[Exam 2] Chapter 23 – Nursing Management of the Newborn with Special Needs Flashcards
(121 cards)
1
Q
Birthweight Vairations: Description of appropriate for gestational age (AGA)?
A
Newborn with weight that falls within 80% of all births. Have lower morbidity and mortality than other groups
2
Q
Birthweight Vairations: Description for small for gestation age? (SGA)
A
Weigh less than 2500 g (5 lb 8 oz). Or if birthweight is below teh 10th percentile correlated to their gestational age
3
Q
Birthweight Vairations: Description for large for gestational age?
A
Those who weight more than 4000 g (8 lb and 13 oz) due to accelerated overgrowth for length of gestation
4
Q
Birthweight Vairations: Weight for low birthweight?
A
Less than 2500 g (5.5 lb)
5
Q
Birthweight Vairations: Weight for very low birthweight?
A
Less than 1500 g (3 lb 5 oz)
6
Q
Birthweight Vairations: Weight for extremely low birthweight?
A
Less than 1000 g (2lb 3 oz)
7
Q
SGA Newborns: Those with fetal growth restriction are considered at risk for what
A
increased morbidity and mortality rates
8
Q
SGA Newborns: What does symmetric FGR refer to?
A
Fetuses with equally poor growth rates of the brain, abdomen, and long bones and thought to result from early global insult
9
Q
SGA Newborns: What is asymmetric FGR refer to?
A
Infants whose brain growth is spared comapred to their abdomen and internal organs
10
Q
SGA Newborns and Nursing Assessment: Begins by reviewing for risk factors such as waht
A
smoking, drug abuse, alcohol consumption, preeclampsia, anemia, and intrauterine viral infection
11
Q
SGA Newborns and Nursing Assessment: Observe for typical characteristics at birth such as?
A
Head disproportionately large compared to rest of body
Wasted appearance of extremities
Jittery
Temperature instability
12
Q
SGA Newborns and Nursing Assessment: Maternal causes of this?
A
Chronic hypertension, soking, low socioeconomic status, abuse, preeclampsia
13
Q
SGA Newborns and Nursing Assessment: Placental factors of this?
A
Abnormal cord insertion , placenta previa, decreased placental weight
14
Q
SGA Newborns and Nursing Mx: Interventions for this may include what?
A
Obtaining weight, length, and head circumference, and comparing them to standards
15
Q
SGA Newborns and Nursing Mx: What is Polycythemia?
A
Venous hematocrit above 65% and hemoglobin of more than 20 grams. Peaks between 6-12 hours of age.
16
Q
SGA Newborns and Nursing Mx - Polycythemia: What does hyperviscosity of the blood lead to?
A
Increased reistance of blood flow an decreased oxygen delivery. Can cause abnormalities of central nervous sytem , hypoglycemia, and decreased renal function
17
Q
SGA Newborns and Nursing Mx - Polycythemia: When should screenings occur?
A
Mothers who are diabetic put at risk. Screening at 2, 12 , and 24 hours of age
18
Q
SGA Newborns and Nursing Mx - Polycythemia: What are some clinical signs of polycyhemia?
A
Respiratory distres, cyanosis, jitteriness, jaundice, ruddy skin color, and lethargy
19
Q
SGA Newborns and Nursing Mx - Polycythemia: What will asymptomatic newborns with hematocrit between 65-70 be prescribed?
A
Fluids, close observation, and a repeat hematocrit level in 12 hours
20
Q
SGA Newborns and Nursing Mx - Polycythemia: Tx if newborn is symptomatic?
A
Partial exchange transfusion with replacement of removed red blood cell volume with volume expanders.
21
Q
LGA Newborns, Nursing Assessment: Maternal factors that increase risk of having this type of infant include what
A
diabetes/glucose intolerance, multiparity, prior hx of a macrosomic infant, postterm gestation, maternal obesity, and gestational weight gain
22
Q
LGA Newborns, Nursing Assessment: How will they appear?
A
Large body and appears plump and full-faced. Have poor motor skills and difficulty regulating behavioral states
23
Q
LGA Newborns, Nursing Assessment: Assess for traumatic injuries such as?
