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Neonate
Health Deviations of the Neonate
| Question | Answer |
|---|---|
| Disorders of Intrauterine Growth: Small for gestational age | <10th percentile for weight; Causes: –1st trimester infection, teratogens, & chromosomal abnormalities; 2nd & 3rd trimester maternal & placental factors. |
| Small for gestational age: Risk to Infant | Smaller head circumference and reduced brain capacity; Hypoglycemia; Polycythemia (RBC); Immunodeficiency; Perinatal asphyxia |
| Disorders of Intrauterine Growth: Large for gestational age | Wt >4000 g or in 90th percentile despite gestational age; Risk to Infant: Birth trauma; Shoulder dystocia; Asphyxia; Hypoglycemia; Congenital anomalies |
| LGA & Diabetic Mother | Enlarged Organs (Liver & Cardiac); Increased body fat; Placenta & umbilical cord are larger; At Risk For: Hypo & Hyperglycemia, Hyperviscosity & Hyperbilirubinemia. |
| Premature | Born before 37 weeks; organs are immature; Lack physiologic reserves to function in an environment. |
| Factors Associated w/Preterm Birth | Gestational hypertension; maternal infection; multifetal pregnancy; HELLP syndrome; premature dilation of cervix; pllacental or umbilical cord conditions that affect the fetus's reception of nutrients. |
| Late Preterm Infant | Born between 34 and 36 6/7 weeks of gestation; referred to as "late preterm" rather than "near term"; Higher risk for: thermoregulation, hypoglycemia, hyperbilirubinemia, sepsis & respiratory function. |
| Later Preterm Infants | At higher risk of mortality because they appear mature and as a result can be treated as term infants. |
| Premature Assessment: Respiratory Function | Difficult pulmnary transition; low surfactant levels; period breathing & apnea; decreased functional aveoli. |
| Premature Assessment: Cardiovascular Function | Hypotension; Hypovolemia |
| Premature Assessment: Body Tempurature | Large surface area in relation to body weight; limited stores of subcutaneous & brown fat; poor muscle tone. |
| Premature Assessment: Central Nervous System Function | Fluctuating systemic blood pressure which causes variation in cerebral blood flow and pressure; recurrent hypoxic and hyperoxic episodes; dependent on gestational age. |
| Premature Assessment: Nutritional Status | Weak or absent suck, swallow and gag reflexes; small stomach capacity; immature digestive capacity; compromised metabolic functions (limited store of nutrients, decreased ability to digest proteins, immature enzyme systems). |
| Prenatal Adaptation: Parental Tasks | Experiencing anticipatory grief over potential loss of infant; accepting failure to give birth to a healthy, full-term infant; resuming process of relating to infant &how they differ from other infants; adjusting home environment to meet needs of infant. |
| Parental Adapation: Parental Response | Progressing through stages of behavior |
| Parental Adaptation: Parenting Maladaptation | Rejection of infant; physical and/or emotional abuse |
| Parental Adaptation: Parental Support | Nurturing parents; providing accurate and consistent information; clarifying nursery policies; help parents connect with other nursery parents. |
| Parental Adaptation: Parent Education | CPR; community resources; lactation/feeding; home care (Oxygen, other equipment). |
| Prematurity Nursing Care: Oxygen Therapy | Extracorporeal membrane oxygenation therapy (ECMO); high-frequency ventilation; mechanical ventilation (surfactant administration); continuouse distending pressure (CPAP); O2 Hood; Nasal Cannula; Weaning from O2. |
| Prematurity Nursing Care: Nutritional Care | Types of nourishment;hydration;elimination patterns;oral feedings;gavage feeding;gastronomy feeding;advancing infant feedings; nonnutritive sucking. |
| Prematurity Nursing Care: Environmental Concerns | Noise Level; Lighting |
| Prematurity Nursing Care: Developmental Outcome | Inappropriate stimulation; containment or facilitated tucking; blanket swaddling or nesting; skin-to-skin (kangaroo care). |
| Post-Term Infant | Born after 42 weeks; Dysmaturity may be evident upon birth: peeling skin, meconium stained skin & nails, loss of subcutaneous fat & muscle mass, no vernix, long hair & nails. |
| Post-Term Infant Risks | Insufficient gas exchange in the post-term placenta puts infant at high risl of intrauterine hypoxia; meconium aspiration; persistent pulmonary hypertension. |
