Ch 43 Neonatal Care Flashcards
(47 cards)
What is the difference between a newborn and a neonate? (pp 2378–2380)
newborn : an infant in the first 24 hrs of life
neonate : an infant in the first month after birth.
What are antepartum (pre-birth) risk factors for neonatal resuscitation? (p 2379)
maternal conditions such as diabetes, hypertension, and infections.
Age of mother <16, >35
Polyhydramnios (excessive amount of amniotic fluid)
Drug abuse
Lack of prenatal care
Hx of perinatal morbidity
What are intrapartum (during birth) risk factors for neonatal resuscitation? (p 2379)
premature labor
prolonged labor
fetal distress
meconium-stained amniotic fluid
Prolapsed cord
Placenta Previa
Breech presentation
What is the process of transitioning from a fetus to a newborn, fetal transition? (pp 2379–2380)
Fetal circulation has 3 major blood flow shunts from that oof adults. At birth, the 3 ducts, foramen ovale, ductus venous, and ductus arteriosus close off.
The transition involves physiological changes such as the initiation of breathing (triggered by mild hypoxia), circulation changes, and thermoregulation.
What are the causes of delayed transition in newborns? (pp 2380–2381)
Hypoxia
Acidosis
Meconium or blood aspiration
Hypothermia
Hypotension
Sepsis
What measures should be performed for neonatal resuscitation? (pp 2384–2387)
Warm, dry, suction, stimulate
Labored breathing? PPV
HR below 60? CPR
Intubate
Epi
What equipment is needed for neonatal resuscitation? (p 2382)
BVM, O2, suction, cardiac monitor, medications, stethoscope, OB kit.
What are the initial steps of assessment for neonates? (pp 2380–2387)
Initial steps include drying and warming, positioning, suctioning, and stimulation.
How do you measure essential parameters for neonates? (pp 2380–2387)
pulse rate
color
respiratory effort
Assess visually and with monitoring devices
What are Apgar scores and when are they obtained? (pp 2383–2384)
Apgar scores assess a newborn’s health at 1 and 5 minutes after birth, evaluating heart rate, respiratory effort, muscle tone, reflex response, and color.
How do you determine if a neonate requires resuscitation? (pp 2380–2387)
Assessment includes evaluating heart rate, respiratory effort, and overall color and tone of the neonate.
What methods improve oxygenation during neonatal resuscitation? (pp 2388–2392
Methods include using positive end-expiratory pressure, free-flow oxygen, oral airways, and bag-mask devices.
What is the technique for using a bag-mask device on a neonate? (pp 2389–2390)
The technique involves proper positioning, cleared of secretions, sniffing position, creating a seal, and delivering breaths at 40-60. Peak inspiratory pressure is 25mm hg for newborns, lower for preemies.
First few breaths after birth will frequently require higher pressures (around 30mm hg) because the lungs are not fully expanded and are still full of fluid.
When is endotracheal intubation required in a neonate? (pp 2390–2392)
Intubation is required when meconium stained fluid is present, congenital hernias (when intestines are on the outside of the body) severe respiratory distress, inability to maintain airway, or when bag-mask ventilation is ineffective.
What are vascular access considerations in the neonate? (pp 2394–2395)
IO are used most commonly, umbilical vein (uncommon) can be used if you’ve been trained to and your local protocols allow.
What are pharmacologic considerations for neonates? (p 2395)
Considerations include dosing adjustments based on weight. Epi is usually the only drug used for neonates, when a HR is persistently below 60. Most newborns can be resuscitated with effective ventilatory support.
What family and transport considerations apply to neonatal emergencies? (pp 2395–2396)
A.) Keep family informed. Do not be specific about survival statistics. A lot of factors are in play and you do not want to mislead the family.
B.) Local hospital for stabilization, then transport to specialty hospital.
What are the pathophysiology, assessment, and management of emergencies in neonates? (pp 2397–2401)
apnea, bradycardia, acidosis, and respiratory distress, requiring prompt assessment and intervention.
What is the pathophysiology, assessment, and care of premature or low-birth-weight infants? (pp 2401–2402)
Care involves monitoring for complications such as respiratory distress and ensuring adequate nutrition and thermal regulation.
Clearing airway, stimulation, O2, PPV & CPR if necessary.
What is the pathophysiology, assessment, and management of seizures in neonates? (pp 2402–2404)
Management includes identifying the cause, providing supportive care, and considering anticonvulsant therapy.
What is the pathophysiology, assessment, and management of hypoglycemia in neonates? (pp 2404–2406)
Management includes monitoring blood glucose levels and administering glucose as needed.
What is the pathophysiology, assessment, and management of vomiting in neonates? (pp 2406–2407)
Some vomiting after birth is normal.
Persistent vomiting suggests obstruction of upper GI tract or increased ICP.
Dark blood suggests GI bleed.
ABC’s
Suction
O2
Gastric tube if necessary to decompress the stomach
Possible fluid resuscitation.
Transport newborn on their side.
What is the pathophysiology, assessment, and management of diarrhea in neonates? (pp 2407–2408)
5-6 avg daily stools for an infant
Most common cause of diarrhea is virus’
Another common cause is lactose intolerance
ABC’s
Fluids
What is the pathophysiology, assessment, and management of neonatal jaundice? (p 2408)
Caused by immaturity of the liver, affects the body’s ability to conjugate & excrete bilirubin from RBC breakdown in the 1st week of life.
Can result from hemolysis, ABO group incompatibility, Rh incompatibility, RBC disorders, polycythemia.
Cholestasis can present after the 1st 2 wks of life, resulting in hepatitis, metabolic disorders, and malnutrition.