A
Fractured clavicles, brachial palsy, facial paralysis, phrenic nerve palsy, skull fractures, or hematoma
24
Q
LGA Newborns, Nursing Assessment: Why are they at risk for hypoglycemia?
A
Due to early depletion of glycogen stores in their liver. Obtain frequent glucose levels.
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LGA Newborns, Nursing Assessment: Clinical signs of hypoglycemia?
Lethargy, drowsiness, tachypnea, weak cry, jitteriness, seizures, bradycardia
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LGA Newborns, Nursing Mx - Hypoglycemia: What level is this at?
Below 40 mg/DL
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LGA Newborns, Nursing Mx - Hypoglycemia: Associated with variety of neonatal conditions like what
prematurity, FGR, and maternal diabetes
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LGA Newborns, Nursing Mx - Hypoglycemia: Initial tx option in asymptomatic hypoglycemia?
Supervisied breast-feeding or formula
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LGA Newborns, Nursing Mx - Hypoglycemia: How should symptomatic hypoglycemia be treated?
Continuous infusion of parenteral dextrose. Need at rate above 12 mg/kg/min
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LGA Newborns, Nursing Mx - Hypoglycemia: When should you assess glucose levels?
Within 30 mins of birth adn repeat the screening every hour
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LGA Newborns, Nursing Mx: Polycythemia and hyperviscosity are associated with what problems?
fine and gross motor delays, speech delays, and neurologic sequelae
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Gestational Age Variations: Mean age of pregnancy?
280 days or 40 weeks.
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Gestational Age Variations: When is a preterm newborn born?
Before 37 weeks
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Gestational Age Variations: When is a postterm infant born?
After 42 weeks
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Gestational Age Variations: When is a late preterm infant born?
BEtween 34 to 36 weeks
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Posterm Newborn: What happens to the placenta after 42 weeks?
Ability to provide adequate oxygen and nutrients compromised. Placenta begins aging . Begins to use its own resources and begins to waste away
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Posterm Newborn - Nursing Assessment: Nursing care activites include what
asseessing neonate complication, assessing for birth trauma, maintaining body tem,p, and offering emotional support
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Posterm Newborn - Nursing Assessment: What characteristics do they often exhibit?
Dry, cracked, peeling skin
Long, thin extremities
Wide-eyed, alert expression
Abundant hair on scalp
Long fingernails
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Posterm Newborn - Nursing Assessment: What to do with meconium?
Observe for meconium-stained umbilical cord and fingernails to assess for meconium aspiration
40
Posterm Newborn - Nursing Assessment: What other typical complications can be associated here?
Perinatal asphyxia, hypoglycemia, hypothermia, and polycythemia
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Posterm Newborn - Nursing Mx: At high risk for perinatal asphyxia, which is attributed to?
Placental deprivation or eligohydramnios that leads to cord compression, thereby reducing perfusion to the fetus
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Posterm Newborn - Nursing Mx: What can help stabilize blood glucose levels?
Give them intravenous dextrose 20% or initiate early feedings to help stabilize the blood glucose levels
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Posterm Newborn - Nursing Mx: What will you observe of the infant?
Skin temp, respiration characteristics, results of blood studies, like aBGs and serum bilirubin levels
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Posterm Newborn - Nursing Mx: How do you treat polycythemia?
This leads to hyperbilirubinemia due to rbc destruction. Providing adequate hydration helps reduce the viscosity of the newborns blood
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Preterm Newborn: Continue to be at high risk for neurodevelopmental disorders such as
cerebral palsy or mental retardation, intraventricular hemorrhage, congenital anomalies, and behavioral problems
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Preterm Newborn: Most common complications seen here?
Respiratory distress syndrome, hemorrhage, retinopathy, anemia, and hypoglycemia
47
Preterm Newborn - Effects on Body System, Resp. System: How is this developmental wise?
One of the last body systems to mature. Greatest risk for resp complications
48
Preterm Newborn - Effects on Body System, Resp. System: When problems here affect the newborns breathing?
Surfactant deficiency.
