Part 1 High Risk Newborn: complication and condition skeleton notes (copy) (copy)

exam 4: chp 25&25

Preterm Infants:
How can preterm birth be prevented?

Adequate prenatal care

• encourage to attend all their prenatal visit

• so mom can get all education on preterm labor

Preterm Infants: Assessments and care of common problems (respiratory) 
Infants born before surfactants production is adequate develop ________ Distress syndrome (RDS)

Respiratory

Preterm Infants: Assessments and care of common problems (respiratory) 

What is periodic breathing?

the baby will stop breathing for like 5 to 10 seconds but won’t have any other changes but all of sudden will do a 10 - 15 sec rapid respiration

Preterm Infants: Assessments and care of common problems (respiratory)

Do we see changes in skin color or heart rate with periodic breathing (YES/NO)? 

NO

Preterm Infants: Assessments and care of common problems (respiratory)

What are apneic spells? How are they treated (first intervention)?

• Absence of breathing lasting more than 20 sec or less if accompany by cyanosis, pallor, bradycardia, or hypotonia (decreased muscle tone).

• Stimulate the baby (gentle) - the least invasive

Preterm Infants: Assessments and care of common problems (respiratory)

When assessing “effort of breathing,” what abnormalities might you come across?

• look for sign of retractions (when chest wall is drawn in with each respiration)

• observe for grunting (early signs of respiratory distress syndrome)

Preterm Infants: Assessments and care of common problems (respiratory) 

Nursing interventions

Collaborate with different teams (RT)

O2 to infant via nasal cannula who can breath independently) - make sure O2 is warm so that it maintain their body temperature

Hydration - keep secretions thin

Positions - Side lying & prone position help facilitate drainage of secretions

Suctioning - Mouth BEFORE nose

Preterm Infants: Assessment and Care of CommonProblems (Thermoregulation) 

Preterm infants spend a shorter amount of time in the uterus, which allows for less ______________ fat to accumulate before birth, impairing the infants ability to produce
____________.

brown fat; produce heat

Preterm Infants: Assessment and Care of CommonProblems (Thermoregulation) 

Assessments

• Monitor temperature continuously by attaching skin probe on abdomen

• use axillary temp to make sure it is correct and maintain temp between 97.3 - 98.4

Preterm Infants: Assessment and Care of CommonProblems (Thermoregulation) : Nursing Interventions

Why is it Important to maintain a neutral thermal environment?

to prevent the need for increased O2 and to maintain infant body temperature

Preterm Infants: Assessment and Care of Common Problems (Skin): Assessments

Assess skin frequently and document changes

Preterm Infants: Assessment and Care of Common Problems (Skin): Nursing interventions 

Do Infants bathed everyday (YES/NO)?

NO

notes: reposition infant frequently and equipments, and remove adhesive slowly and gently

Preterm Infants: Assessment and Care of Common Problems (Infection):

Why are preterm infants at a greater risk of infection?

• invasive procedure like insertion of IV lines and frequent blood draw. 

Preterm Infants: Assessment and Care of Common Problems (Infection): Nursing interventions

________ is one of the most important aspects in preventing hospital-acquired infections.

HANDWASHING

Nutrition:

What are signs that a feeding may be too much?

• frequent regurgitation or vomiting with feeding

Nutrition:

How is TPN (parenteral feeding) provided?

• IV continuous infusion of TPN

Nutrition: Enteral feedings 

What are trophic feedings and when do they begin?

began in first few day of life and practice of feeding very minute (small) volume of enteral feeds in order to stimulate development of preterm infant GI tract

Nutrition: Enteral feedings 

What milk should be used for trophic feedings?

prefer mom’s milks but in some cases donor breast milk

Nutrition: Enteral feedings 

Prior to initiating trophic feedings, what assessments findings should be present?

bowel sounds and infant have to be relatively stable

Nutrition: Gavage Feedings

What are gavage feedings and when are they usually started?

small catheter is inserted through either mouth or nose and known as NG/OG tube and provide intermittent feedings and given slowly over period of 30 min - 60 minutes & started before oral feedings

Nutrition: Gavage Feedings

Why are pacifiers provided during garage feedings?

given during gavage feedings because it help them associate with comfortable feeling of fullness with sucking

Nutrition: what are signs that the newborn may be ready for nipple feedings?

