Contents includes nursing assessment, planning and interventions for newborn at risk for complications
|
1st minute (9)
|
general condition (neuro/respi/circulatory)
|
|
5th minute (10)
|
Determine if neonate can adjust to extrauterine life
|
|
0-3
|
poor: severely depressed, needs CPR
|
|
4-6
|
fair: guarded, moderately depressed
|
|
7-10
|
good: healthy
|
|
RR
|
30-60 bpm (80 bpm in 1st min)
|
|
Breathing
|
Use of abdominal muscles & diaphragm. Newborns are nose breathers
|
|
Reflex
|
Coughing & sneezing to clear airway
|
|
Initiation of repirations:
|
|
|
Chemical
|
surfactant reduces surface tension
|
|
Thermal
|
sudden chilling of moist infant
|
|
Mechanical
|
compression of fetal chest at delivery
|
|
Assess
|
for Respiratory distress
|
|
Plan
|
To maintain a patent airway
|
|
Interventions
|
|
|
Position
|
Head lower
|
|
Suction
|
Bulb near the head, mouth first, avoid trauma to membranes
|
|
Evaluation
|
|
|
RR
|
30-60 bpm with no signs of distress
|
|
Early onset
|
birth to 7 days after delivery
|
|
Late onset
|
8-28 days after birth
|
|
Nosocomial
|
1st week until discharge
|
|
Symptoms
|
|
|
• fever, breathing problems, lethargy
|
|
|
• poor feeding, bloated abdomen. vomiting (yellowish)
|
|
|
• Diarrhea, sleepiness, jaundiced, irregular HR
|
|
|
• low blood sugar and seizures
|
|
|
Treatment
|
|
|
• Sepsis is confirmed with culture test for 7-21 days
|
|
|
• Antibiotics to be given IV
|
|
|
• IV fluids to support the infant till infection clears
|
|
|
• Oxygen or ventilation to support breathing
|
|
|
Prevention
|
|
|
• Antibiotics to control dangerous bacteria
|
|
|
• Breastfeeding may help prevent sepsis
|
|
|
• Providing a clean place
|
|
|
• Delivery within 24 hrs after water breaks
|
|
|
Physiologic Jaundice
|
|
|
• Increase in bilirubin by 2nd day of life, declines in 5th
|
|
|
• Onset and resolution delayed in premature (5-14days)
|
|
|
Pathologic Jaundice
|
|
|
• Persistent jaundice may indicate hepatitis, biliar atresia, down syndrome, hypothyroidism, breast milk inhibitors
|
|
|
• Total bilirubin increasing by >5mg/dl per day
|
|
|
Breastfeeding Jaundice
|
|
|
• appear on breastfed babies after 7 days of life
|
|
|
• peak during weeks 2-3 but may last for a month
|
|
|
Treatment
|
|
|
• Monitor how fast it has been rising
|
|
|
• Needs to be kept hydrated with breastmilk
|
|
|
• Feed baby often up to 12 times a day
|
|
|
• Phototherapy: blue light
|
|
|
• Blood transfusion, IV immunoglobulin
|
|
Physical Findings
|
<2500g (5lb 8 oz)
|
|
Sole creases, skull firmness, ear cartilage
|
|
|
mother's report of last menstrual period
|
|
|
sonographic estimation of gestational age
|
|
|
Risk factors
|
|
|
multiple gest., history of preterm, single teen mother
|
|
|
Physical assessment
|
|
|