Unstable chest wall, leading to atelectasis
Immature respiratory control centers
Smaller respiratory passages
Inability to clear fluid from passages
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Preterm Newborn - Effects on Body System, Cardiovascular System: What problems persist here?
If oxygen remains low, fetal pattern of circulation by persist causing blood flow to bypass the lungs.
There is also a patent ductus arteriosus and open foramen ovale
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Preterm Newborn - Effects on Body System, GI System: Lack the neuromuscular coordination required dot maintain what?
The suck, swallowing, and breathing regimen necessary for sufficient calorie and fluid intake to support growth.
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Preterm Newborn - Effects on Body System, GI System: What does perinatal hypoxia cause?
Shunting of blood from the gut to more important organs such as the heart and brain. . Places at risk for malnutrition and weight loss
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Preterm Newborn - Effects on Body System, GI System: What is not properly developed here"?
Small stomach capacity, weak abdominal muscles, compromised metabolic function, and limited ability to digest proteins.
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Preterm Newborn - Effects on Body System, GI System: How are feedings down here?
Through enteral or intravenous feedings
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Preterm Newborn - Effects on Body System, GI System: What is the rate for enteral feedings?
Usually 0.5 - 1 mL / kg/ h to induce surges of gut hormones that enhance maturation of the intestine
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Preterm Newborn - Effects on Body System, Renal System: What are they not able to do?
Reduced ability to concentrate urine and slowing the glomerular filtration rate. Fluid retention and electorlyte disturbances may occur. Can also not clear drugs as easily.
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Preterm Newborn - Effects on Body System, Immune System: Deficency in IgG may occur why?
Because transplacental transfer does not occur until after 35 weeks.
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Preterm Newborn - Effects on Body System, Immune System: Main problems here?
Cannot create antibodies. Also newborns thin skin and fragile blood vessels provide a limited protective barrier
58
Preterm Newborn - Effects on Body System, CNS: Main risks here?/
Difficulty regulating temperature. Due to lack of fat. Crucial to prevent cold stress.
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Preterm Newborn - Nursing Assessment: Common physical characteristics incldue what?
Birthweight less than 5.5 lb.
Scawny Appearance
Poor muscle tone and flexion
Minimal subcutaneous fat.
Plentiful Lanugo
Fused Eyelids
Soft and spongy skull bones
60
Preterm Newborn - Nursing Assessment: Maternal risk factors associated with this include what?
Previous preterm delivery, low socioeconomic status, preeclampsia, hypertension, poor maternal nutrition, smoking
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Preterm Newborn - Nursing Assessment: What assessments will be done?
VS, temperature, heart rate. And monitor respiratory effort, especially peeriods of apnea lasting longer than 20 seconds
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Preterm Newborn - Nursing Assessment: What will you monitor for with polycythemia?
Hemoglobin and hematocrit
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Preterm Newborn - Nursing Assessment: Observe for nonspecific signs of hypoglycemia such as ?
Lethargy, poor feeding, and seizures
64
Preterm Newborn - Nursing Mx, Promoting Oxygenation: The work in taking the first breath is due to what?
Overcomiing the surface tension of the walls of the terminal lung units at the gas tissue interface
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Preterm Newborn - Nursing Mx, Promoting Oxygenation: Newborns may have asphyxia , which is what?
Who fails to establish a adequate respiration after birth. They are deprived of oxygen during nursing process, resulting in fetal hypoxia that leads to brain damage
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Preterm Newborn - Nursing Mx, Promoting Oxygenation: Why is surfactant important?
Lowers surface tension in alveoli and stabilizes them to prevent their collapse
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Preterm Newborn - Nursing Mx, Promoting Oxygenation: Inability to initiate and establish respirations leads to what?
Hypoxemia and hypoxia, acidosis , and hypercarbia (increased carbon dioxide)
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Preterm Newborn - Nursing Mx, Promoting Oxygenation: What happens if newborn has hypoxia?
Heart rate falls, cyanosis develops, temperature decreases, blood pressure decreases and respirations altered.
