High-Risk Neonatal Nursing Care – Flashcards

very premature: under 32 weeks premature: 32-34 weeks late premature: 34-37 weeks low birth weight: less than 2500 grams very low birth weight: less than 1500 grams extremely low birth weight: less than 1000 grams

life threatening lung disorder that results from underdeveloped and small alveoli and insufficient levels of surfactant (produced at 28 weeks; reduces surface tension within the lungs and increases pulmonary compliance; keeps sacs partially open; 90% phospholipid, 10% protein) atelectasis: collapsed lungs, trouble expanded lung tissue preterm labor or early induction: do an amniocentesis and send off to see if lungs are mature: presence of PG: mature, 2:1 L/S ratio: mature complications: pneumothroax, pulmonary edema, HypoTN, seizures babies end up on vent

chronic lung problem that affects neonates who have been treated with mechanical ventilation and have been intubated with the use of oxygen risk factors: prematurity, RDS, ventilation, low birth weight, infection complications: pneumonia, increased respiratory infection, CHF, cerebral palsy, hearing loss, ROP, SIDS

normally closes w/in 15 hours of age. this occurs when it remains open after birth. connects pulmonary artery w/ descending aorta. risk factor: prematurity complications: chronic lung disease, RF, intraventricular hemorrhage, NEC

common forms of intracranial hemorrhage. occur in preterm infants with RDS and complications from ventilation. occur in 30-40% of infants less than 1500 grams (micropremies). 90% occur in first 72 hours. grade depending on severity: grade 1-4. risk factors: prematurity, LBW, low hematocrit, alteration in BP long term prognosis: depends on severity of bleed

GI disease that results from inflammation or necrosis of the bowels (bowels are dying). can happen very quickly, very painful- fentanyl drip. assess bowel sounds and girth. can perforate quickly risk factors: prematurity, umbilical catheter placement long term outcomes: bowel obstruction, cerebal palsy. 30% die

less than 28 weeks; abnormal growth of tissue around the retina that extends out and causes scar tissue around the retina and macula. pulls on the retina and distorts it. preterm babies will have frequent eye exams to make sure it's not pulling away. risk factors: prematurity, hypoxia, prolonged use of oxygen. infection, blood transfusion risk reduction: proper use of oxygen-- use oxygen blenders to give proper amount long term outcomes: laser treatments, may end up with cataracts, retinal detachments, blindness-- catch early

gestational age by ballard score is at or below 37 weeks thin, transparent skin lanugo- 20-28 weeks eyes fused closed- under 26 weeks dimished or absent reflexes immature sucks and swallows apnea spells- no breathing 10-15 sec hypotension heart murmurs anemic

RDS: retractions, grunting, flaring, grey/dusky skin BPD: retractions, wheezing, rales, hypoxia, edematous PDA: heart murmur, tachycardia, tachypnea, bounding pulses, require an increased demand of oxygen PVH/IVH: bradycardia. shock, low hematocrit, tense/full fontanel NEC: apnea, unstable temperature, abdominal distension, bloody stools, discolored abdomen

born after completion of 41 weeks, post their due date Postmaturity syndrome: fetus uses up SQ fat stores and gylcemic stores macrosomia: BW is above 4000-4500 grams risk: history of PT baby, first pregnancy risks related: meconium aspirtation, hypoglycemia, hypothermia, birth trauma, fetal hypoxia S/S: dry peeling skin, no vernix, profuse hair, long nails, meconium staining skin need oxygen therapy, glucose checks, assess respiratory status, skin care

fetus has had meconium stool into amniotic fluid dangerous for baby to suck it down their lungs complications: airway obstruction, pneumonia, pulmonary edema *assess amniotic fluid once it breaks* respiratory therapy attends delivery to intubate and assess if below vocal cords will see discoloration of skin and nails, resp distress suction once head is out, ABGs, chest xray, possible antibiotics, oxygen nurse: extra suctioning, glucose monitoring

when normal vasodilation and relaxation of the pulmonary vascular bed does not occur hypoxia, RDS, slow to breathe (vent), retractions, grunting, flaring assess for resp distress, administer oxygen, IV fluids, meds, surfactant, vasopressers

