preterm

premature is consider

<37wk

extremely preterm

<28wk

very preterm

28 -31 6/7 wk

moderately preterm

32-33 6/7

late preterm

34-36 6/7

late preterm gestration experince

-resp distress

-hypoglycemia

-temp insytabiloty

-poor feeding

-jaundice

-dischagre delay

-higher readmission

low IQ pissible need speech /cognitve /behabviorual change

viabilityc

capacity to live of uterus outside 22-25wks

LBW categorize

ELBW <1000g

VLB 1000-1499

LBW 1500-2500

incidence of prematurity

leading cuase

highest inlow SES status

elective preterm delivery contributing factor

multiple gestation

preeclampsia

placenta previa

PROM

spontaneous premture contrubuting factor

-IVF

-poor prenatal care

-poor nutrition

-smoking

-young or old maternal age

untreated infection

-multiple gestation

-cervical insufficency

-placental abruptio

-congenital defect

-low SES

preterm infant charcteristic

-frail and weak

-undevelopped flexor and muscle tone

-weak extermity

-lack of sc fat

-abundant vernix caeosa and lanugo

-absen plantar crease

-flat and soft pinnna ear

-low energy

-exhanuster

-feeble cry

male ptreterm

undescended testes

small scrotal sac

big testes

femal preterm

clotoris and labia minor large

covered labia majora

surgactant production

it coat inside of lining of lung

prevent alveoli prolapse

fetus produce it 3rd trimster onlu

surfactant production is inadequate for

prevent alveolar collapse and atelectasis

result resp distress syndrom

factor contribute to ineffective oxygenation

-decrease number of function alveoli

-decrease surfactant

-smaller airway

-smaller tracheal cartilage

-resp passage obsturction

-bony throax with minimun calcificatio

RDS is r/t

developmental dealy in lung maturation

decrease surfactant production

result decrrease lung compliance

RDS ss

tachypnea

nasal flaring

retraction

central cyanosis

apnea

resp support can be given with

RA

supp,emental oxygen tarfet 90-95

invansive supporT:CPAP mechanical ventilation

CPAP

provide constant distending pressure in spontaneois breathing infant

oxygen therapy nursing consideration

-warm and hudified osygen

-asess resp.status q1-2hr

-continue sat monitor

-sunction PRN nasopharynx/trancheal/nasophaynx

-tubing should not compromise vision,holding,bottle fedding

-ensure NP in place,not cause skin irritation

-neutral thermal environment

-adminster surfactant replacement

-prone/side lying postion

-adminsyer percusion,vibration,postural drianage

prone position benefit

-allow more efficent muscle use

-decreae resp effort

-better O2 lung compliance

-promote optimal gas exchange

-early weaning form ventilator to reduce chance of lung injury

-increase bllod return rt heart

-secretion driagnage

-encoruage extermity flexion

surfatant therpay

management of SDS

instill in liquid form via endotracheal tube

rescue tx /prophylactic

reduce mortility/morbidity

coat inside orevent alveoli collapse

RDS lead to

bronchopulmonary dysplasia

damage lung

due to ventilator and oxygen use

lead to life long need

growth fialure

pulmonary hTN

long term tx

thermoregulation

prevent heat loss in distressed newborn s essential for survival

consequnce of cold stress

hypoxia

metabolic acidosis

hypoglycemia

body temp instability influence factor

-large body surface r.t body surface

-Minimal insulating sc fat

-limit brown fat store

-decreae /absent reflex vasoconstriction

-inadeuqate muscle mass

-poor muscle tone more body surface

-immature thermoregulator

-decrease cloric intake

goal of thermoregulation

neutral thermal envrinment

enviornmentla temp

oxygen consumption metabolic rate minimal

but adequate thermoregulation

thermoregulation nursing care

-continue monitor temp

-radiant warmer/incubator

-avoid draft under warmer-hydration needed

-avoid pacing stuff bettwen heat source and infant

-avoid overheating/heat lump

-skin to skin care

skin to skin benefit

direct eye contact

skin to skin sensation

close proximity

healing for mom,increase bonding

promoto stable vs

increae feeding vigor

sleep better

cry less

common infection

sepsis

meningitis

infection infleucning ifacotr

shortage of store maternal immunoglobulion

unable to make antibodu

compromissed skin

invasive procedure

long hospitalization-HAI

sign of possible infection

• temp instablity

• metabolic acidosis

• CNS:lethargy irritability

• color;cyanosis,pallor jaundice

• cardio:instability ,hypotension ,tachy/bradycardia

• resp;tachypnea,apnea,retraction,nesal flaring ,grunting

• GI;feeding intolerenace,dirrhea,vomit,glucose instabilitu

goal of infection

not evidence of nosocomial infection

prvent skin breakdown,maintain good skin integrity

stable thermoregulation

nursing intervention of thermoregulation

-hand hygiene prevent contact

-clean euqipment

-monitor vs

-matenral milk

-avoid skin care product,minimal use of tape

-apply skin barrier

-use transparent elastic dsg instead

-laternate elctrode palcement

-lessen scirssor use

pain occur during routine care

gavage tube placement

bladder cathrization

