complications
list characteristic of a preterm infant vs withdrawal infant
- preterm: lanugo, fluffy hair, thin skin, capillaries visible (red/ wrinkly), lack of subcutaneous fat, poor muscle tone, head appears large
- withdrawal: wakeful, irritable, tachycardia, tremors, hyperreflexia, diarrhea, diaphoresis, apneic attacks, wt. loss/ failure to gain wt., respiratory alkalosis, tears, projectile vomiting, frequent yawning and sneezing
what are risk factors for prematurity?
- maternal gestational HTN, multiple pregnancies
- adolescent, lack of prenatal care, substance abuse, abnormalities of uterus, placenta previa
- smoking, previous hx of preterm
describe SGA and its risk factors, assessment findings and how to treat
- small for gestational age (<10%). Risks for hypoxia, aspiration of meconium (CXR to confirm), hypoglycemia, polycythemia, hypothermia
- risk factors: gestational HTN/ preE, maternal infection, congenital anomalies, placental factors
- findings: sunken flat abd, wide-eyed, decreased subq fat and muscle mass, normal skull
- treatment: SGA will require more frequent feedings, adequate hydration, prevent cold stress (isolette or warmer)
define cold stress and nursing care
- increases o2 requirements and utilization of glucose, decreases surfactant production, releases acids into bloodstream
- care: maintain neutral thermal environment, warm baby slowly, monitor temp frequently, warm IV fluids
list risk factors for SIDS
- pre term, male, 2-4 months more common, maternal smoking, alcohol intake, substance abuse
- sleeping on soft surface, loose bedding, second hand smoke
describe the possible complications of prematurity
-patent ductus arteriosus: does not close or reopens after birth due to neonatal hypoxia
- patent foramen ovale: hole in septum between L&R atria d/t failure to close
- necrotizing enterocolitis
- respiratory distress: decreased surfactant production in the alveoli
- bronchopulmonary dysplasia: causes lungs to become stiff/ noncompliant
- aspiration, intraventricular hemorrhage, retinopathy
define the weeks a baby is considered preterm, late preterm, early term, term and post term
- preterm <38 weeks
- late preterm 34-36 6/7 weeks
- early term 37-38 6/7 weeks
- term 39-41 6/7 weeks
describe LGA and its risk factors, assessment findings and treatment
- >90%, also known as macrosomia
- risk factors: post-term, GDM, obesity, multiparous
- findings: plump face, birth trauma, tremors (hypocalcemia), signs of hypoglycemia and respiratory distress from immature lungs/ meconium asp., BG <40mg/dL
- treatment: early feedings or IV therapy to maintain BG levels, frequent heel sticks (BG), administer surfactant by endotracheal tube, thermoregulation, treat hyperbilirubinemia and polycythemia
define RDS + treatments
- hyaline membrane disease: absence in production of surfactant leading to collapse of alveoli
- causes: GDM, premature, hypoxia, respiratory/metabolic acidosis
- sx: dyspnea (cyanosis, nasal flaring, retractions), xray shows 'white out' appearance
- tx: maintain thermoregulation (beractant to restore surfactant and improve resp. compliance) given via ET tube, suction prior to admin and avoid suction for 1hr, intubate/CPAP
define neonatal sepsis + treatment
- bacteria, fungus or virus in the blood/ tissues within first month of life.
- screen mothers for STDs and GBS. sx: poor feeding, gastric retention, weak suck, hypo/hyperglycemia, lethargy, hypo/hyperthermia
- treatment: abx ophthalmic ointment, prophylactic abx to (+) GBS
complications of GDM on the newborn
- immature lungs d/t increase fetal insulin which interferes with cortisol release
- jaundice + polycythemia
- hypoglycemia: monitor within 1st hour of life, 30 min if mom is GDM
- birth trauma
list the symptoms of hypoglycemia in newborns
- jittery, seizures, irritable
- lethargy, hypotonia, poor feedings
- hypothermia in low birth weight
- apnea, irregular respirations, resp distress
list teaching/ learning regarding phototherapy to treat jaundice
- maintain eye mask over eyes
- keep newborn undressed with exception of genitalia, avoid lotion
- remove newborn from phototherapy every 2-3 hours and unmask eyes to assess
- reposition q2-3 hours to expose all body surfaces
- turn off phototherapy lights before drawing blood
define TTN + treatment
- transient tachypnea of the NB: insufficient/ delayed clearance of lung fluid leading to pulmonary edema.
