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N113 Newborn Care
N113 - Care of High-Risk Newborn
| Question | Answer |
|---|---|
| Premature | Infant born before completion of 37 weeks. Major problem of preterm newborn is immaturity of all systems. |
| Characteristics of preterm infant | Small & scrawny-minimal subq fat, large head, skin-bright pink, abundant fine lanugo hair, soft & pliable ear cartilage |
| Male preterm | Undescended testes, few scrotal rugae |
| Female preterm | Labia minora is under-developed, labia minora & clitoris are prominent. |
| Preterm reflexes | Sucking is absent or weak, swallowing, gag & cough reflexes are absent or weak. |
| Respiratory alteration in preterm | Lungs not fully mature, lack of sufficient surfactant, increased respiratory distress syndrome. |
| Thermoregulation in preterm | Heat loss is major problem - prone to cold stress. Little subq fat, thinner more permeable skin |
| Clinical problems of preterm newborn | Apnea, Patent ductus arteriosis, RDS, intraventricular hemorrhage, hypoglycemia, necrotising enterocolitis, anemia, hyperbilirubinemai, infection |
| Post-mature newborn | Born after 42 weeks |
| Post-mature associated factors | 5 or more pregnancies, history of prolonged pregnancies |
| Post-mature infant characteristics | Absence of lanugo, little vernix, abundant scalp hair, long fingernails, cracked skin, wasted physical appearance (aging of placenta), depletion of subq fat |
| Large for gestational age (LGA) | Best known condition associated with LGA is maternal diabetes. |
| LGA complications | Birth trauma, increased chance of c-section & induction, hypoglycemia, polycthemia - increased # of RBC's |
| Small for gestational age (SGA) | Newborns at or below the 10th percentile, may be preterm or postterm, IUGR - intrauterine growth restriction |
| Maternal factors contributing to IUGR | Maternal factors - smoking, lack of prenatal care, age extremes (under 16 over 40) Maternal disease - heart disease, substance abuse, PIH |
| Environmental factors contributing to IUGR | High altitude, exposure to x-rays, excessive exercise, work related exposure to toxins |
| Placental factors contributing to IUGR | Small placenta, infarcted area, abnormal cord intersections, placenta previa |
| Fetal factors contributing to IUGR | Congenital infections, malformations, chromosomal syndromes |
| Complications of SGA newborn | Prenatal asphyxia, aspiration syndrome, heat loss, hypoclycemia, polycythemia |
| Prenatal asphyxia - SGA | Chronic hypoxia in utero |
| Aspiration syndrome - SGA | In utero - fetus can gasp during birth aspirating amniotic fluid into lower airways Hypoxia can lead to relaxation of anal sphincter & passage of meconium |
| Heat loss - SGA | Diminished subcutaneous fat, depletion of brown fat in utero, large surface area |
| Hypoglycemia - SGA | Inadequate supplies of enzymes to activate gluconeogenesis, increase in metabolic rate in response to heat loss, infant will have routine one touch |
| Polycythemia - SGA | Increased # of RBC's - considered a physiologic response to hypoxic stress, produce more RBC's to carry O2, causes an increase in bilirubin |
| Nursing care for high risk newborn | #1-Support respiratory function, thermoregulation, protect from infection, hydration, nutrition |
| Respiratory distress syndrome (RDS) | Also known as Hyaline membrane disease. Result of absence or deficiency in the production of surfactant. |
| RDS manifestation | Scattered atelectasis, overinflation of some areas, grunting, cyanosis on room air, tachypnea, nasal flaring |
| RDS management | Ventilator support, surfactant replacement therapy, in severe RDS - partial liquid ventilation |
| RDS complications | Too much O2 can damage retina |
Created by:
jrb265
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