NURS-436: Maternal & Child Health (Module 3, Part 2)

What are the primary nursing priorities when caring for high-risk newborns?

Maintaining airway clearance, gas exchange, thermoregulation, glucose stability, infection prevention, injury prevention, and pain management while recognizing deterioration and escalating care

What is the most common cause of newborn mortality?

Preterm birth

What is the normal birth weight range for a term newborn?

2,500–4,000 g (5 lb 8 oz–8 lb 13 oz)

What does SGA stand for?

Small for gestational age

What defines low birth weight (LBW)?

Birth weight less than 2,500 g (5 lbs 8 oz)

What defines very low birth weight (VLBW)?

Birth weight less than 1,500 g (3 lbs 5 oz)

What defines extremely low birth weight (ELBW)?

Birth weight less than 1,000 g (2 lbs 30 oz)

What is the function of the ductus arteriosus during fetal circulation?

Shunts blood away from the fluid-filled lungs in utero; closure after birth is necessary for normal newborn circulation

What is the most common congenital heart defect?

Patent ductus arteriosus (PDA)

What is patent ductus arteriosus (PDA)?

Failure of the ductus arteriosus to close after birth, allowing blood to flow between the aorta and pulmonary artery

What abnormal blood flow occurs in PDA?

Oxygenated blood from the aorta flows into the pulmonary artery, mixing with deoxygenated blood

What clinical findings may indicate PDA?

Systolic murmur at the second intercostal space along the left upper sternal border, tachycardia, tachypnea, bounding pulses, and increased oxygen requirements

What diagnostic test confirms PDA?

Echocardiogram

What treatment options are available for PDA?

Observation if asymptomatic, indomethacin for closure, diuretics, fluid restriction, cardiology consultation, and possible surgical ligation if unresponsive

What is the anatomical abnormality associated with VSD?

An opening in the interventricular septum that allows blood to flow between the right and left ventricles

What assessment findings may indicate VSD?

Heart murmur, failure to thrive, and congestive heart failure symptoms including increased heart rate, increased respiratory rate, cyanosis, and swelling

What diagnostic tests are used to evaluate VSD?

Echocardiogram and chest X-ray

What treatments may be used for VSD?

Diuretics, digoxin, blood pressure medications, high-calorie feedings, tube feeding, and possible surgery

What assessment tool is used to estimate a newborn's gestational age?

Ballard score

What four major complications are associated with prematurity?

Respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP)

Why is prematurity clinically significant?

It is associated with low birth weight and increased mortality and disability

What two categories are assessed using the Ballard score?

Neuromuscular maturity and physical maturity

What six neuromuscular characteristics are assessed in the Ballard score?

Posture, square window (wrist), arm recoil, popliteal angle, scarf sign, and heel-to-ear maneuver

What six physical characteristics are assessed in the Ballard score?

Skin, lanugo, plantar surface, breast tissue, eyes/ears, and genitalia

What does a higher Ballard score indicate?

Greater gestational maturity

What causes respiratory distress syndrome (RDS) in premature newborns?

Immature alveoli and insufficient surfactant, resulting in alveolar collapse and impaired gas exchange

What clinical findings indicate neonatal RDS?

Retractions, tachypnea greater than 60 breaths/minute, cyanosis, nasal flaring, grunting, hypoxemia, and acidosis

What two respiratory abnormalities could be identified in the chest X-ray of a neonate with RDS?

Pneumothorax and atelectasis (collapsed lung tissue)

Why is maintaining a neutral thermal environment important for newborns with RDS?

It decreases stress and prevents increased oxygen demand

What nursing interventions are important for newborns with RDS?

Oral/nasal suctioning, cardiac monitoring, oxygen saturation monitoring, ABGs, strict intake/output, and antibiotics as ordered

What is IVH/PVH, and which newborns are at greatest risk?

Bleeding into or around the brain's ventricular system, particularly in preterm infants

What clinical findings may indicate IVH/PVH?

Apnea, bradycardia, cyanosis, high-pitched cry, seizures, bulging fontanelles, and decreased hemoglobin/hematocrit

What cord-clamping practice is emphasized in relation to IVH/PVH?

