establish newborn-patient bonding?
- Offer a tour of NICU
- quickly move to playing age appropriate toys
- look forward at the next developmental stop
50
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.
Apgar Scoring
51
What examinations are used to determine gestational age?
Dubowitz and Ballard Exam`
52
What aspects are involved in the Dubowitz and Ballard Exam?
- Posture
- Square window
- Arm recoil
- Popliteal Angle
- Scarf Sign
- Heel to ear
53
These neonates are born after the beginning of week 38 and before week 42 of pregnancy (calculated from first day of last menses).
Term
54
Neonates born before the beginning of 38 week.
Preterm
55
Neonates born after the end of week 41
Post-term or postmature
56
Falls between the 10th and 90th percentile of weight.
Appropriate for Gestational Age
57
Falls below the 10th percentile of weight
Small for Gestational Age
58
Falls above 90th percentile of weight
Large for Gestational Age
59
What are the classifications for SGAs?
Low birth weight: < 2500 g
very low: < 1500 g
extremely low: 1000 g
60
They are born before the end of the week 37 of gestational age.
Preterm Infant
61
Late preterm infant
between 34 and 37
62
Early preterm infant
between 24 - 34 weeks
63
What are the needed considerations for preterm infant?
- need intensive care
- prone to hypoglycemia, infection, and intracranial hemorrhage
- lack of lung surfactant and vulnerable to Respiratory Distress Syndrome
64
What are the potential complications of preterm infants?
- Anemia of Prematurity
- Acute Bilirubin Encephalopathy
- Persistent Ductus Arteriosus
65
It refers to the excessive withdrawal of the blood.
Anemia of Prematurity
66
This is a type of anemia where n cells are few in numbers.
Normocytic Anemia
67
Destruction of brain cells by invasion of direct and unconjugated bilirubin.
Acute Bilirubin Encephalopathy
68
When indirect bilirubin rise, what condition occurs?
Jaundice
69
This condition refers to noncompliant lungs, where more opening for blood to move to lung artery causing pulmonary artery hypertension.
Persistent Ductus Arteriosus
70
Persisting Ductus Arteriosus is secondary to what condition?
Inadequate surfactant
71
Is a type of pregnancy that lasts 42 weeks or more
Post term Newborn
72
What happens to the placenta during post maturity?
Placenta is no longer able to provide enough nutrients to the newborn
73
What are the symptoms of Post maturity?
- 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
What are the nursing management for post maturity?
- 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
What are the common conditions of high risk infants?
- Respiratory distress
- Infection
- Jaundice
- Thermal instability
- Neuro disorder
- Hypoglycemia
- Feeding problems
76
This type of condition is uncontrolled during pregnancy which results into a bigger newborn also known as macrosomia,
Maternal Diabetes Mellitus
77
It is teratogenic to a rapidly growing fetus.
Hyperglycemia
78
Maternal Diabetes can result in to fat and puffy appearance called ______.
Cushingoid
79
This type of newborn is characterized by greater chance of birth injuries and severe hypoglycemia.
Macrosomic Newborn
80
What is the value for severe Hypoglycemia?
Glucose < 45 mg/dl
81
What are the managements for a macrosomic newborn?
1. Need to be feed early with formula
2. Continuous infusion of glucose if unable to suck
3. Careful monitoring for bowel movements
82
How many insulin dependent mothers have macrosomic newborn?
1/4th
83
In macrosomia, in what trimester does excessive growth happen?
3rd trimester
84
Why are newborns susceptible to develop infections?
because of their immature ability to produce antibodies
85
How does newborns contract infections?
Exposure to vaginal secretions at birth
86
What are the major causes of infection in newborn?
B-Hemolytic, Group B Streptococcal Infection`
87
When do signs of infection usually appear in newborn?
first 24 hours after birth
88
What are the signs of infection in newborn?
- Being fussy
- very sleepy
- having breathing problems (sign of sepsis)
- breathing fast
- making grunting noises (signs of pneumonia)
89
What are the managements for B-Hemolytic, Group B Streptococcal infection?
- Antibiotics
- Parent Education
- Immunization of all woman of childbearing age against strep B organism
90
Give 3 examples of antibiotic that can be used to treat infection?
- Gentamycin
- Ampicillin
- Penicillin
91
An eye infection that occurs at birth or during the first month.
Opthalmia Neonatorum
92
What causes opthalmia neonatorum?
Neisseria Gonorrhea or Chlamydia Trachomatis
93
What is the mode of transmission of opthalmia neonatrum?
Birth from vaginal secretions
94
Serious form of conjunctivitis may lead to?
Corneal destruction and severe visual impairment
95
What are the nursing management for opthalmia neonatorum?
- 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
What is the mode of transmission of hepatitis B infection?
Infected vaginal blood at birth
97
What are the nursing management for infant who contracted Hepa B infection?
- infections are routinely vaccinated at birth
- administration of immune serum globulin within 12 hours after birth
- gentle suction
98
This type of herpesvirus infection is most prevalent among woman with multiple sexual partners.
Herpes simplex virus type 2
99
What is the common manifestation of infants with mothers who have herpesvirus infection?
