Chapter 29: High Risk Newborn: Complications Associated with Gestational Age and Development Flashcards

Question

signs of overhydration in the newborn

Answer 1

* urine output \>3 mL/kg/hour * urine SG \<1.002 * edema * weight gain greater than expected * bulging fontanels * blood: dec Na, protein, HCT * moist breath sounds * difficulty breathing

Answer 2

* regulate IV fluids with a prevision of 0.1 mL/hour * IV meds diluted in as little fluid as possible * hourly check of IV site for infiltration * strict I&O with SG checks * weigh infants daily

Answer 3

* skin is fragile, permeable, and easliy damaged * do not use standard adhesive tape on their skin * disinfectants can injure their skin * assess skin regularly * nursing interventions: * avoid adhesives, alcohol, or betadine * remove adhesive slowly * chlorhexidine gluconate is a common disinfectant that can be used * pH balanced cleanser (w/ pH from 5.5-7) should be used for bath (preterm infants should not be bathed every day) * humidity in incubators to reduce drying of skin * use emollients on skin to help reduce skin fissures * frequent position changes to reduce skin breakdown

Answer 4

* high rate of infection due to exposure to maternal infection, lack of IgG transfer from mother, immature immune system * prolonged hospital stays and invasive procedures also inc the risk * be alert for signs of sepsis * nursing interventions: * hand washing * no jewelry * limit exposure to family and staff who have contagious illnesses * strict sterile technique for central lines/dressing changes

Answer 5

* pain assessed whenever V/S assessed with NIPS or Premature Infant Pain Profile (PIPP) * these assess gestational age and behavior states, HR, O2 sats, brow bulge, eye squeeze, and nasolabial furrow * common signs of pain: * inc/dec HR and RR * inc BP * dec O2 sats * color changes: red, dusky, pale * high pitched, intense, harsh cry * whimpering, moaning * eyes squeezed shut * mouth open grimacing * furrowing or bulging of brow * tense, rigid muscles or flaccid muscle tone * rigidity or flailing of extremities * sleep wake pattern changes

Answer 6

* prepare infants for painful precedures by waking them slowly and gently and using _containment_ * (simulates the enclosed space of the uterus and prevents excessive and disorganized motor activity--\>keep extremities flexed w/ swaddling or w/ hands, position in supine or side lying w/ at least 1 of the infant's hands near the mouth for sucking) * kangaroo care and breastfeeding can help reduce pain * nonnutritive sucking on a pacifier * put sucrose in infant's mouth 2-3 min before procedure with pacifier * opioids and acetaminophen

Answer 7

* O2 changes: * BP, pulse, RR instability * cyanosis, pallor, mottling * flaring nares * dec O2 sats * sneezing, coughing * behavior changes: * stiff, extended arms and legs * fisting of hands or splaying of fingers * arching * alert, worried expression * turning away from eye contact (gaze aversion) * regurgitation, gagging, hiccupping * yawning * fatigue signs

Answer 8

* schedule periods of undisturbed rest throughout the day * avoid waking infant during quiet sleep phase * cluster or group care so more rest allowed w/o interruption * but keep clustered care short * do not include painful procedures in clustered care * provide short rest periods during activities * reduce stimuli: light and sound * schedule quiet periods that are at least 1 hour long * promote flexion which helps to reduce energy loss and promotes quieting and reduces stress * massage * promoting motor development by keeping infant in an extended, frog leg position * reposition every 2-3 hours * individualize care * communicate an infants' needs

Answer 9

* preterm infants have a lack of fat stores and they use of glucose stores quickly after birth * hypoglycemia often develops * have small digestive capacity * avg healthy preterm infants should gain 15-20 g/kg/day * poor absorption in gut of fats b/c of insufficient bile acids and lipase * poor coordination of suck and swallow * fatigue easily

Answer 10

* assess for feeding readiness and tolerance * gavage * use until about 33-34 weeks gestation * check residual volumes if on enteral feedings to determine if tolerating * if more than 1/2 of last feeding remains, report it, b/c may be a sign of necrotizing enterocolitis (NEC) * vomiting can indicate feedings are too large * watch for signs of visible loops of bowel, abdominal distention, ileus, sepsis, obstruction * nipple feeds * watch for signs of readniess * most infants ready to begin around 34-35 weeks of corrected age * assess coordination of suck and swallow and breathing * assess RR before and during feedings--\>if \>60, then use gavage feeding to prevent aspiration

Answer 11

* rooting * RR \< 60 breaths per min * inc ability to tolerate holding and handling * intact gag reflex * must have enough energy to feed w/o compromised oxygenation * coordination of suck and swallow