- risks: c-section, oversedation on mom, cord prolapse, breech, hypoxic event in utero, male
-sx: appear shortly after birth, cyanosis, tachypnea, nasal flaring, exp. grunt, xray shows overexpansion of lungs
- tx: supplemental o2, IV fluids, maintain NTE
define jaundice and how it is treated
- elevation of bilirubin appears after 34 hours of life and disappears after 14 days due to an increase red cells (physiological)
- tx: frequent feedings, place near window to breakdown bilirubin, phototherapy (primary)
- causes: hemolytic disease (ABO incom, hydrops fetalis, erythroblastosis fetalis)
briefly summarize indications of medications used in pregnancy (mag, terbutaline, nifedipine, indomethacin, bethamethasone, hydralazine, labetolol)
- magnesium sulfate: electrolyte, muscle relaxant. used for preE, eclampsia, labor
- terbutaline: bronchodilator smooth muscle relaxant. used for labor
- nifedipine: antiHTN, antianginal, CCB. used for chronic HTN, labor, PIH
- indomethacin: NSAID used for labor
- bethamethasone: corticosteroid used to stimulate lungs in labor
- hydralazine: antiHTN, vasodilator. used for chronic HTN + PIH
- labetalol: beta blocker used for chronic HTN + PIH
what are the normal ranges for newborn vitals
- heart rate: 110-60
- respirations: 30-60
- temp: 97.7-99.5f
what is kernicterus + symptoms
- untreated jaundice building up in the brain causing neurologic damage
- symptoms: very yellow/ orange, lethargy, hypotonic, poor suck, increased sleepy, if untreated infant will become hypertonic with backward arching of neck and trunk, fever
define meconium aspiration syndrome + treatment
- produces mechanical obstruction of airways, pneumonitis, vasoconstriction of pulmonary vessels, inactivation of natural surfactant
- sx: sudden increase in fetal activity followed by weak/ slow FHR, APGAR <6, pallor, cyanosis, barrel chest, rhonchi, rales
- tx: surfactant replacement, chest physiotherapy, prophylactic abx, correction of acidosis
define treatment goals for hyperbilirubunemia
- resolve anemia
- remove maternal antibodies and sensitized erythrocytes
- increase albumin levels and decrease bilirubin levels
describe the risks and administration methods for these meds (mag, terbutaline, nifedipine, indomethacin, bethamethasone, hydralazine, labetolol)
- magnesium sulfate: loss of reflexes, circulatory collapse, respiratory failure. IVPB
- terbutaline: weakness , hypotension. Oral
- nifedipine: hypotension (not first choice). Oral
-indomethacin: hypotension, closure of DA. Oral
- bethamethasone: increased glucose. IM
- hydralazine: hypotension. Oral
- Labetolol: bradycardia + hypotension. Oral
list risk factors for resuscitation
- difficult birth/ prolonged birth
- meconium in amniotic fluid, SGA/LGA
- prematurity, infection, narcotic use in labor
- fetal scalp/capillary blood sample (acidosis)
- fetal anemia, oligohydramnios/ polyhydramnios, isoimmunization
how is hypoglycemia treated in hypoglycemia
- if glucose <40, give early feedings. if not effective give IV glucose
- corticosteroids
- keep infant warm and quiet to decrease energy requirements (non nutritive sucking to increase wt. gain)
nursing care during phototherapy
- monitor I/Os, wt., dehydration
- check axillary temperature q4, can be elevated
- feed early and frequently q2-3, stools promote bilirubin excretion
- turn q2 and maintain adequate fluid
what are the causes of hyperbilirubinemia
- polycythemia
- bruising, infection, hemolysis d/t ABO incompatibility
- medication (oxytocin)
-inadequate feeding