| Thermoregulation: Four Mechanisms of Heat Transfer | Convection:Heat loss through air currents (avoid drafts);Conduction:heat loss through direct contract (avoid cold objects); Radiation:heat loss without direct contact (keep away from cold sources); Evaporation: heat loss by conversion of liquid into vapor |
| Clinical Manifestations of Cold Stress | Respiratory distress, central cyanosis, hypoglycemia, lethargy, poor feeding, weak cry, abdominal distention, apnea and bradycardia. |
| Complications of Cold Stress | Metabolic acidosis, hypoglycemia, pulmonary hypertension, sepsis. |
| Intraventricular Hemorrhage | Bleeding from the brain due to fragility of cerebral vessels; most common in the first 72 hours after birth; grades I to V |
| Clinical Manifestations of Intraventricular Hemorrhage | Possibly no symptoms, risk factors, unexplained drop in hematocrit, pallor, poor perfusion, seizures, lethargy, weak suck, high pitched cry, hypotonia, cranial ultrasonography. |
| Birth Injuries | IInjuries due to the forces of labor and birth; types: fractures, brachial plexus, injury, cranial nerve trauma, head trauma. |
| Birth Injuries: Nursing Assessment | Risk Factors; physical & neurologic assessment: bruising, bumps, swelling, paralysis, symmetry of structure and function. |
| Birth Injuries: Nursing Management | Supportive; assessment for resolution or complications; support and education: realistic appraisal of situation; community referral for ongoing follow-up and care. |
| Polycythemia | Venous hematocrit about 65%; >65% hematocrit results in increased viscosity of blood (increased resistance of blood flow, decreased O2 delivery, abnormalities in CNS function, hypoglycemia, decreased renal function & coagulation disorders. |
| Treatment of Polycythemia | Asymptomatic hematocrit 65%-72%: fluids, close observation and repeat hematocrit Q12hrs; Symptomatic: partial exchange transfusion. |
| Hyperbilirubinemia: Bilirubin: Unconjugated | Product of RBC breakdown; unconjugated (indirect) (initially released by RBC breakdown, can leave vascular space & permate other extravascular tissue such as skin, sclera & oral membranes, and manifests as jaundice. |
| Bilirubin: Conjugated (direct) | Done by liver with glucuronide, excreted into the bilary tract which excretes it to the GI system and then it is excreted in urine/feces. |
| Hyperbilirubinemia Assessment | Transcutaneous Bilirubinometry (TcB): cannot be used if infant is under phototherapy; Serum Bilirubin; Skin Assessment for jaundice: apply pressure to boney area (nose, forehead or chest), assess color of blanched skin, use natural lighting. |
| Manifestations of Hyperbilirubinemia | Jaundice, lethargy, poor feeding, kernicterus (yellow staining on brain cells), high bilirubin levels in relation to hours old. |
| Treatment of Hyperbilirubinemia | Phototherapy (maintain temp carefully, eye protection); Bilibed; Encourage feedings; Exchange transfusion. |
| Respiratory Distress Syndrome: Risks & Cause | Risks:Prematurity, maternal diabetes, maternal hypotension, hydrops fetalis. Cause: Lack of pulmonary surfactant, muscle weakness, overly compliant chest wall. |
| RDS Clinical Manifestations | Tachypnea, grunting, nasal flaring, intercostal or subcostal retraction, hypercapnia, respiratory acidosis, hypotension, shock. |
| RDS Treatment | Self-limiting disease:Will begin to resolve in 72 hours w/production of surfactant; Supportive: ventilation, O2, surfactant supplementation, positive pressure ventilation (CPAP), monitor (arterial blood gases (ABGs), pulse oximetry, neutral thermal envir. |
| Meconium Aspiration Syndrome: Cause | Fetus passes meconium in utero: occurs in 10-15% of all births, occurs most commonly with term and post-term births. |
| Meconium Aspiration Syndrome: Manifestations | Meconium staining is noted in amniotic fluid and once baby is born on nails & skin; If meconiium is aspirated in lungs either in itero or at birth infant may develop chemical pneumonitis (persistent pulmonary hypertension of newborn (PPHN), sepsis, RD |
| Meconium Aspiration Syndrome: Treatment | Endotracheal suctioning at birth; ECMO (extracorporeal membrane oxygenation); Routine assessments and monitoring for complications. |
| Transient Tachypnea of the Newborn | Mild respiratory distress, pulmonary liquid removed slowly of incompletly, resolution by 72 hours of age; Risk Factors: maternal sedation, cesarean birth. |
| Transient Tachypnea Manifestations | Tachypnea (100-140); expiratory grunting; retractions; labored breathing; nasal flaring; mild cyanosis respiratory; slightly decreased breath sounds. |