Delayed cord clamping

What characterizes Grade 1 IVH?

Hemorrhage confined to the germinal matrix

What characterizes Grade 2 IVH?

Intraventricular hemorrhage without ventricular dilation

What characterizes Grade 3 IVH?

Intraventricular hemorrhage with ventricular dilation

What characterizes Grade 4 IVH?

Hemorrhage involving cerebral tissue

What diagnostic studies are used to evaluate IVH/PVH?

Cranial ultrasound and hemoglobin/hematocrit levels

What nursing interventions are important for infants with IVH/PVH?

Assess changes in vital signs, behavior, and neurological status while maintaining a dark, quiet environment to reduce stress

What defines postmaturity, and what placental complication is associated with it?

Delivery after 42 weeks of gestation, often associated with placental insufficiency

What complications are associated with postmaturity?

Macrosomia, hypoxia/asphyxia, meconium aspiration, hypoglycemia, hypothermia, and polycythemia

What physical assessment findings are characteristic of a postmature newborn?

Thin, wasted appearance; dry or peeling skin; long nails; and absence of vernix

What nursing interventions are important for postmature newborns?

Monitor for meconium aspiration and birth trauma, perform frequent glucose checks, and initiate early feedings

What interventions are used to manage neonatal RDS?

Surfactant administration, oxygen, ventilation, minimizing cold stress, and cardiac/respiratory monitoring

What findings may indicate atelectasis or pneumothorax, and what is the priority response?

Diminished breath sounds, poor oxygenation, and sudden deterioration; support oxygenation and escalate care

Which newborn populations are at increased risk for hypoglycemia?

SGA, LGA, preterm, postmature, and infants of diabetic mothers

What are the clinical manifestations of neonatal hypoglycemia?

Poor feeding, jitteriness, lethargy, and seizures

What nursing interventions are indicated for neonatal hypoglycemia?

Frequent blood glucose monitoring, prompt feeding or IV glucose, and escalation if hypoglycemia persists

What findings are associated with pathological jaundice?

Appears before 24 hours, bilirubin increase greater than 5 mg/dL/day, serum bilirubin greater than 15 mg/dL, jaundice beyond 14 days, or direct bilirubin greater than 2 mg/dL

What findings characterize physiological jaundice?

Appears after 24 hours, serum bilirubin less than 15 mg/dL, resolves by 14 days, and peaks on days 4–5 in term infants or day 7 in preterm infants

What nursing interventions are important for newborns with jaundice?

Review bilirubin labs, assess skin color, maintain hydration, institute phototherapy, protect the eyes, monitor for dehydration and lethargy, and provide discharge teaching

What is necrotizing enterocolitis (NEC)?

An inflammatory disease causing intestinal tissue necrosis that may lead to bowel obstruction and death

Which newborns are most susceptible to NEC, and what factors contribute to its development?

Preterm infants; risk factors include asphyxia, hypoxia, shock, and enteral feeding

What clinical findings may indicate NEC?

Abdominal distention, emesis, and bloody stools

What nursing and medical interventions are indicated for NEC?

Keep NPO, insert an orogastric (OG) tube with low suction, monitor intake/output, administer antibiotics, and prepare for possible surgery

Which infants are at greatest risk for ROP?

Infants born before 31 weeks or weighing less than 1,250 g

What additional factors increase the risk of ROP?

Prolonged hyperoxia, mechanical ventilation, anemia, blood transfusions, and respiratory distress

What nursing interventions help manage ROP?

Maintain prescribed oxygen parameters, use oxygen blenders/calibrators, provide a dark environment, and obtain ophthalmology consultation

What treatments may be used for advanced ROP?

Laser therapy or cryotherapy

What changes require rapid assessment in a high-risk newborn?

Changes in vital signs, neurological status, feeding, or behavior

What should nurses do when a high-risk newborn shows signs of clinical deterioration?

Prioritize immediate interventions, notify the provider, transfer to a higher level of care if necessary, and continuously reassess the response