AOG
|
less than 37 weeks
|
|
Respiratory
|
Irregular
|
|
Digestive
|
bowel sounds diminished
|
|
Thermoregulatory
|
hypothermia = hypoglycemia
|
|
Reflex
|
Poor suck, swallow, flexion
|
|
Nursing Care
|
|
|
Prevention
|
Prevention of acquiring infection
|
|
Promote oxygenation
|
maintain and monitor body temp, apical pulse, respiratory rate
|
|
Provision
|
tactile stimulation for apnea
|
|
safe and effective environment
|
|
|
Nutrition (readiness)
|
respiration is <60/m | rooting, sucking and gag reflex
|
|
Education of parents
|
|
|
Handle carefully when repositioning
|
|
|
Psychological support : sharing info, reinforce positives
|
|
|
Share caretaking responsibilities with parents
|
|
|
Problems
|
|
|
Aspiration
|
Meconium, hypoxia
|
|
Polycythemia
|
Increase number of RBC
|
|
Seizure activity
|
severe hypoxia
|
|
Cold stress
|
loss of subcutaneous fat
|
|
Hypoglycemia
|
use of glucose stores, glycogen
|
|
Nursing Care
|
|
|
- may require prolonged monitoring
|
|
|
- support well being due to wasting effect
|
|
|
- Early detection of polycythemia & hyperbilirubinemia
|
|
|
- Focus on prevention : due date
|
|
|
- Attention to thermoregulation & feeding
|
|
|
Common complications
|
|
|
• 2-3 times higher morbidity than term infants
|
|
|
• Hypoglycemia
|
used depleted glycogen stores
|
|
• Aspiration
|
of meconium in response to hypoxia
|
|
• Polycythemia
|
Increase RBC response to hypoxia
|
|
• Seizure activity
|
from severe hypoxia
|
|
•Cold stress
|
start to lose weight in the utero
|
|
Appearance
|
|
|
• Possible fracture of the clavicles
|
|
|
• Facial head bruising and palsy
|
|
|
• Caput succedaneum (normal: disappear 12 018 mons)
|
|
|
• Cephalhematoma
|
|
|
Complications
|
|
|
• Birth trauma due to cephalopelvic disproportion
|
|
|
• Increased ceasarian sections
|
|
|
• Hypoglycemia , hyperbilirunemia
|
|
|
• Polycythemia, hyperviscosity
|
|
|
• irregular HR, cyanosis
|
|
|
Nursing Care
|
|
|
- Monitor for hypoglycemia
|
|
|
- Screening for polycythemia (cbc, h&h)
|
|
|
- Careful assessment for injuries & address prenatal concerns about injuries like fractured clavicle
|
|
|
- Monitor temp, and minimize heat loss
|
|
|
- Initiate early feedings, touch and cuddling
|
|
|
- Support parents and teach
|
|
Symptoms
|
|
|
• Bluish skin color of the infant
|
|
|
• Difficult breathing (none or rapid)
|
|
|
• Limpness in infant at birth
|
|
|
Treatment
|
|
|
• ET tube placement and suctioning
|
|
|
• Using a face mask with oxygen mixture
|
|
|
• Antibiotic to treat infection
|
|
|
• Radiant warmer to maintain body temp
|
|
Causes
|
|
|
Not enough of substance called surfactants that consists of phospholipids and protein. begins to be produced at 24-28 wks. by 35 wks most have develop adequate surfactant.
