UNIT 5 HIGH RISK NEWBORN CHAPTER 25 Flashcards by &$& Yong

What pre existing conditions can put new borns at risk

High-risk neonate-greater chance of morbidity & mortality
regardless of gestational age or birth weight; period of
viability (20 weeks gestation) to 28 days after birth
 Conditions or circumstances impair adjustment to extra
uterine life
 Prematurity
 Birth trauma
 Infection
 Maternal substance abuse
 Congenital anomalies

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Family care for at risk patient

 Assessment
 Respiratory support
 Thermoregulation
 Thermal stability
 Neutral thermal environment
 Incubator or radiant warmer
 Skin to skin (kangaroo care)

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Should nurses be implementing Standard Precautions

YES

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After birth should you minimize stimaltion for mom?

A. Yes
B. No

A. Yes

 -Darken environment
 -Quiet
 -Rocking or limit handling with baby

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What are risk factor for birth trauma?

Birth injuries often avoidable
 Ultrasonography to diagnose macrosomia, gestation
anomalies, hydrocephalus, presentation,

Elective cesarean birth to prevent birth injury

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Are precipitous labor avoidable?

Some significant birth injuries unavoidable
 Difficult or prolonged labor
 Abnormal presentation-caregiver error
 Precipitous or “explosive” labor

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What type of procedure can prevent birth injry>

Elective cesarean birth to prevent birth injury

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Assessment of fractured clavicle

 Feel crepitus @ fracture site.
 Do not lay infant on affected side.

 No other treatment needed

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Assessment of Era-Duchenne paralysis

Erb-Duchenne paralysis (Erb’s Palsy)
Injury to brachial plexus.
Pulling head away from shoulder as with shoulder
dystocia. Moro reflex absent on affected side.

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Neonatal infections

Sepsis/Septicemia: overwhelming infection; inability to clear
toxins of infection
 Patterns
 Early onset-congenital/prenatal exposure
 Late onset-nosocomial infection
 Pneumonia
 Bacterial meningitis
 Gastroenteritis is sporadic

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Risk factor for Neonatal infections during the 3 stages of pregnancy

AntePartum maternal poor prenatal care, malnutrition,
substance abuse, limited resources, fever, UTI

Intrapartum: premature or prolonged rupture of
membranes, chorioamnionitis, prolonged labor

Neonatal: multiple gestation, male, birth asphyxia,
meconium aspiration, invasive procedures, galactosemia,
low birth weight

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Toxoplasmosis
 Other
 Hepatitis B
 HIV
 Parvovirus
 West Nile
 Rubella
 Cytomegalovirus
 Herpes simplex virus

Can the TORCH Complex cause death in fetus?

A. Yes

B. No

A. Yes

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Signs of Neonatal Sepsis

 Respiratory: apnea, distress, decreased
SaO2

 Cardiovascular: decreased perfusion, heart
rate changes, hypotension

 Central nervous: lethargy or irritability,
hypotonic, temperature instability

 Gastrointestinal: poor feed, vomiting,
diarrhea

 Integument: jaundice, pallor, petechiae,
mottling

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Can HERPES
SIMPLEX VIRUS
(HSV)
cause hearing loss and is It life threatening for neonate?

Yes
No

Yes

HERPES
SIMPLEX VIRUS
(HSV)
 Newborn HSV possibly life threatening.
 Can cause hearing loss

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What type of Drugs are Drug exposed infants exposed too?

