Part 2 High Risk Newborn: complication and condition skeleton notes (copy)

Exam 4

Hyperbilirubinemia: what is it?

When Total Serum Bilirubin (TSB) is >5-6 mg per deciliters (mg/dL) jaundice appear

Hyperbilirubinemia

Hyperbilirubinemia is a concern because it could lead to bilirubin encephalopathy (acute manifestation of bilirubin toxicity), which can then lead to kernicterus. What is kernicterus?

brain damage

• can be a permanent result of bilirubin toxicity

Hyperbilirubinemia

Bilirubin encephalopathy and kernicterus are rare today due to improved treatment; however, if a newborn does develop this, what might they permanently suffer from?

• cerebral palsy

• cognitive impariment 

• other type of neurological and developmental problems

Hyperbilirubinemia: management

What is the most common treatment for jaundice?

phototherapy (most common treatment)

Hyperbilirubinemia: management

Phototherapy involves placing the infant under special fluorescent lights. Bilirubin in the skin __________ the light and changes into water-soluble products. These products do not require conjugation by the ____________ and can be excreted in ________ and __________

absorb, liver, urine and stool

Hyperbilirubinemia: management

Phototheraphy can be delivered in different way:

Bili Lights and BIli Blankets

Bili lights: banks of lamps (incubator, open crib or warmer) - in diaper only and need eye patch

Bili Blankets: does not require eye patch, mom can hold baby but not as effective as bili lights

Hyperbilirubinemia: Nursing care and assessments

In infants with dark skin, how color is assessed?

• look at the color of palate and mucous membrane of mouth and eyes

• document it

Hyperbilirubinemia: Nursing care and assessments

jaundice begins at the ____________ and moves down the body as levels _______________.

jaundice begins at the _head_ and moves down the body as levels _rise_.

Hyperbilirubinemia: Nursing care and assessments

why are frequent feeding important?

• it promote GI motility which help with removal of bilirubibn from intestines

• also prevent hypoglycemia

When can newborn acquired Infection?

Newborn can acquire infections before, during or after birth!

• infection divided into vertical or horizontal infection

Infections: 

Vertical infection is acquired __________ or during birth from the mother

Vertical infection is acquired _before_ or during birth from the mother

Infection:

example of vertical infection

• Organisms that cause Rubella, syphilis, HIV, toxoplasmosis all can cross the placenta and cause infection during pregnancy).

• During labor, organisms in the vagina (GBS), herpes, hepatitis could enter the uterus after ROM or infect the infant during passage through the birth canal.

Infection: 

Horizontal infection occurs___ birth and is acquired from hospital staff members, contaminated equipment, or from family members/visitors.

• Horizontal infection occurs_After_ birth and is acquired from hospital staff members, contaminated equipment, or from family members/visitors.

Infection:

Why are newborns susceptible to infections?

they have immature immune systems

Infection:

Early-onset sepsis is acquired during birth, often from complications such as - _______ ROM, prolonged labor, and chorioamnionitis.

Early-onset sepsis is acquired during birth, often from complications such as - _prolonged_ ROM, prolonged labor, and chorioamnionitis.

• Infants show signs within the first 3 days of life.

Infection:

Late-onset sepsis is most common after the first week of life.
When newborn acquired it?

• Acquired during or after birth; before or after hospital discharge.

Infection:

C-reactive protein (CRP) may be elevated. What is an elevated CRP a sign of?

sign of inflammatory process

• usually elevated in baby who has infection

Infection:

What are signs of infection in a newborn?

• temp instability

• respiratory changes - respiratory distress

  • nasal flaring, grunting, retractions, and tachypnea

• change in feeding habits

• cardiovascular changes: tachycardia

• neurological change

  • lethargy, jittery, and high pitches cry

Infection:

What nursing interventions are important in preventing infection?

• prevent infection - Hand hygiene (most important)

• disinfect equipment 

• use sterile technique on any type of invasive procedure

• Antibiotics administration: sent specimen to lab

  • Broad spectrum antibiotics given before the cultures come back 

• IV fluids

• gavage feedings

• support parents

Infant of a Diabetic Mother (IDM)

Infants of _______ mothers face many risks that depend on the type of diabetes and how well it is _______.

Infants of _diabetic_ mothers face many risks that depend on the type of diabetes and how well it is _controlled_.

Infant of a Diabetic Mother (IDM)

When the mother is _______, large amounts of glucose are transferred to the fetus.
Insulin does NOT cross the ______.

When the mother is _hyperglycemic_, large amounts of glucose are transferred to the fetus.
Insulin does NOT cross the _placenta_.

Infant of a Diabetic Mother (IDM)

Excessive glucose received by the fetus causes the fetal pancreas to secrete __________ amounts of insulin

Excessive glucose received by the fetus causes the fetal pancreas to secrete _large_ amounts of insulin

Infant of a Diabetic Mother (IDM)

Hypoglycemia may occur after birth when the supply of glucose from the mother is no longer available but the infant continues producing high levels of ______.

Hypoglycemia may occur after birth when the supply of glucose from the mother is no longer available but the infant continues producing high levels of _insulin_.

Infant of a Diabetic Mother (IDM)

Why are Infants of Diabetic Mothers at a higher risk for asphyxia and RDS?

• because level of insulin blocks the effects of cortisol on the simulation of lung maturity

Infant of a Diabetic Mother (IDM)

Insulin acts as a ________ hormone, so typically Infants born to Diabetic Mothers are macrosomic. 

growth hormone

Infant of a Diabetic Mother (IDM):

strict control of blood glucose during pregnancy reduces the risk of ______.

macrosomia

Infant of a Diabetic Mother (IDM):

What are the sign if low blood glucose in newborn?

• jitteriness/tremors in newborn

• rapid respiration and low temp

and FEED EARLY

Infant of a Diabetic Mother (IDM):

***Cold stress increases the need for oxygen and _______. It is important to maintain normal temperature in order to prevent exacerbation of hypoglycemia.

Cold stress increases the need for oxygen and _glucose__. It is important to maintain normal temperature in order to prevent exacerbation of hypoglycemia.

Prenatal Drug Exposure:

Substance abuse affects the fetus at ______ during pregnancy ... most drugs readily cross the placenta and cause problems!

Substance abuse affects the fetus at _anytime_ during pregnancy ... most drugs readily cross the placenta and cause problems!

Prenatal Drug Exposure:

Maternal substance abuse may be identified before an infant is born, but some infants are born to women whose substance use is not known . What might cause the nurse to suspect substance abuse?

received no prenatal care during pregancy or very minimal prenatal care

Sign of Neonatal Abstinence Syndrome (NAS):

(star on powerpoints)

• very irritable, high pitche dcry

• hyperactive muscle tone

• tremors

• appear hungry and vigorously suck

• sneezing

Prenatal Drug Exposure:There are different ways to identify infants who have been exposed to drugs.
Urine Drug Screen:

1. The first urine should be obtained!
2. Some drugs last several days because of the infants immature liver and kidneys (excretion is delayed).

Prenatal Drug Exposure:

Meconium Drug Screen:

3. used to detect drug use as far back as the second trimester.

Prenatal Drug Exposure:

Umbilical cord segment

4. test the umbilical cord for prenatal drug exposure

Prenatal Drug Exposure:

Nursing considerations

• trying to minimize withdrawal symptoms

• encouraging feeding

• promoting rest

• if possible: enhance parenteral attachment to the baby

Congenital Cardiac defects:

***Manifestation

(STAR on slide)

• cyanosis

• murmurs

• fatigues

• tachycardia, tachypnea and fatigues

• slow weight gain and feeding issues

• diaphoresis (excessive sweating)