• baby exhibiting rooting reflex

• increased ability to tolerated being held and being handled by nurse/parents

• infants sucking on your fingers or pacifiers

Nutrition: Respirations

What need to be assess before and during feeding?

Respirations must be assessed BEFORE and DURING feedings!!

Nutrition: Respirations

Respirations must be < than _____/minute to begin oral feedings.
If respirations are >60/minute, ________ feedings will be done instead in order to prevent aspiration.

less than 60 breaths per min,

gavage feedings

Nutrition: Respirations

What does frequent choking, gagging, and/or cyanosis during feedings indicate?

Not ready to coordinate feedings movements well enough to be feed by nipples

Nutrition: 

When do oral feeding begins?

when they shows signs of readiness rather than a certain schedule

physiologic and behavioral readiness

Nutrition:

Why are infants allowed to rest before and after oral feedings?

because it involve a lot of energy from the infants 

allow rest and watch for signs of stress or respiration >60 we finish with gavage feedings

Nutrition:

All preterm infants should receive what type of milk due to its benefits and immunologic properties?

human milk

• less stressful than bottle feedings

Intraventricular Hemorrhage (IVH):

This condition is most often seen in premature babies, and the smaller and more premature the infant, the ____________ the risk for IVH.

higher

Intraventricular Hemorrhage (IVH):

Most hemorrhages take place within the ________ week of life. An ultrasound is typically performed at_____ days of age for preterm infants who are at risk for this complication.
If bleeding is found on this ultrasound, serial ultrasounds are performed to determine progression of the problem.

first week of life,

around 7 day of age

Intraventricular Hemorrhage (IVH):

What are situations that increase cerebral blood flow?

hydrocephalus from blockage of cerebral spinal fluids(csf)

Intraventricular Hemorrhage (IVH):

What are signs of increasing ICP (increased intercranial pressure)?

• behavior change

• seizures

• bulging fontanels

Retinopathy of Prematurity (ROP)

This is a condition in which injury the _________ in the eye leads to growth of new blood vessels that abnormally develop and may result in visual impairment or blindness in preterm infants.

blood vessels

Retinopathy of Prematurity (ROP)

***Even though the exact cause is unknown, what is the one MAJOR risk factor in ROP?

** high level of oxygen

Necrotizing Enterocolitis (NEC)

The incidence of NEC is higher after infants have received feedings. Feedings that are too _________ or increased too ________ may cause NEC. This typically happens to babies who are fed __________ instead of breastmilk.

too early,

too fast,

formula

Necrotizing Enterocolitis (NEC)

Early recognition is essential. If one or more signs are recognized, what should the nurse do?

Withhold feedings and notify provider right away

Necrotizing Enterocolitis (NEC)

THINKING POINT: The nurse should be alert for an ___________ in the abdominal girth, decreased or absent bowel sounds; and __________ in the stool. What are other manifestations of this condition?

increased in abdominal girth,

blood in the stool

Small for Gestational Age (SGA) Infants
These are infants who fall below the_____ percentile in size on growth charts. SGA infants can be preterm, __________ term, or post term

10th percentile,

full term 

Small for Gestational Age (SGA) Infants
What does poor placental function interfere with ?

• with oxygen and nutrients going to the baby which interfere with growth of fetus

can cause baby to be small for gestational age

Small for Gestational Age (SGA) Infants
How can Diabetes lead to a newborn being SGA?

• restrict blood flow to placenta

Small for Gestational Age (SGA) Infants
How is this condition managed when it is identified during pregnancy?

the moms may need to go through non stress test and biophysical profile screenings to help physician determine whether or not the infants need to be deliver early

polycythemia

large amt of bilirubin may be released when red blood cell is break down

**Its important to observe sign of jaundice

Large for Gestational Age (LGA) Infants

These are infants who fall above the ______ percentile in size on growth charts. Their size is ___________ than expected for gestational age.

90th, larger

Large for Gestational Age (LGA) Infants

They may have ____________ (which means they weigh > 4000grams/ 8lb 13oz) and are usually born at term, although they may be preterm or postterm.

macrosomia

Large for Gestational Age (LGA) Infants

What type of complication could result if a mother delivers an LGA infant vaginally?

• much longer labor

• suffer injury

• may need c-section

• higher risk of shoulder dystocia