Chapter 19

Caring for the Newborn at Risk

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley



Intrauterine development

Intrapartum development

Extrauterine development





Lung maturity

Circulatory maturity

Neurological maturity





Gestational Age (GA)◦ Preterm (born before 37 weeks)

◦ Term (born between 38 and 42 weeks)

◦ Postterm (born after 42 weeks)





Birth Weight◦ Low birth weight (LBW) (<2500 g)

◦ Very low birth weight (VLBW) (<1500 g)

◦ Extremely low birth weight (ELBW) (<1000 g)





A term used to denote a lack of intrauterine fetal growth that usually results in an SGA newborn





Infants born at any gestational age who have a birth weight that falls below the 10th percentile on the growth charts





Hypothermia

Pain

Hypoglycemia

Polycythemia





Infants born who are over the 90th percentile on the growth chart





Chronic hyperglycemic state Transient tachypnea of the newborn Hypoglycemia Hypocalcemia Hypomagnesemia Birth injuries Brachial plexus injuries Fractures





Severe prematurity◦ 23 to 26 weeks

Moderate prematurity◦ 26 to 30 weeks





Skin Head Chest Cardiac Abdomen Musculoskeletal Genitalia Neurological/sensory



Conditions Affecting the Premature Newborn





Atelectasis with congestion and edema in lung spaces Lecithin-sphingomyelin (L/S) ratio and phosphatidylglycerol

(PG) levels low Underdeveloped alveoli Signs and symptoms begin shortly after birth

Nursing Care: Provide oxygenation

◦ Maintain mechanical ventilation ◦ Assist with endotracheal intubation (ET)

Administer syntheic surfactant via ET Wean ASAP to prevent complications





Apnea >15 to 20 seconds accompanied by pallor, hypotonia, cyanosis, and bradycardia

Nursing Care:◦ Monitor cardiorespiratory (C-R) status ◦ Apply continuous pulse oximeter ◦ Watch for A and B spell





Diagnosed in term infants with a serum bilirubin level >12.9 mg/dL and in preterm infants >15mg/dL

Nursing Care:◦ Based on underlying cause◦ Give phototherapy◦ Ensure hydration (electrolyte solution)

Complications: ◦ Bilirubin encephalopathy◦ Kernicterus





Result of immature retinal vasculature followed by hypoxia Inversely related to gestational age Risk factors Diagnosis –– 5 stages

Nursing Care:◦ Fluctuations in concentrations of oxygen must be

prevented ◦ Wean off oxygen ASAP◦ Decrease constant bright lights◦ Encourage routine examinations





Anemia of prematurity◦ Hemoglobin below 35% and 45%

Nursing Care:◦ Administer recombinant human erythropoieten SC

Sudden Infant Death Syndrome (SIDS)◦ “Back to Sleep”◦ Educate parents about prevention





Newborns in utero after the optimal growth time (42 weeks)

◦ Skin is parchment-like◦ Fingers are long and peeling◦ Muscle wasting is present





Meconium Aspiration Pneumonia — meconium aspirated at birth

◦ Meconium-stained skin, nails, and umbilical cord

◦ Initial respiratory distress◦ Rales and rhonchi on auscultation

Nursing Care: Give chest physiotherapy (CPT) Monitor mechanical ventilation Administer medications





Vascular resistance in pulmonary system◦ Meconium-stained amniotic fluid◦ Brief respiratory distress at birth, then resolves and

returns about 12 hours later ◦ Centrally cyanotic and tachypenic◦ Audible murmur

Nursing Care: Extracorporeal membrane oxygenation (ECMO) See Chapter 19 Nursing Care Plan





Metabolic conditions

Neurologic conditions

Gastrointestinal conditions

Infections





Phenylketonuria (PKU)◦ Phenylalanine-free diet, elimination of protein

Galactosemia ◦ Galactose-free diet

Maple Syrup Urine Disease◦ Low-protein diet, thiamine supplements





Homocystinuria ◦ Diet therapy ― high doses vitamin B6 ◦ Methionine and cystine restriction

Biotinidase Deficiency◦ Pantothenic acid or biotin (types of B vitamins)





Intraventricular and Periventricular Hemorrhage [categorized by extent and involvement (grades)]

Nursing Care:◦ Recognize seizures◦ Administer antiseizure medications◦ Prevent cerebral damage◦ Maintain adequate oxygenation◦ Educate parents





Anencephaly (skull and cerebrum are malformed)

Encephalocele (protrusion of brain through a skull defect)

Microcephaly (smaller than normal head circumference)

Holoprosencephaly (cerebral matter fails to form as two distinct hemispheres)





Cleft Lip and Palate ― has genetic and environmental predispositions

Nursing Care:◦ Provide adequate nutrition◦ Feed in upright position◦ Surgery: CL ― 3 months, CP ― before 18 months◦ Educate and provide emotional support for

parents





Necrotizing Enterocolitis◦ Ischemic episode of the bowel; can produce

septicemia

Nursing Care:◦ Ensure that oral feedings are stopped◦ Discuss possible surgery





Gastroschisis and Omphalocele

Nursing Care:◦ Surgery within 2 to 4 hours◦ Cover abdominal contents with moist gauze and wrap in

plastic◦ Position carefully◦ Place NG/OG◦ IVF at 1.5 times normal maintenance◦ Postoperative care focuses on fluids, electrolyte balance,

nutritional support, infection protection, pain management, and keeping parents informed





Herpes Simplex◦ HSV-1 acquired from people with herpes lesions of the mouth◦ HSV-2 acquired through a genital infection

Nursing Care:◦ Acyclovir (Avirax)◦ Ensure proper developmental stimulation

Neonatal Sepsis◦ Systemic infection

Nursing Care:◦ Review diagnostic workup◦ Give antibiotics for a minimum of 48 hours





Neonatal Abstinence Syndrome (NAS)◦ Drug-abusing mother◦ Irritability

Nursing Care:◦ Laboratory tests done to reveal if drugs are in the

newborn’s system◦ Use neonatal abstinence scoring tool every 3

hours





Blood Pressure Nutritional Care Developmental Care

◦ Noise◦ Lighting◦ Handling ◦ Positioning





Educate parents on what to expect, rules of the unit, and expectations

Create partnership with parents

Encourage touch

Provide discharge planning





Level I ― provides well newborn care and stabilization of high-risk newborns

Level II ― provides premature care (give oxygen and intravenous therapy given)

Level III ― provides care to ventilate newborns





Transport is done if more technologically advanced care is needed

Transport team comprised of professionals

STABLE program Home Work#3: ATI Practice test A & B

Documents

Chapter 19