| Transient Tachypnea Management | Oxygenation, supportive care, IV fluids or gavage feedings, supplemental O2, neutral thermal environment. |
| Bronchopulmonary Dysplasia: Causes | Chronic lung disease acquired as a result of mechanical ventilation and supplemental oxygenation. (Highest risk is infants weighing <1000 G and < 28 weeks gestation. |
| BPD Manifestations | Tachypnea, retractions, nasal flaring, increased work of breathing, exercise intolerance, feeding and handling intolerance, tachycardia, lund sounds: crackles, decreased air movement and occasional expiratory wheezes. |
| BPD Treatment | O2 Therapy, nutrition, fluid restriction, medications (diuretics, corticosteroids and bronchodialators). |
| Retinopathy of Prematurity: Causes | Mechanism is unclear, but seems to be related to high O2 concentrations; retinal vessel formation starts at week 16 and they mature until 42-42 weeks |
| Retinopathy Clinical Manifestations | Visual Impairment (mild to severe); scar tissue formation |
| Retinopathy Prevention | It is recommended to not keep premature infants at 100% O2 saturation with O2 therapy, but rather keep their levels above 90% but below 100%. |
| Neonatal Infection Classifications | Congenital (Intrauterine), Early-onset (perinatal), Late-onset (after perinatal period) |
| Neonatal Infections: Common Types | Group B Strep, Sepsis, Herpes Simplex Virus |
| Neonatal Infection Manifestation (Respiratory) | Apnea, bradycardia, tachypnea, grunting, nasal flaring, retractions, decreased O2 sat, metabolic acidosis. |
| Neonatal Infection Manifestation (Cardiovascular) | Decreased cardiac output, tachycardia, hypotension, decreased perfusion. |
| Neonatal Infection Manifestation (Central Nervous) | Temperature instability, lethargy, hypotonic, irritability, seizures |
| Neonatal Infection Manifestation (GI) | Feeding intolerance, abdominal distention, vomiting, diarrhea |
| Neonatal Infection Manifestation (Integumentary) | Jaundice, pallor, petechia, mottling. |
| Prevention of Neonatal Infection | Hand washing, standard precautions, frequent replacement of equipment (IV tubing, NG/OG tubes), keeping environment and equipment free of contamination, breastfeeding. |
| Treatment of Neonatal Infection | Medication therapy: antibiotic agents, antifungal agents, antiviral agents; supporting compromised body systems. |
| Necrotizing Entercolitis: Cause | Acute inflammation of the GI mucose complicated by perforations; exact cause is unknown, but the following has been associated with the development of NEC (intestinal ischemia, colonization, substrate in intestinal lumen. |
| Necrotizing Entercolitis: Manifestations | Lethargy, hypotonia, pallor, recurrent apnea/bradycardia, decreased oxygen saturation, respiratory distress, temperature instability, metabolic acidosis, cyanosis, GI s/s (abdominal distention, increasing or bile stained gastric aspiration, bloody stools) |
| Necrotizing Entercolitis: Treatments | Supportive in regards to compromised body systems; prevention in regards to bowel perforation (NPO, NG to low suction, antibiotic therapy, prevention of further infection, parental nutrition); surgical intervention |
| (PPHN) Persistent Pulmonary Hypertension: Cause | Unknown; heart is structurally normal however the right-to-left shunt that was present in fetal circulation persists into extrauterine life; most common in tern & post-term infants. |
| PPHN Manifestations | Cyanosis & tachycardia at birth; progresses into respiratory distress and severe pulmonary hypertension. |
| PPHN Treatment | ECMO; high frequency ventilation, nitric oxide therapy. |
| SIDS | Death of an infant <1 year that is unexplained after a complete investigation and post-mortem exam. (Attributed to back sleep). |
| SIDS Prevention | Back to sleep until 6 months; appropriate bedding; maternal smoking risk; dangers of co-sleeping on non-infant surfaces. |
| Substance Exposed Newborns: Most Common | Tobacco, Alcohol, Marijuana |
| Fetal Alcohol Syndrome | Physical and mental disorders that appear at birth; long term |
| Neonatal Abstinence Syndrome | Drug dependency aquired in utero manifested by neurological behaviors and physical behaviors. |
| Nursing Assessment for Substance Exposed Newborns | Maternal history, risk behaviors, toxicology, newborn behaviors. |
| Nursing Management of Substance Exposed Newborns | Comfort promotion, stimuli reduction, nutrition, prevention of complications, parent-newborn interactions. |
Created by:
nglidden
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