Answer 12

* tachycardia * bradycardia * inc or dec RR * nasal flaring * markedly dec O2 sats * cyanosis, pallor * apnea * choking, coughing * gagging, regurgitation * drooling, gulping * falling asleep early in feeding * feeding longer than 20-30 min

Answer 13

* IV infusion of solution containing major nutrients needed for metabolism and growth * may be necessary due to respiratory problems, limited gastric capacity, surgery, or reduced peristalsis

Answer 14

* also called trophic feedings * stimulate development of the GI tract, enhance gut motility, dec need for TPN, and shorten hospital stay * bowel sounds should be present, there should be no abdominal distention, and infants should be stable * human breast milk or colostrum can be used and is preferred * but preterm infants often need special formulas or fortified breast milk b/c more easily digested and have more calories (at 24 cal/oz instead of 20)

Answer 15

* offer support and encouragement and tell her her milk is important to help her baby * help her to use a breast pump ASAP after birth, then for at least 8 times daily for 10-15 min * give mom sterile containers to store milk in * if fortifiers will be put in milk, explain the higher needs of the preterm infant so that the mother does not think something is wrong with her milk * encourage mom in her efforts * provide privacy and relaxation * teach mom to use football and cross cradle holds

Answer 16

* emotionally traumatic experience * parents cannot hold or feed infant or offer care * when infant is not capable of normal newborn behaviors or when the infant's appearance is not what is expected, attachment may be delayed * extended hospitalization causes separation, produces emotional trauma, and disrupts family life * guilt and loss of control are common feelings

Answer 17

* assess for signs of parental attachment * they may be fearful at first, but they should talk about infant in positive terms, make eye contact, name the infant and call it by name * they should ask questions about the infant, should smilke and talk to infant * determine if other stressors in parents' lives that may interfere with ability to visit and form attachment with infant: * financial need to work * lack of transportation * long distances * other children

Answer 18

* using negative terms to describe infant * discussing infant in impersonal or technical terms * failing to give infant a name or use the name * visiting or calling infrequently * dec number/length of visits * showing interest in other infants equal to their own * refusing offers to hold and learn to care for infant * showing dec in or lack of eye contact * spending less time talking to or smiling at infant

Answer 19

* advance preparations and education * allow parents to see and touch newborn in delivery room--helps bonding process * allow father to watch initial care in NICU to allow him to inc confidence in staff and enables him to give mom a full description * take parents to NICU ASAP * teach them what to expect, support them as they visit with infant * help them hold baby ASAP * support fathers and encourage them to participate in hands on newborn care * provide accurate info to the parents * may often have to repeat things, b/c of emotional stress, they often forget what they heard * institute kangaroo care

Answer 20

* KC should begin ASAP and is method of providing skin to skin contact * infant wears only a diaper and a hat and is placed upright under the mother's clothes b/w the breasts (father can also do KC) * advantages: opportunity for parents to be involved in care, stabilizes vital signs, inc weight gain, shorter hospital stay, more quiet sleep, less crying, promotes thermoregulation/bonding, helps relieve pain * upright position also makes breathing easier * containment of extremities dec purposeless movement that uses O2 and calories * gentile stimulation is provided * should last at least an hour to improve th einfant's sleep

Answer 21

* begin to teach parents early about procedures, treatments, and meds * observe the parents and praise their efforts * teach them what is normal for their infant and how to respond to abnormal signs * help determine any adaptations that need to be made at home * infants may require O2, cardiorespiratory monitoring, suctioning, gavage or gastrostomy feedings * feedings will need to happen Q3 hours and may be time consuing * infants may have a hard time sleeping at first * assist parent into determining how to integrate new infant into family * car seat challenge should be performed * immunizations and hearing screen should be done

Answer 22

* sustained pattern of weight gain, adequate maintenance of body temp in open bed, feeding w/o cardiorespiratory compromise, and stable, cardiorespiratory functioning * appropriate immunizations given * car seat challenge completed * metabolic screening and hearing test performed * family and home evaluated * family must have at least 2 members who can feed and provide care, perform CPR, give meds, operate equipment * f/u care has been scheduled

Answer 23

* condition caused by insufficient production of surfactant in the lungs * occurs most often in preterm infants under 28 weeks * also occurs in birth asphyxia, C/S, multiple births, male gender, cold stress, and GDM--\>all interfere with surfactant production * less frequent if antenatal corticosteroids or chronic fetal stress (materal HTN or prolonged ROM) occurs * enough surfactant to prevent RDS not usually made until 34-36 weeks * if too little surfactant, the lungs become noncompliant or stiff and resist expansion, so WOB inc and retractions result along with seesaw respirations * tests of amniotic fluid can detect lecithin, sphingomyelin, phosphatidylglycerol, and phophatidylinositol which are components of surfactant * the test can predict whether the fetal lungs are mature enough for survival of the lungs * tests are always performed before an induction or C/S of an infant younger than 38 weeks

