Newborn at Risk Flashcards
(75 cards)
1
Q
Extremely preterm babies are classified as?
A
≤ 25 weeks
2
Q
Very preterm babies are classified as?
A
26-31 6/7 weeks
3
Q
Moderately preterm babies are classified as?
A
32-33 6/7 weeks
4
Q
Late preterm babies are classified as?
A
34-36 6/7 weeks
5
Q
preterm baby is defined as?
A
infant born prior to 37 weeks gestation
6
Q
most hospitals are monitored to make sure they are not doing what?
A
elective inductions prior to 39 weeks
7
Q
why do preterm babies have more frequent and severe complications from jaundice?
A
their brains cannot handle high levels of bilirubin
8
Q
preterm birth is the top contributor to what?
A
disability
9
Q
what is seen on micro-preemie? (4)
A
Transparent red skin
Impaired muscle tone
Very little tissue development
Very little fat
10
Q
what is seen on moderately preterm baby? (2)
A
Skin thicker
Tones slightly improved
11
Q
what is seen on late preterm baby? (2)
A
Thicker skin
More maturity
12
Q
why do we use phototherapy?
A
in newborns with jaundice to help body break down & eliminate bilirubin more easily
13
Q
Assessing for jaundice:
what assessment for jaundice is inaccurate but you should look anyway?
A
visual estimation
14
Q
Assessing for jaundice:
jaundiced babies get ______ and _____ _____
A
lethargic and feed poorly
15
Q
Assessing for jaundice:
How do you assess for jaundice using transcutaneous bilimeter?
A
do on forehead (starts in head and travels to toes)
16
Q
Assessing for jaundice:
what other tools are used to assess for jaundice? (2)
A
serum bilirubin & bilitool
17
Q
list the tx options for jaundice (3)
A
Supplementation
Encourage stooling
Phototherapy
18
Q
What should be done when phototherapy is used (5)
A
- Overhead or blanket
- Baby wear diaper
- Eye protection for overhead (goggles)→ Can damage eyes
- Temp probe if in isolette
- Monitor bilirubin levels
19
Q
what babies are at risk for hypoglycemia? (5)
A
- babies who experience cold stress
- babies who experience respiratory distress
- small for gestational age (SGA)
- large for gestational age (LGA)
- babies born to diabetic mothers
20
Q
an infant of a diabetic mother is usually large, especially if..?
A
maternal glucose is poorly controlled
21
Q
The lungs of infants born to diabetic mothers may be slow to mature, what is common?
A
Patent ductus arteriosus and respiratory distress syndrome
22
Q
What congenital heart defects are babies born to diabetic mothers at risk for?
A
heart, palate, spinal cord, etc
23
Q
maternal glucose in diabetic mothers leads to hypersecretion of fetal insulin = ?
A
hypoglycemia
24
Q
hypoglycemia in infants can cause loss of what?
A
brain cells
25
list sx of hypoglycemia in infants (4)
Jittery
Low temp
Disorganized, poor feeders
Glucose via heel stick < 40
26
list tx for hypoglycemia in infants (4)
Feed the baby (preferred!)
Glucose gel
Dextrose IV
Monitor until stable
27
infants who are large for gestational age (LGA) is most commonly due to what?
gestational diabetic mothers
28
why do LGA babies have risk for hypoglycemia?
due to baby making a lot of insulin in utero and continuing to produce it without need after birth (monitor for 12-24 hrs)
29
list ways to provide comfort care to babies that have Neonatal abstinence syndrome (11)
- whenever possible, involve mom
- skin to skin w mom
- breastfeeding unless polysubstance abuse
- swaddling
- holding
- swinging
- rocking
- decreased stimuli
- volunteer "cuddlers"
- pacifiers/non-nutriative sucking
- cream to prevent diaper rash
30
what is given to babies for neonatal abstinence syndrome (NAS)?
morphine, methadone, and suboxone
31
when is breastfeeding encouraged & discouraged for NAS?
Encouraged if on methadone or suboxone but discouraged if on harder drugs
32
phototherapy encourages bilirubin to be excreted through _____
stool
33
what is the difference between care for vigorous infants vs non-vigorous?
Care of vigorous infants – bulb suction mouth & nose
Non-vigorous infants – require intervention from NICU team: need tracheal suctioning & may require supplemental oxygen
34
What does caffeine citrate do/used for?
Prevents episodes of apnea in preterm infants
long term treatment using cardiorespiratory monitor for apnea of prematurity (AOP)
35
What does surfactant do?
decreases airway resistance for preterm infants
36
when is surfactant administered and how?
administered in respiratory distress syndrome via ET tube
can also be administered via CPAP but usually child is intubated
37
what does indomethacin do?
Promotes closure of the ductus arteriosis
38
what is vancomycin?
broad spectrum abx used to tx sepsis
39
what can vancomycin cause?
ototoxicity & nephrotoxicity
40
what must be monitored when a baby is taking vancomycin? (4)
- peaks & troughs
- BUN/Creatinine
- Hearing screens
41
why would prophylaxis therapy be used?
to keep from acquiring respiratory infections or ventilator acquired infection (i.e. pseudomonas)
42
What methods of oxygenation are used in respiratory distress syndrome?
nasal cannula, mask, CPAP ( can help open airways; not for prolonged periods)
43
Why do we wean newborns with bronchopulmonary dysplasia off of O2 as soon as possible?
it is an invasive method of prevention
44
retinopathy of prematurity is most common in who?
infants born < 31 weeks or < 1250 g
45
what can retinopathy of prematurity cause?
retinal detachment & blindness
46
when can retinopathy of prematurity be detected?
at their eye exam 4-9 weeks post birth
47
what may cause retinopathy of prematurity?
unstable oxygenation
48
how should supplemental oxygen be administered in infants with retinopathy of prematurity?
