Unit 7 Flashcards
Risk Factors associated with Birth Trauma
- Maternal risk factors: age younger than 16 or older than 35, primigravida, prolonged or precipitous labor, preterm or postterm labor, and cephalopelvic disproportion
- Injury can result from dystocia caused by fetal macrosomia, multifetal gestation, abnormal or difficult presentation, and congenital anomalies.
- Forceps- or vacuum-assisted birth
Birth Trauma
How can Ultrasonography and Elective C/S help?
The use of ultrasonography allows antepartum diagnosis of macrosomia and unusual presentations.
- BPP
Elective cesarean birth may be chosen for selected pregnancies to prevent significant birth injuries (for macrosomia or abnormal presentation)
- Also: gastroschisis
Describe Skull fracture and treatment
The newborn’s skull can withstand considerable deformation (molding) during the labor and delivery process because suture lines are not completely fused
A neonate who suffers a skull fracture is also likely to have a cephalhematoma (remember, it does not cross suture lines)
Scan done to verify there is no skull fracture
Treatment: typically heals on its own
Fractured clavicle
Risk Factors
Signs/Symptoms
Treatment
Risk Factors
- Shoulder dystocia, forceps/vacuum, macrosomia
Signs and symptoms
- Unilateral Moro Reflex (doesn’t move affected arm), limited movement of the arm, crepitus over the bone
Treatment:
- Gentle handling
Fracture of the humerus or femur
Risk Factor
Treatment
Risk Factor
- Difficult birth
Treatment
- Immobilizer (slings, splints, swaddles)
Erb-Duchenne Palsy
What is it?
Risk Factors
Signs and Symptoms
Treatment
Result of injury to the upper plexus involving nerves C5 and C6 caused by stretching or pulling the head away from the shoulder during a difficult birth
Associated with a shoulder dystocia, fractured clavicle
S/S: arm hangs limp at side, limited movement, absent Moro (do NOT see crepitus)
Treatment: Range of motion exercises
Facial Palsy
Risk Factors
S/S
Treatment
Risk Factors: forceps delivery, prolonged labor
The face on the affected side is flattened and unresponsive to the grimace that accompanies crying or stimulation and the eye remains open on the affected side.
Treatment: Education on how to properly feed! Feeding can be prolonged, with milk flowing out of mouth on the affected side
Prevention of damage to the cornea of the open eye (artificial tears, taping eye closed)
Intracranial hemorrhage
Risk Factors of ICH?
Types include:
Symptoms:
Management
Risk Factors: forceps or vacuum-assisted delivery
More common in babies before 30 weeks
Subdural hematoma: blood pooling in the subdural space
- The typical history includes a nulliparous mother, with precipitous birth; a difficult forceps-assisted birth; or a LGA infant
- Can see seizures, coma, unequal pupil sizes, apnea
Subarachnoid hemorrhage
- More common type
- Seen when a premature baby has experienced hypoxia during labor and delivery
- Some babies have no symptoms; others can have seizures or apnea
- Diagnosis: Lumbar puncture shows blood in CSF
Important Assessment: Respiratory and Neuro**
Seizures: Reduce stress in the environment by dimming the lights, keeping things quiet, cluster care
Intraventricular hemorrhage
What is it?
S/S?
Bleeding into ventricles of the brain
S/S:
- Moro Reflex is diminished or absent
- Apnea
- Lethargy
- Poor feeding practices in baby
- High pitched cry
- Seizures
Prognosis depends on severity of bleeding
Describe the weight categories:
Low Birth Weight:
Very Low Birth Weight:
Extremely L0w Birth Weight:
SGA:
AGA:
LGA:
IUGR:
Why is weight important to viability?
What is the primary cause of low birth weight?
What is important is these infants right after birth
- Low Birth Weight: < 2500 g
- Very Low Birth Weight: < 1500 g
- Extremely L0w Birth Weight: < 1000 g
- SGA: < 10%
- AGA: 10-90%
- LGA: > 90%
- IUGR: intrauterine growth does not reach the expected potential
Prematurity is the primary reason for low birth weight
LBW and prematurity: Second leading cause of death in babies because their organs are immature (infection is the first leading cause)
Less brown fat, difficulty with stable glucose levels -> issues with viability
Important after birth: Resuscitation
Assessment of preterm infants
Gestational age assessment
Physical characteristics
Gestational age assessment
- New Ballard Score, important to do
Physical characteristics
- Minimal creasing in the hands and feet
- Hypotonia
- Extended posture
- Translucent skin, more red
- Decreased subcutaneous fat
- More vernix caseosa
- More lanugo, patchy
- Pinna of the ear is sometimes folded still; very thin and soft
- Undescended testes in males
- Weak cry
- Diminished or absent reflexes
- Weak suck and swallow reflex (poor feeding ability)
Non-modifiable risk factors for preterm labor and birth
- Previous preterm birth
- Multiple abortions
- Race/ethnic group
- Uterine/Cervical anomalies
- Multiple gestation
- Polyhydramnios
- Oligohydramnios
- Pregnancy-induced hypertension
- Placenta previa
- Short interval between pregnancies
- Abruptio placenta
- Premature rupture of membranes
- Bleeding in first trimester
Treatable/Modifiable Risk factors for preterm labor and birth
- Age <17 or >34
- Unplanned pregnancy
- Single
- Low educational level
- Poverty, unsafe environment
- Domestic violence
- Life stress
- Number of implanted embryos
- Low pre-pregnancy weight
- Obesity
- Incompetent cervix
- Infection
- Substance/alcohol use
- Late or no prenatal care
Describe Respiratory system in preterm infants
Nursing consideration for respiratory system in preterm infants
- Preterm Infants typically do not experience second period of reactivity; they stay in decreased responsiveness
- Decreased or no surfactant (needed to keep lungs open)
- Distress: grunting, retractions, nasal flaring, central cyanosis (late sign)
Have O2 on board**
Important for O2 to be warm and humidified for thermoregulation and to prevent drying of mucosal membranes*
Cardiovascular assessment in preterm infants
Heart rate and rhythm, skin color, blood pressure (BP), perfusion, pulses, oxygen saturation, and acid–base status
Vasodilation -> bradycardia
What puts preterm infants at risk for temperature instability?