Drug addiction
 Narcotics
 Heroin
 Methadone
 Other drugs/illicit substances
 Smoking
 Alcohol abuse

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NURSING CARE MANAGEMENT of Drug Exposed Infants

Neonatal abstinence scoring system
 Finnegan tool
 Neonatal intensive care unit network neurobehavioral scale
(NNNS)

 Treatment modalities FOR WITHDRAWAL
 Swaddle, rock or limit handling
 Low stimuli environment, NO LOUD NOISES, NO LIGHTS

MEDICATIONS TO HELP WITH BABY WITHDRAWALS
 Methadone, phenobarbital, morphine

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What are the facial features of an infant with fetal alcohol syndrome/FETAL
ALCOHOL
SYNDROME

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FETAL
ALCOHOL
SYNDROME
(FAS)
 Microcephaly-a condition where a baby’s head is much smaller than expected.
 Small eyes, thin upper
lip, flat mid-face
 Growth restriction
 Neurodevelopmental
deficits (fine motor, IQ,
speech

Hemolytic Disorders
Blood incompatibility
(isoimmunization)
Rh incompatibility

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Rh- mom Rh+ baby

must need program with 72 hours of delivery

What is ABO imcompatibility

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Occurs if fetal blood type is A, B, or AB, &
maternal type is O
 Incompatibility arises because naturally
occurring anti-A & anti-B antibodies are
transferred across placenta to fetus
 Jaundice
 Exchange transfusions rare

Do diabetic mothers normally produce macrosomic babies?

A. Yes

B. No

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A. Yes

Characteristic appearance
 Macrosomia
 Increased risk for birth injuries
 Increase in congenital anomalies

 Nursing care management
 Adequate thermoregulation
 Carbohydrate feedings as appropriate
 Serum glucose level

What are the characteristics of Large for Gestational Age babies?

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Respiratory distress
Hypoglycemia (< 40 mg/dL)
Hypocalcemia
Polycythemia
Neurological deficits
(seizures, jitteriness, lethargy)

less vernix

CHARACTERISTICS OF A PRETERM INFANT

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Small, lack brown fat
Large head, soft poorly shaped ears
Thin, translucent skin
Lanugo; copious vernix
Genital development

?Are late preterm babies at risk for sepsis?

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Born between 34 and 36 6/7 weeks of
gestation
 Termed preterm rather than near term
 Higher risk for problems related to:
 Respiratory function
 Thermoregulation
 Hypoglycemia
 Hyperbilirubinemia
 Sepsis

Complications of Preterm birth

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 Respiratory distress syndrome
 “Hyaline membrane” disease
 Surfactant insufficient
 Absence of alveolar stability
 Prolonged hypoxemia

 Oxygen therapy
 Endotracheal tube
 Continuous positive airway pressure (CPAP

What is Kangaroo care?

skin to skin, mom and baby Encourage bonding & relationships  Touch/skin to skin contact

Post Term Baby cOmplications

Gestation that extends beyond 42 weeks  3.5 -15% of pregnancies  Cause of delayed labor is unknown  Placental dysfunction  Significant increase fetal & neonatal mortality  Fetal distress; placental insufficiency  Increased risk for birth injuries(DYSTOCIA)

Hypospadias and Epispadias

Hypospadias- urethral opening located behind glands penis or anywhere along ventral surface of penile shaft.  Epispadias- Meatal opening is located on dorsal surface of the penis.  Management: requires surgical repair

Assessment of Post TermBaby

 Dry, cracked, peeling skin,  Well formed ears with instant recoil  Loss of subcutaneous tissue  Well developed genitalia  High incidence of meconium release prior to delivery

S/S of respiratory distress

* Tachypnea (60breaths/min)initially * Dyspnea *Pronounced intercostal or substernal retractions * Fine inspiratory crackles * Audible expiratory grunt * Flaring of the external nares * Cyanosis or pallor * Apnea * With progression of condition, deteriorating vital signs including blood pressure, apnea, body temperature instability * hypotension

You have acknowledged that during your patient's pregnancy, She has been using illicit drugs consistently. What would you anticipate for Health Care Provider to prescribe for the newborn? A. Naloxone B. Phenobarbital C. Methylphenidate D. Lithium

B. Phenobarbital

At 3 hours of age, a term newborn seems jittery and has a weak and high-pitched cry and irregular resp The nurse suspects that the infant may have which of the following? 1. Hypoglycemia 2. Hypercalcemia 3. Hypervolemia 4. Hypothyroidism