physcial exam

pain occur moderately invasive procedure

sunctioning

phlebotomu

IV access

common sign of pain

-increase/decrease HR RR

-desaturation

-hypertension

-high pitch ,intense cry

-whimpering,moaning

-eye squeezed

-grimacing

-bulging/furrowing brow

-tense rigid /flaccif musclr tone

-rigidity/flainling extermiety

nursing intervention pain

-flexed exteremity

-allow one hand to be near mouth

-pacifier

-gentle talk

-hold rocking swaddling

-pain med

-bf by mother

-skin toskin

-tactile soothing

poor nutrtion factor

120kcal/kg/day

-GI do not absorb,specially fat

-lack coordiantion of sucking and swallow

-weak/absent suck swallow

-poor gaga reflex

-immature digestive capacity

-oral feeding need more nergy too

-risk of aspiration/regurgitation

BF preterm benefit

-immunologic to pass passive immunitu

-easily digested

-increase feeding tolerance

-higher o2

keep bb warm

BF education

add fortifier

provide privacy

teach mom to maintain lactation

gavage feeding

thorugh nasoagastric tube,orogastric tube

intermittenting-bolus/continuously -indwelling tube

gastronomy feeding

surgical placement of tube

start hours after,slowly

skin care needed aroung insertion site

monitor IO

feed/satiation with sucking and nonnutrtive sucking

TPN

When GI is impossible/inadeuqate /hazardous to be use provide nutrtion need

-highly concetraed glucose,protein,other nutrtion

-routine blood work if needed

-by PICC

what can used in feeding

IV TPN with gavage feeding

nipple feeding

non nutetive sucking

nipple feeding adverse sign

tachycardia,,bradycardia

tachypnea

desat

apnea

couging/gaging

25-30min

poor sucking reflex

sign of fatigue

inadequate weight gain

cyansosi

when is it ready for nipple feeding

rooting sucking reflex

improve motor skill

stable BS

interstr in feeding cue

weight gain

non nutrtive sucking do

improve oxygenation/facilate early nipple feeding transition

improve weifht gain

improve milk intake

stabilize VS

help with oral feeding

elevated side lying

coregualte pacing and resting

avoid prodding mechanism to provide support

constant light noise exposure cuase

changei in VS behabior

noise level of 7-120 from alarm

distube sleep

noise level

corelayte with intracranial hemorrhage

audotory problem

24hr ssurveillance

light scheldue rest period

nursing intervention can le

hypoxia

desta

increase ICP

before 33wk external stimualtion procedue

jerky movement

irregualr vs

patent ductus artierous

seen in most of LOW infant

need rx or or

lead to rt HF

ss of ductus arterious

systolic murmur

widen pulse pressure-bouding peripheral pulse

tachycardia

tachypnea

crackle

hepatomegalu

CNS common problem

poor sucking and swallow reflex

intraventricular hemorrhage

developmental/cognitive delay

intraventricular hemorrhage

neuro injury

unknow incidence

<32wk <1500g

risk factor intraventricular hemorrhage

intavasualr problem

hypoglycemia

acidosis

RDS

unsstable VS

infection

coagulopathy

fluctating cerebral blood flow\increase cerbrall venous pressure-increase ICP

intraventricular hemorrhage nursing intervention

head midline HOB highly elevated

NTE maintain

maintain oxygenation

avoid rapid infusion of fluid

NTE could

p0ermit newborn to maintain normal core temp with minimum odygen consumption andcalorie expendicture

cerbeal palsy ss

non progressive ataxia

spasticity

involuntary movement

CP cause

premature

nenatal enceloopathy

kernicterus

perinatal asphysia

CNS infection

periventricular white mayer infarction

retinopathy premature

poor eyesight -ned glasses til adolescent

<26wk hearing aid

cosequence of excessive [rolong use of oxygen

GI common problem

feeding intolerance d/t small stomach,poor sucking,nectrotiziing enterocolitis

GERD

premature

transfer gastic content intoesophagus

necrotizing enterocolitis

short gut syndrom,uncontrol stollling

imparied grwoth

cause:r/t instinal ischemia,immatue GI host defense,bacterial proliferation,formiula

TPN reuqired

why at risk for electolyte imbalance

lung:tachypnea,high oxygen

higher extracellular water

immture kidney,unbale concentrate

immture skin barrier.lack of surface area,lack of flexion

larger body surface

higher metoblic rate

phottherpay

nursing intervention electolyte imbalnce

monitor vs

adminster parental fluid supplment

hudified envrionment:isolette

monito IO and weight

monitor USG,elctorlye,serum drug level

assess behavioru altreation:altert,activity,termor,seizure

NICU promote family centered care

prematue is unexpected and stressful

quckly seperate with mom

need to infrom parent

NICU family center care

prep pt for infant apperance ,equipment attch,genral atmosphere

help to express guilt,anxiety,helplessness

startle response to touch pt prepare

involve parent in small act of caregiving activity

encoruage to bring toy/ohoto

set goal

prep discharge

interdispilanry colab

medcial and nursing f/u

refer to home care specialist

develop,ental f/u

help familuy creat nomral routine

support group

maintain communciation

health teaching