|
|
|
Symptoms
|
|
|
• Difficulty of breathing (tachypnea, grunting)
|
|
|
• Cyanosis (blue coloring)
|
|
|
• Flaring of the nostrils
|
|
|
• Chest retractions (pulling in ribs & sternum)
|
|
|
• symptoms peak at 3rd day, diuresis dec. need of O2
|
|
|
Treatments
|
|
|
• Placing an ET tube, mechanical ventilation
|
|
|
• Supplemental oxygen
|
|
|
• Continuous positive airway pressure (CPAP)
|
|
Methods of Heatloss
|
|
|
Evaporation
|
wet surface exposed to air
|
|
Conduction
|
Direct contact with cool objects
|
|
Convection
|
surrounding cool air. Drafts
|
|
Radiation
|
Transfer of heat to cooler objects
|
|
Manifestations
|
|
|
CC
|
cold skin on trunk & extremities. cyanosis
|
|
DD
|
decrease in temperature & activity
|
|
P
|
poor feeding in form of suckling
|
|
S
|
Shallow respirations
|
|
Nursing Care
|
|
|
Prevention
|
radiant warmer. careful not to burn
|
|
Provision
|
quick dry, head cap & dry warm blankets
|
|
Cold Stress
|
|
|
R
|
respiratory distress
|
|
I
|
increased oxygen need
|
|
D
|
decreased surfactant production
|
|
H
|
hypogylcemia (<30 mg/dl)
|
|
M
|
metabolic acidocis
|
|
Causes
|
|
|
- may be born preterm, term, post term
|
|
|
- may have experienced (IUGR) or failed to grow
|
|
|
- Placental anomaly, poor nutrition
|
|
|
- Smoking, cocaine, teratogen exposure
|
|
|
- Severe DM, decreased blood flow to placenta
|
|
|
Common complications
|
|
|
Perinatal asyphaxia
|
deficient oxygenation
|
|
Hypothermia
|
Inadequate surfactant
|
|
Hypoglycemia
|
Use of glycogen stores
|
|
Meconium aspiration
|
Hypoxia | RDS
|
|
Still birth
|
loss from death
|
|
Nursing Care
|
|
|
• Maintain airway and temperature
|
|
|
• Monitor for signs of respiratory distress
|
|
|
• Monitor glucose level, or signs of hypoglycemia
|
|
|
• Minimize heat loss to prevent hypothermia
|
|
|
• Provide feeding, touch, support, teaching
|
|
|
• Evaluate Hct level : hypoxia & polycythemia
|
|
|
• Monitor signs of sepsis, infection, malformations
|
|
|
• Fluids and frequent feedings
|
|
|
LBW
|
less than or equal to 2500g (5lbs 8 oz)
|
|
VLBW
|
less than or equal to 1500g (3lbs 5oz)
|
|
ELBW
|
less than or equal to 1000g (2lbs 3oz)
|
|
Prevention
|
|
|
• Early & regular prenatal care
|
|
|
• Seek medical check uo
|
|
|
• Quit smoking and other teratogenic factors
|
|
|
• Take multivitamin containing 400 micg of folic acid
|
|
|
Symptoms
|
|
|
• height,weight, and head do not match growth charts
|
|
|
• Weight is lower than 3rd percentile (20% below ideal)
|
|
|
• growth may have slowed or stop
|
|
|
• Delayed or slow to develop physical, mental, social
|
|
|
Treatment
|
|
|
Nutritional
|
provide a well balanced diet
|
|
Supplements
|
talk to HCP first, correct deficiency
|
|
Symptoms
|
|
|
• Back pain, blood in urine
|
|
|
• Chills, fever, jaundice, impending doom
|
|
|
Treatment
|
|
|
• Antihistamines to treat allergic reactions
|
|
|
• Steroids to treat swelling and allergies
|
|
|
• Fluids given intravenously
|
|
|
• Medicines to raise blood pressure if drops too low
|
|
|
• Rh immune globulins (Rhlg) for rh incompatibility
|
|
|
Exams and tests
|
|
|
• Coombs' test to llok for cell destroying antibodies
|
|
|
• Bilitubin test shows high. CBC: damage to RBC
|
|
|
• Urine test shows presence of hemoglobin
|
|
Factors causing SIDS
|
|
|
Brain Ab.
|
portion that controls sleep & breathing doesn't work properly
|
|
LBW
|
baby's brain has not matured completely
|
|
infection
|
contributes to breathing problems
|
|
Sleeping
|
on side, on soft surface, with parents
|
|
Prevention
|
|
|
• Sleeping on the back
|
|
|
• Keep the crib as bare as possible. use firm mattress
|
|
|
• Don't overheat baby. blanket should be lightweight.
|
|
|
Baby should sleep alone. baby can be rolled over by parents
|
|
|
• Breast feed for six months lowers risk of SIDS.
|
|
No comments yet.
Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