Titrate oxygen down w/o desatting
49
what can prevent retinopathy of prematurity?
Prevent erratic O2 levels during delivery, maintaining at a constant level of O2 delivery
50
retinopathy of prematurity may require what?
surgical intervention to repair sight
51
list signs and sx of necrotizing enterocolitis (5)
- Lack of bowel movements
- Abdominal distention
- Increase in abdominal circumference of 1 to 2 cm since last feed
- Irritability
- Lethargy
*If you note poor color or poor tone or any abnormality suspect NEC
52
necrotizing enterocolitis can lead to ________ _________
respiratory difficulties
53
how is necrotizing enterocolitis diagnosed?
X-ray will show free air in the abdominal cavity and distended loops of bowel
54
to prevent necrotizing enterocolitis, how should infants less than 32 weeks be fed?
with humans milk, either mom's or donors
55
to prevent necrotizing enterocolitis, what should be measured?
abdominal circumference should be measured and recorded
56
to prevent necrotizing enterocolitis, what should be done before every feeding?
auscultate bowel sounds and observe for abdominal distention
57
to prevent necrotizing enterocolitis, what should be done before any gastric tube feeding?
check for aspirates of undigested formula or breast milk
58
to prevent necrotizing enterocolitis, what should you record and monitor regarding bowel movements?
amount, consistency & frequency
59
list the tx measures for necrotizing enterocolitis (4)
Stop all feeds (gut rest)
TPN
Place replogle tube for venting
Surgical resection of bowel; possible ostomy
60
what is bronchopulmonary dysplasia (BPD)?
Chronic condition in which the newborn becomes oxygen dependent past 36 weeks of gestation
61
what causes bronchopulmonary dysplasia (BPD)?
extreme prematurity & damage from vents causing airway remodeling
62
what is the main S&S of bronchopulmonary dysplasia (BPD)?
inability to wean off O2 completely
63
How can we prevent bronchopulmonary dysplasia (BPD)?
Wean newborns from O2 as soon as possible
Prevent erratic O2 levels during delivery, maintaining at a constant level of O2 delivery
**this also prevents retinopathy of prematurity!**
64
what are the long-term consequences of bronchopulmonary dysplasia (BPD)? (5)
- Poor feeding
- Delayed growth (bc of poor feeding)
- Susceptibility to infection
- Right-sided heart failure
- Susceptibility to other lung disease, i.e. asthma, frequent resp infections (RSV)
65
list the tx methods for bronchopulmonary dysplasia (BPD) (3)
Antibiotics
Bronchodilators
Continued oxygenation support, trach may be necessary
66
How can you promote attachment and bonding when there is an unexpected outcome in delivery? (5)
- Taking part in care and allowing them to do something, same methods we use for normal newborn
- Let's say you have a baby with an obvious facial defect → say things like “aww look at him holding onto your finger” “she's got such long eyelashes”
- Involving them in care is important
- Explaining everything you do is important
- Being available to them is important
67
when a baby is admitted to the NICU after birth, what contributes to impaired bonding? what does this cause?
- separation from infant
- “fear factor” → fear of hurting child esp with all of the wires and lines
causes grief & separation
68
What are some methods to ease parents whose infant was admitted to NICU? (9)
- anticipatory guidance before delivery
- tour of NICU
- skin-to-skin w warm blankets
- involve in routine tasks like diapering & feeding
- give frequent updates
- help build their confidence by introducing them to new things as much as possible
- social services
- march of dimes
- peer support
69
why are social services important following NICU admission?
esp if unexpected situation; can talk about PPD
70
why is it important to give mom tour of NICU?
she can get used to sounds, get familiar with equipment, talk to neonatologist about expectations, and build confidence
71
when a baby has an unexpected outcome of a congenital anomaly, what do they go through?
they expected idealized infant and experience stages of grief
72
what should the nurse encourage when a newborn has an unexpected congenital anomaly? (4) what else can the nurse do? (3)
- encourage expression of feelings
- encourage bonding incrementally
- encourage parents to care for baby
- encourage visitation if newborn is taken to intensive care
- emphasize all of the “good” characteristics of the child
- provide information
- refer to support groups & march of dimes
73
What can the nurse say when parents experience perinatal loss?
“I’m sorry”
“I’m here for you”
74
what should the nurse NOT say when parents experience perinatal loss?
“God must have had a reason”
“Your baby’s an angel in heaven”
“You are young, you can have more”
75
What nursing interventions are appropriate for perinatal loss? (7)
- Allow the family to see and hold the baby
- If possible, provide a room away from main maternity traffic
- Post a symbol on the door to alert housekeeping, dietary and other staff
- Pastoral care or family pastor/ priest
- Blessing or emergency baptism
- Mementoes → photos, blankets, footprints, lock of hair
- Refer to perinatal bereavement
