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NUR514: Maternity Exam 2 > Newborn at risk/ Unexpected outcomes of childbearing > Flashcards

Newborn at risk/ Unexpected outcomes of childbearing Flashcards

(68 cards)

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1
Q

How many weeks is considered an extremely preterm infant?

A

≤ 25 weeks

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2
Q

How many weeks is considered a very preterm infant?

A

26 weeks to 31 weeks 6 days

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3
Q

How many weeks is considered a moderately preterm infant?

A

32 weeks to 33 weeks 6 days

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4
Q

How many weeks is considered a late preterm infant?

A

34 weeks to 36 weeks 6 days

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5
Q

How can a premature infant be classified?

A

As an infant born prior to 37 weeks gestation

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6
Q

List 5 things that are immature/ not fully developed in premature infants

A

1) Impaired oxygenation
2) Thermoregulation
3) Nutrition
4) Immune function
5) Immature neuro development

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7
Q

Premature infants are at increased risk of ____ & ____

A

Hypoglycemia & Jaundice

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8
Q

Why are complications of jaundice more frequent & severe in preterm infants?

A

B/c their brains can’t handle the high levels of bilirubin

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9
Q

Preterm infant complications can cause lifelong disabilities such as? Hint: 5

A

1) Blindness
2) Hearing loss
3) Chronic resp issues (BPD; asthma; ↑ risk of RSV lifelong)
4) Developmental delays
5) Seizure disorders

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10
Q

List 4 findings of a micro preemie

A

1) Transparent red skin
2) Impaired muscle tone
3) Very little tissue development
4) Very little fat

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11
Q

List 2 findings of a moderate preemie

A

1) Skin is thicker than micro preemie
2) Tones slightly improved from micro

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12
Q

List 2 findings of late preemie

A

1) Skin thicker than moderate preemie
2) More maturity

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13
Q

Why would we use phototherapy for infants?

A

In NB with jaundice to help body break down & eliminate bilirubin more easily

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14
Q

How can nurses assess a baby for jaundice? HInt: 4

A

Visual estimation inaccurate but we look anyway
1) Babies get lethargic, feed poorly
2) Transcutaneous bilimeter
3) Serum bilirubin
4) Bilitool

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15
Q

3 Tx options for jaundice infant

A

1) Supplementation
2) Encourage stooling
3) Phototherapy

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16
Q

4 key points when using phototherapy

A

1) Overhead or blanket
2) Eye protection for overhead → can damage eyes
3) Temp probe if in isolette
4) Monitor bilirubin levels

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17
Q

List 6 things we may see of an infant to a diabetic mother

A

1) Usually large
2) “Ruddy” → extra RBCs → ↑ risk of jaundice
3) ↑ abdominal circumference, fatty tissue
4) Thick umbilical cord, large placenta
5) Lungs may be slow to mature (RDS & PDA more common)
6) Congenital birth defects (heart, palate, spinal cord, etc)

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18
Q

Maternal glucose leads to …

A

Hypersecretion of fetal insulin Hypoglycemia

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19
Q

List 4 signs of hypoglycemia

A

1) Jittery
2) Low temp
3) Disorganized, poor feeders
4) Glucose via heel stick < 40

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20
Q

List 4 Tx options for baby with hypoglycemia

A

1) Feed the baby (preferred)
2) Glucose gel
3) Dextrose IV
4) Montior until stable

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21
Q

LGA babies are most commonly caused by…

A

Gestational diabetic mothers

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22
Q

Why are babies born to gestational diabetic mothers at risk for hypoglycemia?

A

Due to baby making a lot of insulin in utero & continuing to produce it w/o need after birth

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23
Q

How long should we monitor a hypoglycemic baby after birth?

A

12-24 hrs

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24
Q

List 8 comfort care measures used for neonatal abstinence syndrome

A

1) Involve mom whenever possible (kangaroo care)
2) Swaddling, holding, swinging, rocking
3) Decreased stimuli → low light, less noise
4) Volunteer “cuddlers”
5) Pacifiers/ non-nutritive sucking
6) Cream to prevent diaper rash
7) Admin of morphine or other agent
8) Monitor growth