69
Preterm Newborn - Nursing Mx, Resucitating Newborn: What steps should be done if newborn not breathing properly?
Stabilziation , dry newborn, provide wwarmth, and clear airway with bulb
Assess for breathing
Pulse OX
Ventilation
Assess HR
Chest compressions
Administer epinephrine
70
Preterm Newborn - Nursing Mx, Resucitating Newborn: What considerations must be taken of the newborn when performing resuscitation?
Have immature blood vessels in brain prone to hemorrhage, thin skin which means rapid heat loss, increased susceptibilty to infection, increased risk of hypovolemic shock
71
Preterm Newborn - Nursing Mx, Resucitating Newborn: What is the ABCD mnemonic that should be remebered?
Airway, breathing, circulation, and drugs
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Preterm Newborn - Nursing Mx, Resucitating Newborn: Measured are done until what happens?
Pulse above 100 bpm, good healthy cry, and pink tongue.
73
Preterm Newborn - Nursing Mx, Administer Oxygen: What to know for oxygen?
Oxygen should be used judiciously to prevent development of further complications.
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Preterm Newborn - Nursing Mx, Administer Oxygen: Common practice for oxygen?
Maintain oxygen saturation levels in the high 80s to mid 90s
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Preterm Newborn - Nursing Mx, Administer Oxygen: Respiratory distress in commonly caused by
deficiency of surfactant, retained fluid in lungs, meconium aspiration, pneumoniam hypothermia or anemia
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Preterm Newborn - Nursing Mx, Administer Oxygen: Princples of care for newborn here?
Keep newborn warm
Handle newborn as little as possible
Provide energy through calories.
Tx cyanosis with oxygen hood.
REcord observations eveyry hour
77
Preterm Newborn - Nursing Mx, Maintaining Thermal Regulation: How does infant attempt to conserve body heat?
By vasoconstriction and thermogenesis by metabolizing brown adipose tissue and increasing oxygen consumption
78
Preterm Newborn - Nursing Mx, Maintaining Thermal Regulation: How will an infant appear that is having problems with thermal regulation?
Cool to cold to the touch. Hands, fet, and tongue may appear cyanotic. Respirations are shallow
79
Preterm Newborn - Nursing Mx, Maintaining Thermal Regulation: What to know when promoting thermal regulation for preterm newborn?
Remmeber four mechanisms of heat treansfer
Frequencya ssess temperature
Utilize plastic wraps and bags
Assess newborns temperature every hour.
Observe for clinical signs of cold stress and respiratory distress, centreal cyanosis, and hypoglycemia.
80
Preterm Newborn - Nursing Mx, Promoting Nutrition and Fluid Balance: How can they receive nutrition?
Orally, enterally, or parenterally via infusion
81
Preterm Newborn - Nursing Mx, Promoting Nutrition and Fluid Balance: Why are gavage feedings used?
For compromised newborns to allow them to rest during the feeding process. Many may have a weak suck
82
Preterm Newborn - Nursing Mx, Promoting Nutrition and Fluid Balance: How do newborns born after 34 weeks feed?
Orally.
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Preterm Newborn - Nursing Mx, Promoting Nutrition and Fluid Balance: How do those born before 34 weeks feed?
with parenteral nutrition within the first 24 hours of life.
84
Preterm Newborn - Nursing Mx, Promoting Nutrition and Fluid Balance: How can you promote nutrition and fluid balance in preterm newborn?
Measure daily weight
Monitor intake
Assess fluid status by monitoring weight, urinary output, urine SpG
Continually assess for enteral feeding intolerance, measure abdominal girth, and auscultate bowel sounds
Encourage and support breast feeding
85
Preterm Newborn - Nursing Mx, Promoting Nutrition and Preventing Infection: sources of infection Can be divided into what three categories?
TRansplacental Acquisition (Intrauterine Infection)
Perinaal Acquisition during Childbirth (intrapartum infection
Hospitall acquisition in neonatal period (postnanal infection)
86
Preterm Newborn - Nursing Mx, Promoting Nutrition and Preventing Infection: Why are they at risk for infection?
