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WCF > Newborn at Risk > Flashcards

Newborn at Risk Flashcards

1
Q

Weight <2500g (5.5lbs)

A

low birth weight (LBW)

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2
Q

Weight <1500g (3.3lbs)

A

very low birth weight (VLBW)

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3
Q

Weight <1000g (2.2lbs)

A

extremely low birth weight (ELBW)

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4
Q

Neonatal resuscitation is __________ focused

A

Neonatal resuscitation is respiratory focused. Not cardiac.

Babies are respiratory driven.

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5
Q

Weight below the 10th percentile for age

A

SGA: Small for gestational age

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6
Q

Weight between the 10th and 90th percentile for gestational age

A

AGA: Appropriate for gestational age

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7
Q

Weight above the 90th percentile for gestational age

A

LGA: Large for gestational age

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8
Q

SGA Characteristics

A

Wasted muscle tissue
Lack of brown fat
Scaphoid abdomen (sunken in)
Eyes appear large, “wise old man” look
Long fingernails
Meconium-stained thin cord often present

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9
Q

Conditions affecting SGA newborn

A

Cold stress/temperature instability- prolonged hypothermia with no brown fat reserves
Pain- if life-saving interventions indicated (ex. IV’s), they may be painful
Hypoglycemia- due to muscle wasting and low brown fat
Polycythemia- venous hematocrit ≥ 65% Red Baby!

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10
Q

LGA Characteristics

A

May be genetically large
More commonly exposed to imbalance of nutrients in utero

Ex. Infant of a diabetic mother

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11
Q

Conditions affecting LGA newborn

A

Hypoglycemia- chronic hyperglycemia in utero due to elevated maternal glucose levels (uncontrolled GDM)

Hypocalcemia- calcium levels should be > 7.5 mg/dL in preterm newborns and 8 mg/dL in term newborns. Low calcium levels can produce seizures in the newborn and may be present along with hypoglycemia

Birth injuries- one of two types: neurological injuries or bone fractures

Brachial plexus injuries (BPI)- occur when the nerves are stretched and leave the arm without function

Fractures- involve the clavicle, or long bones of the humerus or femur

Transient tachypnea of the newborn (TTN)- delayed clearance of fetal lung fluid

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12
Q

LGA newborns & shoulder dystocia

A

Nerve damage/paralysis:
-Brachial plexus injury (affects upper arm)
-Erb’s Palsy (affects upper and lower arm)
-Klumpke’s Palsy (affects hand and possibly eyelid on contralateral side)

Most completely recover. Follow up w/ therapy.

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13
Q

Born before 37 weeks

A

preterm

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14
Q

Born between 37-41 weeks

A

term

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15
Q

born on or over 42 weeks

A

post-term

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16
Q

-Born after 42 weeks’ gestation (3-14% of all pregnancies)
-Most are of normal size and healthy, may or may not be LGA
-Large fetus may have a difficult time passing through birth canal
-Potential problems: cephalopelvic disproportion and shoulder dystocia

A

post-term newborn

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17
Q

Post-term complications

A

Polycythemia (red baby!)
Meconium aspiration
Oligohydramnios
Congenital anomalies
Seizures
Hypoglycemia
Cold stress

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18
Q

Baby gets stressed during birth and poops, inhales meconium which is sticky and blocks airways/atelectasis develops (collapse portions/entire lung) leading to hypoxia

A

meconium aspiration

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19
Q

Post-term assessment findings

A

Dry, cracked skin without vernix or lanugo
Long fingernails
Profuse scalp hair
Long, thin body with loose skin and nonexistent fat layers
Meconium staining, tinting the nails, skin, and umbilical cord green

20
Q

Preterm newborn - systems affects

A

· Resp: surfactant deficiency
· Thermogenesis: Low. No brown fat > insensible H2O loss
· Gastrointestinal: poor oral feedings, high caloric needs
· Renal: Low GFR, bad kidneys
· Immune: no passive IgG antibodies
· Neuro: brain bleeds and delayed reactivity

21
Q

Preterm newborn complications

A

intracranial hemorrhage, respiratory distress syndrome, apnea of prematurity, anemia of prematurity, retinopathy of prematurity, necrotizing enterocolitis

22
Q

Related to rapid birth and birth trauma

Fragile blood vessels in highly vascularized areas

Can cause changes in activity level, seizures, decreased HCT, full anterior fontanelle

A

intracranial hemorrhage (ICH)

23
Q

Lack of surfactant and underdevelopedalveoli

Atelectasis with congestion and edema in lung spaces

S/S: grunting, retractions, nasal flaring, cyanosis, tachypnea, decreased breath sounds, respiratory acidosis, apnea

A

Respiratory distress syndrome (RDS)

24
Q

Spontaneous pause in breathing that can be accompanied by pallor, hypotonia, cyanosis, bradycardia, O2 desaturation

Continuous cardiorespiratory and O2 saturation monitoring

Treat with caffeine

A

Apnea of prematurity

25
Q

Due to multiple blood draws, rapid growth, and erythropoietin release

Assess HCT level, blood transfusions, replace erythropoietin

A

Anemia of prematurity

26
Q

Due to immature retinal vasculature followed by hypoxia

Can lead to blindness

The longer O2 exposure the higher the risk

Wean off O2 as soon as possible (limit amount of O2)

