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variations in newbrn
normal term newborns, hyperbilirubinemia, skin, circumsision
| Question | Answer |
|---|---|
| what are the two types of jaundice? | physiologic - nonpathological or developmental Pathologic- disease related... |
| physiologic jaundice | not present during first 4 hours in term infants, occurs during 2nd or 3rd day. visible @ 5-7 mg/dl. face-5-7mg/dl, midabdomen-15 mg/dl, soles-20mg/dl |
| Pathologic jaundice | appears during the first 24 hours after birth due to disease. Nonphysiological, direct biliruben above 1.5 to 2 mg/dl, total serum bilirubin concentration increase by > 0.2 mg/dl p/hr or 5mg/dl p/day, total serum bilirubin > 95% age/hrs, >2wks full term |
| Pathologic jaundice usually happens as a result of what factors? | abnormalities causing excessive dextruction of erythrocytes, Incompatibilities between: Mother's and infant's blood types, Infection, Metabolic disorders. |
| Pathologic jaundice left untreated leads to kernicterus a characterized by a dangerous level of bilirubin that leaves pt's suffering from what conditions? | cerebral palsy, MR, Hearing loss, long term neurological/developmental problems |
| Hemolysis of excessive erytrhocytes, short RBC life, liver immaturity, lack of intestinal flora, dlayed feeding, trauma resulting in bruising or cephalohematoma, and fatty acids from cold stress or asphyxia are all factors that increase what? | hyperbilirubinemia |
| Common risk factors for hyperbilirubinemia | Prematurity. Cephalohematoma. Bruising. Delayed or poor intake. Cold Stress. Asphyxia.Rh incompatibility. ABO incompatibility. Sepsis. Sibling with jaundice. Breastfeeding. Infection. |
| Where does the nurse blanch the infant's skin to assess for jaundice? | nose or sternum |
| what is determined by this assessment? | how far down the body the jaundice extends. |
| What is the focus and most common treatment for hyperbilirubinemia? | prevent kernicterus by placing the infant under special fluorescent lights, or fiber optic blanket placed against the infant's skin, aka phototherapy. |
| what if performed when phototherapy cannot reduce dangerously high bili levels quickly enough? | Exchange transfusion is seldom necessary, but used when phototherapy is ineffective |
| Name nursing interventions for hyperbilirubinemia in infants... | Maintain a neutral thermal environment. Provide optimal nutrition. Protect the eyes. Enhance response to therapy. Detect complications. Parent Teaching. |
| what is a benign rash of unknown cause in newborns, blotchy red areas that may have white or yellow papuoes or vesicles in the center? | Erythema Toxicum... |
| what is Erythema Toxicum commonly known as? | a harmless condition called newborn rash or fleabite rash and resembles small bites or acne, it appears during 1st 24-48 hrs after birth, although occasionally not until 1 to 2 weeks |
| ET normally covers the face, back shoulders and chest and is not caused by infection. How does infection distinguish it from other skin problems? | pustular rash caused by staph infection, or vesicles from herpes simplex. ET's cause in unk, but occurs in 50% of full term infants and disappears within hours or up to 10 days... |
| Mongolian Spots... resemble bruises usually in the sacral area and occur frequently in newborns with what? | dark skin |
| Petechia resembles a rash and is caused by what? | Increased intravascular pressure. May indicate infection or a low platelet count. |
| What is nevus simplex | Flat, pink, or reddish discoloration. Usually on face or neck. Color blanches. Disappear by 2 years of age. |
| Nevus flammeus | Known as port wine stain. Permanent, flat, dark, reddish-purple mark. Varies in size and location. Can be removed by laser surgery. |
| nevus vasculosus | Known as strawberry hemangioma. Enlarged capillaries in the outer layer of skin. Dark red and raised with a rough surface. No treatment is necessary. |
| Cutis Marmorata | Lacelike red or blue pattern. Cold stress, overstimulation, hypovolemia, or sepsis. May indicate a chromosomal abnormality. |
| Harlequin Color Change | Deep red color over half of body with pallor on the other half of the body. Cause is unknown. Usually occurs with preterm infants who are placed on their side. |
| Bruises | May occur on any part of the body. Bruising on the head. Document size, color, and location. |
| Acrocyanosis | Hands and feet may appear slightly blue. Acrocyanosis is common during the first day and is a result of poor peripheral circulation. |
| Milia | Pearly white pinpoint papules on face and nose of newborn. Due to clogged sweat and oil glands (sebaceous glands) not functioning normally. Disappear w/in a few weeks. pt teach parent not to "sqeeze out" white material causing infection |
| what is the most common surgical procedure of the neonate? | circumsicion, due to hygeine/preference. parents opt out of circumsision due to pain caused and pt can have surgery later in life. |
| what are methods of circumcision? | foreskin is first separated from the glans with a probe and incised to expose the glans. gomco clamp, and plastibell |
| nursing considerations | Assist in decision making. Verify signed consent. NPO 2-4 hours before. Bulb syringe for secretions. Comfort measures. Gentle pressure for bleeding. Note first void. Parent teaching. |
| For what reason should a parent contact a nurse or provider following a circumcision? | Plastibell slips to base of penis, s/s of infection, |
Created by:
redhawk101
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