They have not developed antibodies needed for passive protection
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Preterm Newborn - Nursing Mx, Promoting Nutrition and Preventing Infection: Clinical manifestations may include?
Apnea, diminished activity, poor feeding, temperature instability, respiratory distress, seizures, tachycardia, hypotonia, and pallor, jaundice
88
Preterm Newborn - Nursing Mx, Promoting Nutrition and Preventing Infection: What interventions can be done to prevent infection?
Assess for risk factors in maternal hx.
Monitor for changes in VS
Assess Oxygen
Assess Feeding tolerance
Monitor lab test results
Avoiding using tape on newborn sskin
Use sterile gloves when assissting with procedure
89
Preterm Newborn - Nursing Mx, Providing Appropriate Stimulation: What cn be done to help newborn progress in feeding abilities more quickly?
Rocking, pacifier, skin-to-skin contact with parents, containment, music, nonnutritive sucking, breas-feeding
90
Preterm Newborn - Nursing Mx, Providing Appropriate Stimulation: Overstimulation can have what negative effects?
Reducing oxygenation and causing stress
91
Preterm Newborn - Nursing Mx, Providing Appropriate Stimulation: How do they react to stress?
By flaying the hands or bringing an arm up to cover the face. RR, HR may bdecrease and periods of apea or bradydcardia may follow
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Preterm Newborn - Nursing Mx, Providing Appropriate Stimulation: Appropriate developmental stimulation would include what?
Kangaroo holding, rocking, soft singing or music, cuddling, or gentle stroking of infants skin
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Preterm Newborn - Nursing Mx, Managing Pain: What can be done for comfort during painful procedure?
Appropriate sized pacifier.
Administration of oral sucrose with and without nonnutritive sucking.
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Preterm Newborn - Nursing Mx, Managing Pain: What does the Premature Infant Pain Profile (PIPP) assess?
Heart rate and oxygen saturation
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Preterm Newborn - Nursing Mx, Managing Pain: What does the CRIES tool lnclude?
Cry, Requires Oxygen, Increased VS, Expression, And Sleeplessness
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Preterm Newborn - Nursing Mx, Managing Pain: What is the NIPS scale?
Neonatal Infant Pain Scale, which evalutes respiratory patterns
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Preterm Newborn - Nursing Mx, Managing Pain: Suspect pain if newborn exhibits what?
Sudden, high-pitched cry. Facial grimace. Increased muscle tone. Oxygen desaturation. Increased HR, Body Posturing. Limb Withdrawal
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Preterm Newborn - Nursing Mx, Managing Pain: Effective pain management strategies for newborns include?
Preventing, limiting, or avoidign noxious stimuli
Using nonpharm techniques to reduce pain
Administer pharamcologic agents when appropriate
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Preterm Newborn - Nursing Mx, Managing Pain: Nonpharm pain management strats include?
Nonnutritive sucking, breast-feeding, radiant heat to promote warmth, skin-to-skin contact, and sweetened solutions
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Preterm Newborn - Nursing Mx, Managing Pain: Pharm strats may include what?
Narcotic analgesics, but they are limited. Morphine and FEntanyl usually administered IV.
ACetaminophen for mild pain
Benzos used as ssedatives
101
Preterm Newborn - Nursing Mx, Promoting Growth and Development: Developmentally supporitve care is defined as?
Care of a newborn or infant to support positive growth and development.
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Preterm Newborn - Nursing Mx, Promoting Growth and Development: Developmental care focuses on what?
What newborns or infants can do at that stage of development.
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Preterm Newborn - Nursing Mx, Promoting Growth and Development: What strats are included in developmental care?
Clustering care to promote rest and conserve infants energy
Flexed positioning to stimulate in utero positioning
Environmental management to reduce noise
Kangaroo care to promote skin-to-skin
104
Preterm Newborn - Nursing Mx, Promoting Growth and Development: What activites promote self-regulation and state regulation?
Surrounding newborn with nesting rolls/devices
Swaddling blanket to maintain flexed positon
Providing sheepskin or waterbed to stimulate uterine environment
Providing nonnutritive sucking
105
Preterm Newborn - Nursing Mx, Promoting Growth and Development: How can developmental car e be clustered?