Skin vesicles
100
What are the signs and symptoms of infants with herpesvirus?
- loss of appetite
- low-grade fever
- lethargy
- stomatitis
101
What are the management for herpesvirus infection?
- Antiviral drug: Acyclovir (zovirax)
- Cesarean birth (to minimize newborn's exposure)
- separated from other infants
102
What are the most common fate of drug-dependent birthing parents?
- 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
When do signs of drug-dependent birthing parents usually appear?
begins at 24-48 hours after birth and last approximately 2 weeks and mild signs may appear for up to 6 months
104
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.
2; 72
105
In ______ addicted newborns, withdrawal begins later and lasts longer than heroin withdrawal.
Methadone
106
What are the specimens taken for infants with mothers who are cocaine addicted
urine, meconium and hair
107
Infants exposed to drugs in utero may have long term neurologic problems. True or False
True
108
What are the nursing care for infants with drug dependent birthing parents?
- 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
Alcohol crosses the placenta in the same concentration as in the maternal bloodstream causing what specific condition?
Fetal Alcohol Syndrome
110
What are the dysmorphic features of fetal alcohol syndrome?
- small palpebral features
- smooth philtrum
- thin upper lip
- micrognathia
- epicanthal folds
- low nasal bridge
111
What are the other manifestations of micrognathia?
- prenatal and postnatal growth restriction
- CNS involvement: cognitive challenge
- Cerebral palsy
- Weak suckling reflex
- Always awake or always asleep
112
What are the common illness that appear in newborn?
1. Respiratory distress syndrome
2. Meconium Aspiration Syndrome
3. Apnea
4. Sudden Infant Death Syndrome
5. Hemolytic Disease
6. Hemorrhagic Disease
113
What is the most common indication of a preterm newborn?
Low levels of surfactant
114
What does ABG stands for?
Arterial Blood Gas
115
What does RDS stands for
Respiratory Distress Syndrome
116
What is the other term for RDS?
Hyaline Membrane Disease
117
Respiratory Distress Syndrome occurs in what specific conditions?
- 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
What are the specific management for Respiratory Distress Syndrome?
- 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
It is termed for belly breathing.
Subcostal Retraction
120
It is a dark green, sterile fecal matter that baby's produce in the intestines while in the womb.
Meconium
121
Who discovered and termed the word Meconium?
Aristotle
122
In the olden times Aristotle theorized that meconium can _______.
induce sleep
123
Infants first bowel movement.
Meconium
124
What is meconium made of?
Proteins
Fats
Epithelial Cells
Lanugo
Mucus
Bile
Water
Intestinal Secretions and amino fluids
125
What percent of meconium is water?
85-95%
126
What percent of meconium is a combination of intestinal secretions and clumps of amino fluids?
5-15%
127
When does meconium starts to develop?
10th week of gestation
128
Is meconium a sterile product? Yes or No
Yes
129
It is 5 to 10% of births leading cause of illness and death.
Meconium Aspiration Syndrome
130
What is the nursing management for meconium aspiration syndrome?
- 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
What may indicate a sleeping disorder?
Open mouth while sleeping
132
It is a pause in inspiration longer than 20 seconds during sleep.
Apnea
133
Who are at risk of Apnea?
- Preterm infants
- infection
- hyperbilirubinemia
- hypoglycemia
- hypothermia
134
What are the management for apnea?
- 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
What does SIDS stand for?
Sudden Infant Death Syndrome
136
What are the risks for SIDS?
- 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
What are the post autopsy findings for SIDS?
- Laryngospasm
- Blood-streaked sputum and vomiting
- Petechiae in the lungs
- Inflammation of respiratory tract
138
This diseases is caused by RH blood type incompatibility or ABO incompatibility which can lead to hyperbilirubinemia.
Hemolytic Disease of the Newborn
139
This Hemolytic Disease have mild effects and can go away with time.
ABO incompatibiltiy
140
This type of incompatibility has a serious effect including a baby born with severe jaundice due to the build up of bilirubin.
RH incompatibility
141
What test is use to determine Hemolysis or Hemolytic Disease?
Coombs Test
142
What are the management for Hemolytic Disease in infants?
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
What considerations should be taken note when doing phototherapy?
1. Lights are placed 12-30 inches above bassinet/incubator
2. Do not undress diaper
3. Eyes covered
144
What are the steps of exchange transfusion?
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
This disease results from deficiency of vitamin K?
Hemorrhagic Disease of the Newborn
146
Vitamin K is essential for the formation of _____ by the liver?
Prothrombin
147
Hemorrhagic disease is also known as what?
Vitamin K deficiency bleeding
148
In Hemorrhagic disease there is an impaired production of coagulation factors such as _________.
II, VII, IX, X
149
What are the symptoms of Hemorrhagic Disease?
- Petechiae from superficial bleeding
- conjunctival mucus membrane or retinal hemorrhage
- vomits fresh blood out
- black tarry stool
- occurs in day 2 of life
150
What is the prevention for hemorrhagic disease?
injection of 1 mg vitamin K IM to allow membranes immediately after birth
151
What is the care for infant with hemorrhagic disease?
- handle infant gently
- blood transfusion in severe bleeding