Prevent O2 fluctuations

Routine checks by an ophthalmologist

A

Retinopathy of prematurity (ROP)

27
Q

Due to an ischemic bowel episode, might see bloody stools

Check abdominal circumference, bowel sounds, stool hematest, stool frequency, stop feedings immediately

A

Necrotizing enterocolitis (NEC)

28
Q

Nursing care of preterm newborn

A

Maintain respiratory function
Maintain thermoneutral environment
Balance fluids and electrolytes
Provide adequate nutrition
Prevent infection
Promote parent-infant attachment

29
Q

Hyperbilirubinemia: Yellow discoloring of the skin and sclera

Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin.

A

Jaundice

30
Q

Risk factors for jaundice

A

bruising, neonatal hypoxia, congenital infection, Rh incompatibility, inadequate oral intake

Encourage feeding with human milk to encourage stooling

31
Q

Complications of jaundice

A

Kernicterus – bilirubin in the basal ganglia

Cerebral palsy
Developmental delays
Hearing loss/perceptual impairment
Delayed speech development
Hyperactivity
Muscle incoordination
Learning difficulties
Death

32
Q

-Can occur if the mother is Rh negative or has blood type O
-Rh incompatibility (erythroblastosis fetalis)
Rh-negative mother
Rh-positive fetus
-Maternal antibodies cross the placenta and destroy fetal red blood cells
-Treated with RhoGAM around 28 weeks

A

Hemolytic Disease of the Newborn

33
Q

Med that stops your blood from making antibodies that attack Rh-positive blood cells.

A

RhoGAM

34
Q

O mother
A or B fetus

Results in jaundice

Rarely results in severe hemolytic disease

A

ABO Incompatibility

35
Q

-Incidence: 55-95% of substance exposed infants become symptomatic
-Withdrawal: depending on substance of choice and its half-life, withdrawal can become evident between 6 hours to 8 days of life
-Increased risk of premature delivery, low birth weight, microcephaly (small head), long term cognitive/behavioral problems

Substances: cocaine, heroin, methadone, oxycodone, fentanyl, buprenorphine, Xanax

Withdrawal signs/onset vary depending on substance

A

Neonatal abstinence syndrome (neonatal opioid withdrawal syndrome)

NAS/NOWS

36
Q

Signs of withdrawal

Neurological Excitability

A

-Irritability
-High, pitched crying
-Excessive/continuous crying
-Difficulty sleeping
-Tremors (disturbed and undisturbed)
-Excoriation
-Exaggerated Moro
-Hypertonicity
-Myoclonic jerks
-Excessive sucking
-Seizures

37
Q

Signs of withdrawal

Autonomic Dysregulation

A

Tachypnea
Nasal flaring
Increased RR
Stuffiness
Hyperthermia
Sweating
Sneezing
Mottling
Yawning

38
Q

Signs of withdrawal

GI dysfunction

A

Diarrhea –> diaper rash
Hyperphagia
Regurgitation
Vomiting
Poor feeding

39
Q

Scoring tool for NAS/NOWS

A

-Finnegan
-Eat, sleep, console (ESC)

40
Q

Treatment goals of NAS/NOWS

A

Relieve signs of withdrawal
Improve feeding & weight progress
Prevent seizures
Mitigate poor neurological outcomes

41
Q

Blood infection in infants younger than 90 days old

A

sepsis

Early-onset sepsis – first week of life
Late-onset sepsis – between days 8 and 89

42
Q

-Acquired while the infant is in the NICU
-Two most common: MRSA & Candida
-Related to invasive procedures and the infant’s immature immune system
-Presents as sepsis, UTIs, meningitis, or pneumonia
-Preventing infections: WASH HANDS, clean phones, no jewelry, do not visit if sick

A

Nosocomial Infections

43
Q

S/Sx of sepsis

A

Respiratory distress
Lethargy or irritability
Hypotonia
Pallor, duskiness, or cyanosis
Cool and clammy skin
Temperature instability
Feeding intolerance
Hyperbilirubinemia
Tachycardia followed by apnea/ bradycardia

44
Q

Tx of sepsis

A

Control the infant’s environment

Prevent the spread of infection

Antibiotic treatment
-Broad-spectrum before septic workup
-Specific antibiotics after workup

Physiologic supportive care

Encourage parental interaction

45
Q

-Typically diagnosed in utero
-Intestines herniate through abdominal wall
-Monitor color of bowel (should be beefy red)
-Omphalocele: covered by sac
-Keep abdominal contents sterile
-Positioned in silo above the defect to reduce over a few days
-Give fluids, antibiotics, surgical repair
-pain management

A

Gastroschisis

46
Q

End of Life Care

A

Palliative care
Home with hospice care
Lift visitor restrictions
Pain management
Spiritual/religious care
Memory boxes/keepsakes
Organ donation
Grief support for parents
Let parents be involved w/decisions
May need ethics committee involved

WCF (12 decks)

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