What is the goal of thermoregulation interventions?
- Minimal insulating subcutaneous fat
- Limited stores of brown fat
- Inadequate muscle mass activity
- Poor muscle tone, resulting in more body surface area being exposed to the cooling effects of the environment
- An immature temperature regulation center in the brain
The goal of thermoregulation is to create a neutral thermal environment - Incubator: 97.4 - 98.4 degrees
- Pre-warm incubator, linens, diaper, monitor probes, stethoscope
Describe preterm infant risks associated with their Central Nervous System?
Very immature
* Birth trauma with damage to immature structures
* Bleeding from fragile capillaries
* Predisposition to hypoglycemia
Maintaining adequate nutrition in a preterm infant
Nursing considerations/assessments
Best thing to feed a preterm infant: Breastmilk!!!
- Contains immunoglobulins to help fight infection
- Digest breast milk easier
Babies with weak swallow and suck reflexes
- IV dextrose to treat drop in glucose levels
Once baby can suck and swallow, it can feed from bottle or breast
- MONITOR for respiratory difficulties; make sure baby is able to breathe through nurse
- May need tube feedings before taking bottle/breast
Assessments
- Monitor for aspiration
- Monitor voids and stools
- Make sure GI system is working BEFORE feeding by listening to bowel sounds, measuring abdominal girth
- Tube feedings: look at gastric residual
- Check stools for blood
- WEIGH the baby everyday
Respiratory Distress Syndrome
Risk Factors
What causes RDS?
Symptoms
Treatment
Risk Factors
- The earlier the baby is born, the more the baby is at risk
- C/S
- White males
- Infection
- Mom has diabetes
Lack of pulmonary surfactant
- Can lead to atelectasis
Symptoms
- Lethargy, hypotonia, tachypnea
Treatment
- Make sure there is a patent airway
- Provide O2, intubation may be necessary
- Monitor for infection
Necrotizing Enterocolitis
Less common in:
When does it occur?
What is it and what causes it?
- Less common in breastfed babies
- Occurs about 1 month after birth
- NEC: acute inflammatory disease of the GI mucosa, commonly complicated by bowel necrosis and perforation
- Cause 1: Intestinal ischemia
that occurs as a result of asphyxia/hypoxia or blood flow away from the GI tract - Cause 2: Bacterial colonization of the initially sterile GI tract with harmful organisms prior to the establishment of normal intestinal flora
- Cause 3: Enteral feedings though to provide a substrate for bacterial proliferation OR feedings can increase intestinal oxygen demand during absorption, resulting in tissue hypoxia
Necrotizing Enterocolitis
S/S:
Treatment:
S/S
- Abdominal distension
- Respiratory distress
- Unstable temperature
- Lethargy
- Bile stained spit up
- Increased gastric residual in tube feedings
- Bloody stools
Treatment
- Goal = prevent it from going further
- Stop tube feedings (may need to do TPN)
- Antibiotic therapy
- Surgery (bowel resection)
If it has gone far, not a good prognosis
Postmature Infants
More at risk for:
Physical Characteristics:
Placental insufficiency leads to…
- Increased risk for RDS (not getting O2 needed from placenta)
- Hypoglycemia (monitor Blood Glucose)
Physical characteristics
- Less Subcutaneous Fat (“muscle wasting” because of the decreased nutrients from placenta)
- “Pruny” hands
- NO vernix caseosa
- Dry, cracked (desquamating), parchment-like skin
- NO lanugo
Firm nails extending beyond the fingertips
Can have meconium staining (golden yellow to green) of skin, nails, and cord
Meconium Aspiration Syndrome
What is it?
Interventions
Assessment
Complications
Baby passes meconium in utero
Interventions
- The presence of a team skilled in neonatal resuscitation is required at the birth of any infant with meconium-stained amniotic fluid
- The mouth and nares of the infant are not routinely suctioned on the perineum before the infant’s first breath
- Meconium aspirator for Fetal asphyxia
Assessment
- Typically see low APGAR scores, respiratory distress, RALES and RHONCHI
Complications
- Can lead to pneumonia in baby
Infants of Diabetic Mothers have increased risk of…
Why?
Congenital anomalies
- Seen in moms with poorly controlled Type 1 or Type 2 diabetes
- Glucose is teratogenic in the embryonic period
- Cardiac, renal, musculoskeletal anomalies
Macrosomia
- Organs tend to be bigger (insulin = growth factor)
- Cardiomyopathy: usually do not show symptoms
- Hyperbilirubinemia
Hypoglycemia
- Baby’s pancreas produces insulin to combat mom’s high blood sugar
- Once delivered, the baby still produces insulin
- Experiences a period of hypoglycemia
Polycythemia
- Increased number of RBCs circulating
- Bruising from difficult delivery: increased RBCs
- Also play a role with hyperbilirubinemia
Respiratory distress
- Decreased amount of surfactant-> higher risk for RDS
- Monitor temperature, glucose, respiratory
