Chapter 13 preterm and postterm newborns

Some preterm infants are fed by gavage because of:

1. confinement to the incubator.

2. overdeveloped gag and cough reflexes.

3. refusal of formula.

4. weak sucking and swallowing reflexes.

4. weak sucking and swallowing reflexes.

A characteristic sign of necrotizing enterocolitis (NEC) in the newborn is:

1. bloody diarrhea.

2. necrosis of the abdomen.

3. projectile vomiting.

4. high fever.

1. bloody diarrhea.

Which of the following observations of a preterm neonate would indicate the presence of respiratory distress? (Select all that apply.)

1. Substernal retractions

2. Respiratory rate of 70/min

3. Grunting

4. Lethargy

1. Substernal retractions

2. Respiratory rate of 70/min

3. Grunting

An infant is born at 43 weeks' gestation. The nurse should monitor the infant for common problems, such as (select all that apply):

1. respiratory distress caused by immature lungs.

2. increased weight gain resulting from increased glucose availability.

3. hypoglycemia resulting from reduced glucose reserves.

4. presence of increased amounts of lanugo.

1. respiratory distress caused by immature lungs.

3. hypoglycemia resulting from reduced glucose reserves.

The nurse observes that a preterm infant has a pulse rate of 96 and a pulse oximetry reading of 89%. The first action of the nurse should be:

1. Go and call the health care provider.

2. Gently rub the infant's back and suction the nose.

3. Call a code

4. Continue observation and documentation as this is normal.

2. Gently rub the infant's back and suction the nose.

Aroma therapy in the NICU is accomplished by:

a. placing a sweet-smelling room deodorizer in the room that has a calming effect.

b. using baby oil on the infant's skin.

c. placing an article of the mother's clothing in the infant's crib.

d. using gentle touch to calm the infant.

c. placing an article of the mother's clothing in the infant's crib.

d. using gentle touch to calm the infant.

What terminology will the nurse use when considering how well developed the infant is at birth and the ability of the organs to function outside the uterus?

a) Level of development

b) Gestational level

c) Level of growth

d) Level of maturation

d) Level of maturation

A preterm infant in the NICU is receiving calcium gluconate for hypocalcemia and hypoglycemia. What assessment would the nurse prioritize?

a) Heart rate

b) Temperature

c) Level of consciousness

d) Color

a) Heart rate

What benefit does kangaroo care provide, in addition to using skin-to-skin contact to warm and calm the child?

a) Maintains skin integrity

b) Promotes bonding

c) Increases appetite

d) Stabilizes vital signs change to stabilizes blood sugars

b) Promotes bonding

What physical characteristic most likely indicates postmaturity?

a) Abundant lanugo

b) Thin, transparent skin

c) Abundant vernix caseosa

d) Peeling skin

d) Peeling skin

Which characteristic put a preterm infant at risk for sepsis?

a) Immature liver

b) Decreased prothrombin

c) Hypocalcemia

d) Lack of brown fat

a) Immature liver

Which signs and symptoms characterize cold stress? (Select all that apply.)

a) Hyperactivity

b) Mottling of the skin

c) Fever

d) Periods of apnea

e) Tachycardia

b) Mottling of the skin

d) Periods of apnea

Identify the physical characteristics that would be present in an infant with respiratory distress syndrome. (Select all that apply.)

a) Grunting and retractions

b) Edema

c) Respiratory rate above 60

d) Meconium stained sputum

a) Grunting and retractions

b) Edema

c) Respiratory rate above 60

gestational age

age of neonate based on the time in utero

give corticosteroids silestone*

give to mom for baby to produce more surfactant to help baby breathe easier

RDS in baby

give mom silestone preterm, baby goes home with apnea monitor

bronchopulmonary dysplasia

caused by oxygen toxicity

02 sat for baby

92% or above

sepsis tx

antibiotics

s/s cold stress*

skin temp decreased, tachypnea with apnea, bradycardia, mottling of skin, lethargy

reason for incubator or warmer for baby*

inability to mintai own temp

preterm infant physical appearance

loose transparent skin, lots of blood vessels close to surface, alot of vernix, lanugo, soles of feet have creases, male genitalia testes in scrotum/undescended, female genitalia labia majora doesnt cover labia minora

hypoglycemia s/s

high pitch cry*, weak, tremors, jittery

reason for intracranial bleed in preterm infant

fragile capillaries of head/capillaries on surface, immature clotting system/deficiency in prothrombin/unable to clot

ROP/retinopathy prematurity

need oxygen, check o2 sat

preterm baby hypoglycemia

blood glucose <30

reason for preterm having hypoglycemia

poorly developed thyroid gland

baby might need gavage feeding because of

poor sucking and swallowing

signs of bloody stools during gavage feeding look for s/s of

NEC/Necrotizing enterocolitis

signs of NEC/Necrotizing enterocolitis

abdominal distention, bloody stools, diarrhea, bilious vomitus

icterus

jaundice

if bilirubin is above 12.9*

report it

put baby under bili lights to help

breakdown bilirubin so it can be excreted

when baby is under bili lights

must be diapered/cover genitals, wear eye shield/cover eyes

notify doc of*

paleness, vomiting, bulging fontanelle for preterm baby

physical characteristics of postterm newborn

no vernix, long thin appearance, dry peeling crack skin

reason for cold stress in postterm newborn

brown fat was used in utero

ideal feeding for preterm baby

breastmilk

what should you do before a gavage feeding

aspirate

postterm baby complications

risk for RDS, hypoglycemia