-SGA: weight is less than 10 % for their gestational age -IUGR: growth is inconsistent with their gestational age -symmetric: proportional reduction in all sizes/structures except for heart and brain -asymmetrical: disproportional reduction in size of organs due to decrease in cell production or chronic malnutrition risk factors: multiple gestation (twins), no prenatal care, small placenta, smoking, HTN related risks: meconium aspiration, hypoglycemia large head, dry/flaky skin, RDS, hypothermia ultrasounds, measure belly, good if found in pregnancy. US for anomalies frequent VS, assess for RDS

weight is above 90% for their gestational age risk factors: maternal diabetes, multiparity, previous large baby, prolonged pregnancy risk related: c-sec, shoulder dystocia, breech, birth trauma, hypoglycemia fractured clavicle, facial nerve damage, cephalahemotoma assess for trauma, respiratory distress

*kernicterous*: abnormal accumulation of unconjugated bilirubin in the *brain cells*. causes deafness and maybe permanent brain damage physiological jaundice: hyperbilirubinemia after first 24 hours of birth pathological: occurs withint first 24 hours of birth phototherapy/bili lights: cover eyes, keep warm, can come out to feed, but need to be under lights as much as possible

risk factors: birth trauma, breech, precipitous labor (quick), forceps, assess: subdural hemorrhages, ischemic brain injuries, facial nerve damage lab tests, behavioral evals, neuro consult nursing: family support, oxygen

complications: congenital anomalies, RDS, hypoglycemia (used to mom regulating it), shoulder dystocia, childhood obesity risk assess: macrosomia, fractured clavicles, poor feeders assess for complications, lab tests, xrays for clavicle check glucose, early feedings family support, educate

***vertical*: passing of infection from mother to baby *transplacental*: through the placenta (syphillis) *ascending*: ascends into uterus related to prolonged ROM. vaginal exam after ROM introduces bacteria *intrapartal*: exposed during birth (herpes: outbreak on vagina at delivery--- have a c-section instead) ***horizontal*: nosocomial transmission- hospital staff or equipment causes: bacerial (group B strep, chlamydia, E coli) viral (rubella, hep B, HIV, varicella) fungal (candidia) syphillis, toxoplasmosis risk: prematurity, invasive procedures, LOS, fetal scalp electrode, substance abuse

doesn't affect mom but could make baby very sick if untreated. treat during labor. routine screening during 35-37 weeks by a swab in the vagina. primary cause of neonatal meningitis and sepsis 15-40% all pregnant women are asymptomatic carriers baby: grunting flaring, tachypnic, fever, tremors, seizures, rash vent, IV antibiotics, labs respiratory support ampicillin if positive or unknown

4% pw report use of illicit drugs 10% alcohol use 16% tobacco use withdrawal symptoms: apnea, diarrhea, excessive crying, *high pitched cry*, immediately in withdrawal; tremors, irritability, frantic sucking, seizing put on methadone or morphine; frequent small feedings, diagnostic tests, educate mom on shaken baby syndrome vitals, toxicology, social work, collect first urine

associated with maternal alcohol use eyes close together, tongue protrudes, neurological and developmental issues

a normal life crisis without any formalized manner of dealing with it. each person's experience is unique to them. there is no single way to work through it.

implantation of the fertilized ovum outside the uterus, usu the fallopian tube

loss of pregnancy that occurs naturally. in Alabama, it's less than 20 weeks.

birth of a deceased infant

death of an infant after a live birth

grief: physical, emotional, social, and cognitive response to a loss (lost your job, divorce, friendship) mourning: act of sorrow rituals: social customs (funerals, visitation, baptism) do whatever comforts the family

not in order and do not have to complete one to move onto the other denial and isolation: initially; want to see doctor, ultrasound, can still feel kicks anger: normal; angry at nurse, doctor, God bargaining: with God depression: after d/c, inform them it's normal, it's ok to take meds acceptance

physical: insomnia, N/V emotional: crying, anger social spiritual: angry w God recovery

words and actions that comfort: assist with death certificate and funeral arrangements (don't suggest or tell them which one) provide privacy and sensitive d/c info (not the normal packet, nothing about baby, just breast care, etc) DO: say "I'm sorry" and offer to help DON'T: "keeping going for her" "angel in Heaven" "God's will" Communication leads: don't ignore it, acknowledge it and apologize. Call baby by name if no name, use daughter, son, or baby

parents know their kids use "the baby died" not "we lost the baby" religious: "she went to Heaven" comforted by touch Moms: keep a journal kids: play therapy- barbies die art therapy: draw a baby up in Heaven ALL normal, healthy responses & very therapeutic teens: could be the patient, sometimes family is OK w/ it. take care of mom, who is sad. encourage pt to see and hold baby

bereavement boxes journal clothes birth/death certificate rituals arrangements for infant photos: B&W is better only give Bible to those who mention religion