CH 17 KEY TERMS AND REVIEW QUESTIONS

which assessment finding may cause nurse to suspect brachial plexus syndrome?

new born does not demonstrate a Moro reflex

signs of hypoglycemia in a newborn

tremors, weak cry, lethargy

nurse check blood sugar of 2 hr newborn in the glucometer reading is 32 mg/dL. which nurse action is next?

initiate breastfeeding

nurse has been explaining TTN to newborns mother, which statement indicates that mother understands?

this breathing problem may have happened bc I had a cesarian birth

what is TTN?

transient tachypnea of the newborn, or TTN, is a respiratory disorder usually seen shortly after delivery in babies who are born near or at term

risk factors for neonatal sepsis ?

• preterm birth

• frequent vaginal exams

• mother has GBS infection

What is GBS?

Group B Streptococcus

what is a sign that a newborn may be at risk for meconium aspiration syndrome?

yellow - green tent on umbilical cord

meconium aspiration syndrome

Meconium aspiration syndrome occurs when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery.

what physical signs could indicate a risk for hyperbilirubinemia?

cephalohematoma

which is a physical characteristic of a preterm infant?

lanugo

possible complications of prematurity?

• retinopathy

• apnea

• cerebral palsy,

• learning disabilities

when observing a drug exposed newborn, what symptoms suggest infant maybe be experiencing withdrawal symptoms?

irritability

anoxia

no oxygen

Hypoxia

lack of oxygen

Birth asphyxia also known as perinatal asphyxia, asphyxia neonatorum, or hypoxic-ischemic encephalopathy

acute brain injury caused by asphyxia when the baby did not get enough oxygen during the birth process

Respiratory distress syndrome (RDS) of the newborn

a lack of surfactant in and immaturity of the fetal lungs. RDS is seen almost exclusively in premature infants, but it can occur in infants experiencing birth asphyxia, those born to diabetic mothers, and those born by cesarean section.

hypercapnia

elevated carbon dioxide

Echocardiography

(a test that looks at how blood flows through the heart vessels, valves, and chambers) to diagnose heart defects

Neonatal hypoglycemia

plasma glucose level of less than 30 mg/dL in the first 24 hours of life and less than 45 mg/dL

hyperinsulinism

(increased levels of insulin)

brachial plexus

injury to the newborn occurs from an increase in the infant's neck-shoulder angle, resulting in a traction force to the brachial plexus. The brachial plexus is a network of nerves that originate in the neck area and branch off to form the nerves that control movement and sensation in the shoulders, arms, and hands

neonatal sepsis

blood infection that presents within the first 28 days of life

small-for-gestational age (SGA) newborn

an infant whose weight is less than the 10th percentile for his or her gestational age.

intrauterine growth restriction (UGR).

limited fetal growth caused by a decrease in placenta perfusion during gestation

hypoglycemia

low blood dugar

large-for-gestational-age (LGA) newborn

is an infant whose weight is greater than the 90th percentile for gestational age

respiratory distress

The immature respiratory system lacks surfactant to keep the alveoli open.

hypothermia

Thermoregulation is difficult for the premature infant because of the lack of subcutaneous fat, and the infant may not have developed brown fat to assist with heat production during stress. Cold stress can occur easily in a premature newborn.

Intraventricular hemorrhage in the brain.

In the very premature infant, these can occur because of the fragile, underdeveloped blood vessels in the brain. The blood vessels rupture and bleed into the ventricles of the brain. There may be no symptoms, or the nurse may observe:

• Apnea

• Decreased muscle tone

• Decreased reflexes

• Excessive sleep

• Weak suck

• Seizure and other abnormal movements

birth asphyxia a.k.a. hypoxic-ischemic encephalopathy

acute brain injury caused by asphyxia when the baby did not get enough O2 during birth process

asphyxia

slows or ceases breathing

Transient Tachypnea of the Newborn (TTN)

common self-limiting condition of infants in which tachypnea, increased O2 needs, & mild respiratory distress occurs.

Persistent Pulmonary Hypertension of the Newborn (PPHN)

fetal circulation persists or remains as it was in the uterus; ductus arteriosus and/or foramen ovale remain open & blood is shunted away from lungs, causing lungs to have high pressure, & there is inadequate blood flow to the lungs for oxygenation

common causes of PPHN

• Perinatal asphyxia

• RDS

• Neonatal sepsis

• congenital defect of heart or lungs

• cyanosis that don't improve w/ oxygen administration

• shock(low bp&tachycardia)

• possibility of a heart murmur

birth injuries

known as "birth trauma"

• fetal macrosomia

• cephalopelvic disproprotion

• prolonged or very rapid delivery

• use of forceps or vacuum extration

• abnormal presentation like breech

• large fetal head

preterm birth

less than 37 weeks, 6 days

early term birth

Birth occurring between 37 weeks, 6 days and 38 weeks 6 days

full term birth

Birth occurring between 39 weeks and 40 weeks 6 days.

late term birth

41 weeks to 41 weeks and 6 days

post term birth

42 weeks and over

Necrostizing enterocolitis (NEC)

damage of intestinal tract; may have occurred from abnormal intestinal flora, immaturity of the intestinal mucosa, intestinal ischemia, & a genetic predisposition

may affect only mucosal lining or may be full-thickness necrosis and bowel perforation

hematochezia

BRIGHT RED blood in stool

Retinopathy of Prematurity (ROP)

visual disabilities from prematurity, where oxygen used to help the infant breathe but damages the retina

Retinopathy of Prematurity (ROP)

visual disabilities from prematurity, where oxygen used to help the infant breathe but damages the retina
(visual impairment and blindness)
early surgical laser tx is tx of choice

cerebral palsy

D/O of muscle tone and movement can be caused by infection or inadequate blood flow to the developing premature infabts brain

spina bifida (20 times higher in IDM)

birth defect in which spinal cords fails to develop or close properly in the utero

caffiene

preferred drug to tx apnea of prematurity infants

• stimulates respiratory center & relaxes smooth brochial muscles

• IV/oral

• rapid onset

• dose is 5mg/kg q 24 hr

hyperinsulinemia

excess insulin circulating in blood which causes increased growth in the fetus

Chronic fetal hypoxia

can lead to extrauterine death or to respiratory depression at birth

polycythemia

condition where fetus attempts to compensate for the decreased oxygen by producing extra red blood cells

dx when hematocrit is greater than 65%

• increases risk of strokes, seizures, & hyperbilirubinemia

Hypocalcemia and hypomagnesemia

• poor control of maternal glucose leads to maternal glycosuria, causing magnesium loss which causes fetal deficiency

• insufficient magnesium levels cause loss of calcium

severe hypomagnesemia causes a secondary hypocalcemia & hypoparathyroidism (PTH)

bc magnesium is needed for the appropriate secretion of the PTH

Neonatal Abstinence Syndrome (NAS)

drug withdrawal that occurs in newborn infants whose mothers were frequent drug users during pregnancy

neonatal abstinence scale

tools used to evaluate newborn reflexes and behaviors that indicate the severity of withdrawal symptoms and a plan for medical interventions

perinatal transmission

disease transmission involving the infection of a fetus or newborn through the mother during pregnancy, labor & delivery, or breastfeeding

kernicterus

Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain.(brain dysfunction)

• Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death