Cluserting lights in one area, installing visual alarm systems, and limiting overhead pages to minimize noise
106
Preterm Newborn - Nursing Mx, Promoting Growth and Development: What is the ideal enviroment for newborns development?
Dim the lights and cover isoletes at night
Support ealy extubation from mechanical ventilation
Encourage early and consistent feedings with breast milk
Adminsiter prescribed antibiotics
Positio newborn as if she was still in utero
107
Preterm Newborn - Nursing Mx, Promoting Parental Coping: What interventions can be done to reduce parental anxiety?
Reviewing what occured since birth
Provide individualized support while in NICU
Providing simple relaxation and calming techniques
Exploring their perception of newborns condition
Validating their anxiety as normal
Encourage frequent visits to NICU
108
Preterm Newborn - Nursing Mx, Preparing for Discharge: When is this process started?
With evidence that recovery of newborn is certain. Goal of discharge plan is to make a successful transition to home care.
109
Preterm Newborn - Nursing Mx, Preparing for Discharge: When planning for discahrge of high-risk infant, nurse should include what?
Assess physical status of mother
Discuss early signs of complicatiosn adn waht to do
Stress importance of proper car seat use
Reinforce instructions for equipment
Provide breast-feeding support
110
Preterm Newborn - Nursing Mx, Preparing for Discharge: Infants born at what weeks are at the highest risk for morbidity and mortality?
Those born beetween 34 weeks and 37 weks
111
Late Preterm Newborn: When is this infant born?
Between 34 weeks and 36 6/7 weeks of gestation.
112
Late Preterm Newborn: Most common complicatiosn from here are what?
Cold stress, respiratory distress, hypoglycemia, sepsis, cognitive delays, hyperbilirubinemia and feeding difficulties
113
Late Preterm Newborn: What challenges face this group?
```
Respiratory didstress
Thermoregulation Issues
Hypoglycemia
Apnea
Jaundice and hyperbilirubinemia
Feeding Challenges
Sepsis
```
114
The nurse documents that a newborn is postterm based on the understanding that he was born after:
38 weeks’ gestation
40 weeks’ gestation
42 weeks’ gestation
44 weeks’ gestation
42 Weeks
115
SGA and LGA newborns have an excessive number of red blood cells related to:
Hypoxia
Hypoglycemia
Hypocalcemia
Hypothermia
Hypoxia
116
Because subcutaneous and brown fat stores were used for survival in utero, the nurse would assess an SGA newborn for which of the following?
Hyperbilirubinemia
Hypothermia
Polycythemia
Hypoglycemia
Hypothermia
117
In assessing a preterm newborn, which of the following findings would be of greatest concern?
Milia over the bridge of the nose
Thin transparent skin
Poor muscle tone
Heart murmur
Heart murmur
118
In dealing with parents experiencing a perinatal loss, which of the following nursing interventions would be most appropriate?
Sheltering the parents from the bad news
Making all the decisions regarding care
Encouraging them to participate in the newborn’s care
Leaving them by themselves to allow time to grieve
Encouraging them to participate in the newborn’s care
119
The nurse is providing care to several newborns with variations in gestational age and birthweight. When developing the plan of care for these newborns, the nurse focuses on energy conservation to promote growth and development. Which measures would the nurse include in the nursing plans of care? Select all that apply.
Keeping the handling of the newborn to a minimum
Maintaining a neutral thermal environment
Decreasing environmental stimuli
Initiating early oral feedings
Using thermal warmers in all cribs
A,B,C
120
Which of the following concepts would the nurse incorporate into the plan of care when assessing pain in a newborn with special needs?
Newborns experience pain primarily with surgical procedures.
Preterm newborns in the NICU are at least risk for pain.
Pain assessment needs to be comprehensive and frequent.
A newborn’s facial expression is the primary indicator of pain.
Pain assessment needs to be comprehensive and frequent.
121
Evidence-based practice refers to the use of which of the following to validate your practice?
Research findings
Written guidelines
Traditional practices
Institutional policies
Research Findings
