High Risk Newborn (SGA, Juandice)
Preterm & Post-term newborns
NAS & FAS babies
Newborns w/ complications
IUGR & Neonatal Sepsis
100
Assessment findings for SGA baby?
Disproportionately large head, wasted extremities, wide skull sutures, loose dry skin, thin umbilical cord, reduced sub Q fat stores, temp instability, jittery (hypoglycemia), poor muscle tone, ↓ amount breast tissue, sunken abdomen appearance.
100
Common Problems of Preterm Newborn?
RDS, Problems coordinating suck, swallow and breathing, Hypothermia, Hypoglycemia, Hyperbilirubinemia, Problems related to immaturity of body systems Respiratory system last to mature so very big problem with pre-termers: lack of surfactant.
100
Signs & Symptoms of NAS newborn?
W wakefulness, sleeps <3hrs after feeding
I irritability
T Temp >37.2 ax, tachycardia, tremors, tonic (myclonic) jerks
H Hyperactivity, high-pitched persistent cry, hyperreflexia, hypertonus
D Diarrhea, diaphoresis, disorganized suck
R respiratory distress, rub marks, rhinorrhea
A apneic attacks, autonomic dysfunction
W weight loss (more than normal)
A alkalosis (resp)
L lacrimation
100
Assessment for Transient Tachypnea?
Assess: observe for tachypnea, grunting, retractions, decreased lung sounds nasal flaring and/or mild cyanosis. Sx generally gone by 72 hours after birth
Hx-heavy sedation in labor, prolonged labor, C/S, macrosomia, precip delivery,
100
Risk Factors for Neotanal Sepsis?
Meconium aspiration, LBW, Preterm birth, Formula feeding, Prolonged hospitalization, need for resuscitation
Patho-presence of bacteria, fungal or viral microorganisms (Congenital, Early onset, Late onset)
200
Jaundice Types & Management Considerations for photo therapy?
Physiologic: normal- appears during the 3rd-4th day of life & then rapidly declines over 1st week, Breastfeeding can cause jaundice & cure as it encourages passage of meconium, place baby in sun
Pathologic: appears within the 1st 24 hours after birth and is associated with Rh, ABO. S/S: lethargy, poor suck, hypotonic, seizures possible
Phototherapy: lowers the bilirubin levels. Important to cover eyes and genitals.
200
Common Problems for post-term newborns?
Perinatal asphyxia, thermoregulation, hypoglycemia, mec aspiration,
200
Assessment findings of FAS newborn?
microcephaly, abnormally small eyes, IUGR, Thin upper lip >inadequate sucking and poor appetite, joint and limb defects, Septal defects, Growth and developmental delays for life.
200
What is transient tachypnea?
Involves a mild degree of respiratory distress; Occurs when the lung liquid is removed slowly or incompletely or not absorbed.
200
Causes of Symmetric IUGR (onset early in utero <20 wks)?
3 C's
Chromosomal abnormalities (T12, T18, T13)
Congenital Anomalies (NTD, ventral wall defect)
Congenital infections (TORCH)
300
What is considered an SGA baby?
2500 grams or less at term or <10th percentile; includes IUGR.
300
Characteristics of Post-Term Newborns?
dry, peeling skin, absence of vernix and lanugo, long thin extremities, mec stains, wrinkles.
300
Nursing Management for NAS baby?
Promote Comfort (swaddle, low-light, quiet, pacifier, gentle walking/rockving, etc); Meeting Nutritional Needs (small amounts and position newborn upward, burp frequently, high cal, etc); Preventing Complications (drug therapy, skin protection, observe behaviors, etc).
300
When is a newborn considered hypoglycemic?
when the blood sugar is less than 50 (40-45).
300
Causes of Asymmetric IUGR (later onset > wks)?
USMH
Utero-Placental Insufficiency
Smoking
Malnutrition
Hypertension
400
SGA Risk Factors (Maternal, Fetal, Placental):
Maternal :chronic HTN, DM, smoking including passive smoke, SA, preeclampsia, no PNV, age, nutrion, autoimmune disease, etc.
Placental factors: abnormal cord insertion, chronic abruption, ↓ Surf. Area, infarction, ↓ placental weight, previa,insufficiency
Fetal: Trisomy 13 18, 21, chronic fetal infection, congenital abnormalities, Multiples, radiation exposure.
400
Nursing Management for Preterm newborn?
Oxygenation, Thermal regulation, , nutrition and fluid balance, Infection prevention, Appropriate stimulation, Pain management, Growth and development, Kangaroo care,
Parental support: high-risk status; possible perinatal loss; Discharge preparation; Criteria must be met, breathing without apnea spells, gaining weight, maintaining
400
Diagnosis of FAS newborn?
documentation of all 3 facial abnormalties, growth deficits, and CNS abnormalities.
400
Clinical manifestations of hypoglycemia in newborn?
lethargy, tachycardia, resp distress, jitters, drowsiness, poor feeding and sucking, temp instability, hypotonia, Chronic mild hypoxia secondary to placental insufficiency
400
Assessment Neonatal Sepsis?
general --> Lethargy, Poor feeding, Poor weight gain, Irritability, hypothermia, jaundice, apnea, hypoglycemia
500
SGA newborn Management/Care?
obtaining weight, length & circumference to compare to standards, monitor VS… Manage and monitor thermoregulation, perinatal asphyxia, polycythemia, hypoglycemia, meconium aspiration… initiate early feedings, assess respiratory status, monitor glucose.
500
Nursing Management for Post-Term newborns?
Assess for abnormalities, Monitor for need for resuscitation, perinatal asphyxia, monitor glucose; Monitor temperature> loss of sub q fat, hypothermic.
500
Nursing Implications FAS?
Educate about prevention of FAS and decreasing/eliminating alcohol; Assistant woman to find treatment; Inform pregnant women about effects; educate using non-judgmental, culturally connected approach; warn women that there is no safe time or amount to drink.
500
Management for Transient Tachypnea
provide oxygen as ordered, ensure a neutral thermal environment, monitor and observe respiratory status frequently, maintain acid-base balance, nutrition.
500
Management Neonatal sepsis:
Early recognition and diagnosis. Abx therapy, circulatory and respiratory support, nutrition, prevention-hand washing, oral care, turning. Particularly in NICU babies, why… all of our interventions