Answer 24

* begin during 1st hours after birth * tachypnea * tachycardia * nasal flaring * xiphoid and intercostal retractions * cyanosis * audible grunting * acidosis develops as a result of hypoxemia * inc CO2 and dec O2 * ground glass appearance of lungs of CXR * signs become worse and peak w/in 3 days then begin to improve

Answer 25

* surfactant is instilled into the infant's trachea shortly after birth or as soon as signs of RDS apparent * O2 * CPAP * inhaled nitric oxide * correction of acidosis * IV fluids

Answer 26

* also known as chronic lung dz * chronic condition in which damage to infant's lungs requires prolonged dependence on supplemental oxygen * occurs most often in infants less than 32 weeks and if VLBW * patho: results from combo of high levels of O2, oxygen free radicals, and pressure of mechanical ventilation that injure bronchial epithelium and result in inflammation, atelectasis, edema, and airway hyper-reactivity with loss of cilia, thickening of the walls of alveoli, and fibrotic changes

Answer 27

* manifestations: * inc need for or an inability to be weaned for respiratory support * tachycardia * tachypnea * retractions * crackles * wheezing * respiratory acidosis * cyanosis * inc secretions * bronchospasm * changes on CXR * aim for prevention * steroids before birth to reduce prematurity and RDS * minimize exposure to O2 and pressure of ventilation * avoidance of fluid overload * inc nutrition * tx: supportive therapy: antibiotics and bronchodilators and gradual dec in O2 * diuretics, fluid restriction * need frequent rehospitalization

Answer 28

* it is bleeding into and around the ventricles in the brain * most common during 1st few days of life in infants less than 1500 grams or less than 32 weeks * also occurs in term infants from asphyxia or trauma * results from rupture of fragile blood vessels in the germinal matrix around the ventricles * assoc with inc or dec BP, asphyxia or respiratory distress, and inc cerebral blood flow * hemorrhage graded from 1-4 * 1: small bleed * 2: extends to lateral ventricles * 3: causes distention of ventricles * 4: causes ventricular dilation and extends to other brain tissue

Answer 29

* manifestations: determined by severity of hemorrhage * poor muscle tone * deterioration in respiratory status with cyanosis or apnea * dec HCT * acidosis * hyperglycemia * dec reflexes * tense fontanel * seizure * management: ultrasounds done to assess * tx: supportive and focuses on maintaining respiratory function * hydrocephalus may develop so a ventriculoperitoneal shunt may be necessary * nursing: * avoid situations that may inc the risk of IVH: so keep handling to a minimum, pain and environmental stressors should be reduced * daily assessments of hed circumference and changes in neuro status

Answer 30

* condition where injury to the blood vessels in the eye may result in visual impairment or blindness * more often in infants less than 1000 g and less than 29 weeks * patho: cause is unknown but high O2 is a risk factor * prolonged ventilation, acidosis, sepsis, shock, IVH are also risk factors

Answer 31

* screen infants to detect changes int he eye * laser surgery can be used to destroy abnormal blood vessels * may also need cryosurgery (reattachment of the retina) * nursing: * check pulse ox if infant receiving O2 * teach parents about reasons for eye exams * mydriatic eye drops used to dilate eyes may cause HTN, bradycardia, apnea

Answer 32

* this is a serious inflammatory condition of the intestinal tract that may lead to cellular death of areas of intestinal mucosa * ileum and proximal colon are most affected * immaturity of the intestine is a major factor * previous hypoxia of the intestines may be the causative factor * incidence is higher after infants receive feedings * when infants are fed, bacteria proliferate, and gas forming organisms invade the intestinal wall which causes necrosis, perforation, and peritonitis * breast milk (due to the Igs, leukocytes, and antibacterial agents) may be preventive

Answer 33

* inc abdominal girth due to distention * inc gastric residuals * dec or absent bowel sounds * loops of bowel seen thru abdominal wall * vomiting * bile stained residuals or emesis * abdominal tenderness * signs of infection * occult blood in stools * respiratory difficulty * apnea * bradycardia * temp instability * lethargy * hypoTN * _presence of air in loops of bowel on radiograph is characteristic of this_

Answer 34

* supplementing formula with probiotics and breast milk may help prevent NEC * tx: abx, discontinuaiton of oral feedings, gastric suction, use of TPN to rest intestines * surgery may be needed if perforation or lack of improvement to remove necrosis (which may lead to short bowel syndrome) * nursing: * encourage moms to breast feed * early detection--\>withhold next feeding and inform provider * measure abdominal girth and maintain IV fluids and TPN * measure I&O * position infant on their side to prevent pressure on diaphragm

