NB stress-2

Question 1

cold stress risks-2

Answer 1

higher w hypoxemia, ICH

Question 2

cold stress s/s-4

Answer 2

O2 needs increase, glu use increase, acids released into blood, surfectant production decrease

Question 3

cold stress treat-7

Answer 3

• VLBW- polyethylene wrapping
• mon skin temp (vasoconstriction first response), maintain neutral thermal enviro, warm slow (1 degree hr)
• remove plastic wrap/caps/heat shield when rewarming
• warm IV fl
• check for hypogly w decrease in temp

Question 4

hypogly definition

Answer 4

glu below 40-45

*if below 20 give parenteral glu D10W

Question 5

hypogly s/s-8

Answer 5

-lethargy/apathy/limp, poor feed/suck/vomit, pallor/cyanosis, low temp, resp distress, tremors/seizures, high pitch cry, exaggerated moro

Question 6

hypogly test

Answer 6

-lab must confirm, blood on ice and test w/n 30 min

Question 7

hypogly treat-4

Answer 7

early feed, oral glu in formula/breast milk, D5W-D10W immediately after birth, corticosteroids

Question 8

pain relief-5

Answer 8

reduce stimulation, swaddle, skin-to-skin, nonnutritive suck, oral sucrose

Question 9

pathological jaundice

Answer 9

s/s w/n 24hrs, total bili higher 0.2/hr, surpass 95% for age in hrs, or persistent visable s/s after 1 wk term or 2 wk preterm

Question 10

kernicterus (aka acute bili encephalopathy)

Answer 10

deposit of indirect/unconjugated bili in basal ganglia of the brain due to the permanent neuro sequelae of untreated hyperbilirubinemia

• most common w Rh and ABO incapatability
• bili screen required before leave hosp

Question 11

pathological jaundice causes

Answer 11

1. hemolytic disease of the NB (mom Rh neg or O bld)
   * alloimmune hemolytic disease, erythroblastosis fetalis
   * RBC destroyed
2. hydrops fetalis-RBC susceptible to destruction
3. oxytocin

Question 12

pathological jaundice early s/s

Answer 12

poor tone, lethargy, poor feed/suck

Question 13

alloimmune hemolytic disease treat

Answer 13

IV gamma globulin

Question 14

coombs test and jaundice

Answer 14

determine if from Rh or blood type

• NB w pos test have higher risk of jaundice if bili 10+
• spherocytes seen only w ABO

Question 15

phototherapy

Answer 15

• based on gest age and age in hrs

- urine darker when bili excreted

Question 16

exchange transfusion

Answer 16

replace NB blood w donor blood

Question 17

hemolytic disease s/s

Answer 17

large placenta, edema w pleural and pericardial effusion plus ascites, pallor/jaundice w/n 24 hrs, spleen/liver enlarged

Question 18

jaundice assessment

Answer 18

blanche skin over bony prominence (forehead, nose, sternum), oral mucosa and posterior portion of hard palate, eyes
-cephalocaudal progression-> face-trunk-lower extremities

Question 19

phototherapy rn care

Answer 19

eye patches, reposition q 2 hrs, stop q 2-3 hrs or when testing bili, I and Os, skin for bronzing/macropapular rash, no lotion/ointments

Question 20

anemia Hgb level

Answer 20

Hgb term 14-20

Question 21

physiologic anemia of infancy

Answer 21

normal gradual decline in hgb w lowest point 2-3 mo

-marrow stops prod of RBCs in response to O2 levels

Question 22

anemia s/s

Answer 22

pallor, cap refill 3 sec+, low pulse, tachycardia, low BP

Question 23

anemia treat

Answer 23

constant cardiac and resp mon, s/s shock