1. Hypoglycemia

The mother of a newborn is breastfeeding her infant on the delivery table. How can the nurse best assist 1. Touch the infant's cheek adjacent to the nipple to elicit the rooting reflex 2. Leave the mother and baby alone and allow the infant to nurse as long as desired 3. Position the infant to grasp the nipple so as to express milk 4. Give the infant a bottle first to evaluate the baby's ability to suck

1. Touch the infant's cheek adjacent to the nipple to elicit the rooting reflex

Parents of a newborn note petechiae on the newborn's face and neck. The nurse should tell them that this of which of the following? 1. Increased intravascular pressure during delivery 2. Decreased vitamin K level in the newborn infant 3. A rash called erythema toxicum 4. Excessive superficial capillaries

1. Increased intravascular pressure during delivery

A newborn has a total body response to noise or movement that is distressing to her parents. What should tell the parents about this response? 1. It is a reflexive response that indicates normal development. 2. It is a voluntary response that indicates insecurity in a new environment. 3. It is an automatic response that may indicate that the baby is hungry. 4. It is an involuntary response that will remain for the first year of life.

1. It is a reflexive response that indicates normal development.

When changing her newborn infant, a mother notices a reddened area on the infant's buttocks. How shoul respond? 1. Have staff nurses instead of the mother change the infant 2. Use both lotion and powder to protect the area 3. Encourage the mother to cleanse and change the infant more frequently 4. Notify the physician and request an order for a topical ointment

3. Encourage the mother to cleanse and change the infant more frequently

A woman, at 32 weeks gestation, delivers a 3-Ib, 8-oz baby boy two hours after arriving at the hospital. What is the baby at risk for because of his gestational age? 1. Mental retardation and seizures 2. Hypothermia and respiratory distress 3. Acrocyanosis and decreased lanugo 4. Patent ductus arteriosus and pneumonia

2. Hypothermia and respiratory distress

Orders for a premature infant are for nipple feedings or gavage. What assessment findings are necessary feedings are given? 1. The baby must have a respiratory rate of 20 to 30 and heart rate of 110 to 130. 2. The baby must be alert and rooting. 3. Sucking and gag reflexes must be present. 4. Weight and temperature must be stable.

3. Sucking and gag reflexes must be present.

.The mother of a term newborn born two hours ago asks the nurse why the baby's hands and feet are blu information should the nurse include when responding? 1. Blue hands and feet can indicate possible heart defects. 2. This is normal in newborns for the first 24 hours. 3. This pattern of coloration is more common in infants who will eventually have darker skin color. 4. Once the baby's temperature is stabilized, the hands and feet will warm up and be less blue

2. This is normal in newborns for the first 24 hours.

Risk factors for hyperbilirubia

*Preterm * Breastfeeding: especially if exclusively breastfeeding and weight loss is excessive * Rh- or ABO incompatibility or other known hemolytic disease (e.g., G6PD deficiency) * Polycythemia * Asian or Native American race * Bruising related to birth trauma * Previous sibling who received phototherapy *Bruising can increase the risk for hyperbili- rubinemia.

Signs and symptoms of infection in Newborn

Lethargy, irritability, poor feeding, vomiting or diar- rhea, decreased reflexes, and pale or mottled skin color are some of the clinical signs that suggest infection. Respiratory symptoms such as apnea, tachypnea, grunting, or retracting can be associated with infec- tion such as pneumonia.

Characteristic of Post Term baby

*little if any vernix caseosa, *absence of lanugo, *abundant scalp hair, *long fingernails. *The skin is often cracked, parchment-like, and peeling. *A common finding in postmature infants is a wasted physical appear-ance that reflects placental insufficiency. *Depletion of subcutaneous fat gives them a thin, elongated appearance. *The scant amounts of vernix caseosa that remain in the skinfolds may be stained deep yellow or green, which is usually an indication of meconium in the amniotic fluid.

HOW MANY DAYS SHOULD YOU DO A CIRCUMCISION ON JEWISH NEW BORN MALE

8 days

UNIT 5 HIGH RISK NEWBORN CHAPTER 25 Flashcards

(42 cards)