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25
When do we encourage/ discourage BF in neonatal abstinence syndrome?
BF is encouraged if on methadone or suboxone but discouraged if on harder drugs
26
What is the scoring scale used for neonatal abstinence & how does it work?
**Finnegan NAS scoring** → scoring should begin shortly after birth → Infant should be observed for 7 days
27
Tx for neonatal abstinence syndrome **Hint: 2**
1) Scores consistently ≥ 8 → Morphine or Paregoric 2) Some places start w/ Methadone or Suboxone
28
What babies are at risk for meconium aspiration syndrome?
Post date's babies
29
What can happen if baby has a BM in utero?
Usually fine but every so often fetus can take a big breath of it & it settles particles causing inflammation & aspiration pneumonia
30
MAS care of vigorous infant
Bulb suction mouth & nose
31
MAS care of non-vigorous infant
**NICU intervention team** 1) tracheal suctioning 2) May require supp O2
32
What team is important to have at delivery if there is MAS?
Resuscitation team
33
Why is caffeine citrate administered to preterm infants?
Long term Tx using cardiorespiratory monitor for apnea of prematurity (AOP) **Prevents apnea in preterm infants**
34
Why is surfactant administered to preterm infants?
Administered in respiratory distress syndrome via ET tube to ↓ airway resistance **can also be admin via CPAP but baby is usually intubated**
35
What preterm infant disorder can Abx be used for?
Bronchopulmonary dysplasia (BPD)
36
Why are prophylactic Abx given to preterm infants?
To keep from acquiring respiratory infections or ventilator acquired infections (i.e. pseudomonas)
37
What adverse effects can vancomycin cause? **Hint: 2**
1) Ototoxicity 2) Nephrotoxicity
38
What 3 labs/ diagnostics should be assessed when using vancomycin?
1) Monitor peaks & troughs 2) BUN/ Cr 3) Hearing screens
39
List 3 methods of supp O2
1) Nasal cannula 2) Mask 3) CPAP
40
What should be done with supp O2 in infants with bronchopulmonary dysplasia?
Wean from O2 ASAP → b/c it's an invasive method of prevention
41
Retinopathy of prematurity is most commonly seen in...
Infants born < 31 weeks or < 1250 g
42
Retinopathy of prematurity can cause... **Hint: 2**
1) Retinal detachment 2) Blindness
43
What can cause retinopathy of prematurity?
Unstable oxygenation
44
When do we detect retinopathy of prematurity?
Eye exam at 4-9 weeks post birth
45
Tx for retinopathy of prematurity **Hint: 2**
1) Tritrate O2 down w/o desatting 2) May require surgical intervention to repair sight
46
List 6 S/S of necrotizing enterocolitis
1) Lack of BM 2) Abdominal distention 3) ↑ in abd circumference of 1-2 cm since last feed 4) Irritability 5) Lethargy 6) Any poor color or poor tone / any abnormality
47
Necrotizing enterocolitis can lead to ...
Respiratory difficulties
48
How do we Dx necrotizing enterocolitis?
X-ray will show free air in abd cavity, distended loops of bowel
49
List 6 ways to prevent necrotizing enterocolitis
1) Human milk feeding for infants < 32 wks (mom or donor) 2) Measure & record abd circumference 3) Auscultate bowel sounds before every feed & observe for distention 4) Before any gastric tube feeding, check for aspirates of undigested formula or breast milk 5) Record all BM for amount, consistency, freq 6) If problem is suspected: hold feed & SBAR to neonatologist
50
List 4 Tx options for necrotizing enterocolitis
1) Stop all feeds (gut rest) 2) TPN 3) Place replogle tube for venting 4) Surgical resection of bowel; possible ostomy
51
What is bronchopulmonary dysplasia (BPD)?
Chronic condition in which the NB becomes O2 dependent past 36 wks of gestation
52
List 2 causes of BPD
1) Extreme prematurity 2) Damage from vents causing airway remodeling
53
List a S/S of BPD
1) Inability to wean off O2 completely
54
How can we prevent BPD?
By preventing erratic O2 levels during delivery, maintaining a constant level of O2 delivery
55
Preventing BPD also prevents what?
Retinopathy of prematurity
56
List 4 long term consequences of BPD
1) Poor feeding → delayed growth 2) Susceptibility to infection 3) Right-sided HF 4) Susceptibility to other lung disease (i.e. asthma, freq RSV)
57
List 3 Tx options for BPD
1) Abx 2) Bronchodilators 3) Continued oxygenation support, trach may be necessary
58
List 5 ways to promote attachment & bonding when there is an unexpected outcome
1) Taking part in care & allowing them to do something 2) Involving them in care 3) Explaining everything you do 4) Being available to them 5) i.e. baby w/ facial defect → say "Aww look at him holding onto your finger"
59
What can impair bonding?
NICU admission → separation from infant "fear factor"
60
If there is a known issue before baby is born how can we help the mom so bonding is not impaired?
Have mom tour the NICU → get used to sounds, get familiar w/ equipment, have her talk to neonatologist ab expectations, build confidence
61
List 4 ways to promote bonding when baby goes to NICU
1) Kangaroo care (skin-to-skin w/ warm blankets) 2) Involve in routine tasks (diapering, feeding) 3) Frequent updates → esp. if mom had c-section 4) Build confidence by introducing them to as much as possible
62
When would we involve social services?
If unexpected admission; make sure to talk about PPD
63
What other types of support can be used when there are unexpected outcomes?
March of Dimes & peer support
64
How can infants with congenital anomalies affect parents? **Hint: 7**
1) Parents expect idealized infant 2) Stages of grief 3) Encourage expression of feelings & bonding 4) Encourage parents to care for NB 5) Encourage visitation if infant is taken to ICU 6) Provide info 7) Refer to support groups, March of Dimes
65
Perinatal loss: What to say **Hint: 2**
1) "I'm sorry" 2) "I'm here for you"
66
Perinatal loss: What not to say **Hint: 3**
1) "God must have had a reason" 2) "Your baby's an angel in heaven" 3) "You are young, you can have more"
67
List 7 nursing interventions when perinatal loss occurs
1) Allow family to see & hold baby 2) Provide room away from main maternity traffic 3) Post symbol on door 4) Pastoral care or family pastor/ priest 5) Blessing or emergency baptism 6) Mementoes → photos, blankets, footprints, lock of hair 7) Refer to perinatal bereavement
68
Why should we try to provide a room away from main maternity office when theres been perinatal loss? **Hint: 3**
1) Want to avoid hearing babies cry 2) Seeing mom w/ her baby can be triggering 3) Avoids staff coming in & congratulating them

NUR514: Maternity Exam 2 (7 decks)

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