Answer 35

* caused by a bowel that is shorter than normal due to surgical removal or a congenital condition * patho: dec mucosal surface causes inadequate absorption of fluids, electrolytes, and nutrients * manifestations: * malabsorption * diarrhea * faliure to thrive * management: * restore and stabilize fluid and electrolyte balance * nutritional support (TPN) * nursing: * manage TPN and enteral feedings * strict aspesis on central venous access device where TPN is infusing * advance enteral feedings slowly * monitor for signs of electrolyte imbalances

Answer 36

* those born after 42nd week of gestation * problems: * placenta begins to function poorly * if placental insufficiency--\>dec amniotic fluid and compression of umbilical cord may occur--\>fetus doesn't receive appropriate O2 and nutrition--\>SGA, hypoxia, malnourishment (_postmaturity syndrome_) * when labor begins, poor O2 reserves may cause fetal compromise * fetus may pass meconium due to hypoxia and inc risk for meconium aspiration

Answer 37

* if large, assess for injury and hypoglycemia * if postmaturity syndrome, may have apprehensive look associated with hypoxia * unusually alert and wide eyed * may be thin with loose skin and little subQ fat * no vernix or lanugo, but usually has abundant hair on head and long nails * may have green staining on cord, skin, and nails * umbilical cord is thin with little wharton's jelly * cracked skin

Answer 38

* if a mother overdue, placenta is tested for functioning, and if deteriorating, then labor is induced * apgar scores less than 7 more likely in post-term infants * may need respiratory support if asphyxia or meconium aspiration occurred * nurse: prevent complications and monitor for changes in status * respond to FHR decels, prepare for and assist with emergency delivery * if signs of postmaturity, assess for hypoglycemia ASAP * temp regulation may be poor b/c of fat stores used up for nourishment in utero * provide extra blankets, assess temp

Answer 39

* those below the 10th percentile * causes: * congenital malformations, * chromosomal abnormalities, * genetic factors, * multiple gestations, * fetal infections (rubella, CMV), * poor placental functioning or small placental size or malformation, * illness in the mother such as pre E or GDM, * smoking, drug abuse, alcohol

Answer 40

* low apgar scores * meconium aspiration * polycythemia * hypoglycemia * inadequate thermoregulation r/t subQ and brown fat stores being used up to survive in utero

Answer 41

* involves the entire body: measurements of the head, chest, length, and weight are below normal, or below the 10th percentile * caused by congenital anomalies, genetic disorders, exposure to infection or drugs early in pregnancy, genetic predisposition * body is proportionate and appears normally developed for size * total number of cells and cell size is dec * small throughout their lives

Answer 42

* caused by complications like pre eclampsia that begin in 3rd trimester and interfere with uteroplacental function * head is normal in size but seems large for rest of body * brain growth and heart size are normal * length is normal, but weight is below 10th percentile * abdominal circumference is dec b/c liver, spleen, and adrenals are small * SO, _head circumference and length are normal, but abdominal circumference and weight are low_

Answer 43

* infant appears thin, long, waster * dry loose skin with longitudinal thigh creases from loss of subQ fat * sunken abdomen * sparse hair * thin cord * facial appearance of being elderly * anterior fontanel may be wide or overlapping sutures * usually catch up in growth by 2 years if adequately nourished

Answer 44

* prevent with good prenatal care * if suspect SGA is a problem, serial nonstress tests help determine if infant should be born early * problems should be treated early and as they occur (include asphyxia, meconium aspiration, hypoglycemia, polycythemia, temp instability) * nursing: * observe for complication * assess for hypoglycemia * early and frequent feedings * temp regulation and respiratory support * observe for jaundice

Answer 45

* those who are above the 90% for gestational age on intrauterine growth charts * may have macrosomia: weigh between 8 lb 13 oz-9 lb 15 oz (4000-4500 g) * causes: * multiparous * large parents * mothers who are obese * ethnic groups known to have large infants * GDM * erythroblastosis fetalis

Answer 46

* longer labor * suffer injury during birth * need a cesarean section * shoulder dystocia * fractures of the clavicle or skull * injury to the brachial plexus or facial N * cephalohematoma * subdural hematoma * bruising * congenital heart defects * mortality

Answer 47

* management is based on identification of increased size during pregnancy by measurements of fundal height and ultrasound * delivery problems may be managed with the use of vacuum extraction, forceps, or cesarean birth * nursing: * assist with difficult delivery * assess for injuries, hypoglycemia, polycythemia * daily weights * assess for congenital heart defects: pulse ox, ECG, CXR

Answer 48

* preterm: respiratory problems * postterm: metabolic problems

Chapter 29: High Risk Newborn: Complications Associated with Gestational Age and Development Flashcards

(72 cards)