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Developed by D. Ann Currie, RN, MSN
High Risk Newborn Nursing Care
Fetal/Neonatal Risk Factors for Resuscitation Nonreassuring fetal heart rate patternDifficult birth Fetal scalp/capillary blood sample-acidosis pH<7.20Meconium in amniotic fluidPrematurityMacrosomia or SGAMale infant Significant intrapartum bleedingStructural lung abnormality or oligohydramniosCongenital heart diseaseMaternal infectionNarcotic use in labor
Fetal/Neonatal Risk Factors for Resuscitation (continued) An infant of a diabetic motherArrhythmiasCardiomyopathyFetal anemia
Respiratory Distress Syndrome (RDS)
Deficiency or absence of surfactantAtelectasisHypoxemia, hypercarbia, academiaMay be due to prematurity or surfactant
deficiency
RDS: Nursing Care Maintain adequate respiratory statusMaintain adequate nutritional statusMaintain adequate hydrationEducation and support of family
Transient Tachypnea of the Newborn (TTN)
Failure to clear lung fluid, mucus, debrisExhibit signs of distress shortly after birthSymptoms
Expiratory grunting and nasal flaringSubcostal retractionsSlight cyanosis
TTN: Nursing Care Maintain adequate respiratory statusMaintain adequate nutritional statusMaintain adequate hydrationSupport and educate family
Meconium Aspiration Syndrome (MAS)
Mechanical obstruction of the airwaysChemical pneumonitisVasoconstriction of the pulmonary vesselsInactivation of natural surfactant
MAS: Nursing Care Assess for complications related to MASMaintain adequate respiratory statusMaintain adequate nutritional statusMaintain adequate hydration
Persistent Pulmonary Hypertension (PPHN
Blood shunted away from lungsIncreased pulmonary vascular resistance
(PVR)Primary
Pulmonary vascular changes before birth resulting in PVR
SecondaryPulmonary vascular changes after birth
resulting in PVR
PPHN: Nursing Care Minimize stimulationMaintain adequate respiratory statusObserve for signs of pneumothoraxMaintain adequate nutritional statusMaintain adequate hydration statusSupport and educate family
Cold Stress Increase in oxygen requirementsIncrease in utilization of glucoseAcids are released in the bloodstreamSurfactant production decrease
Cold Stress: Nursing Care Observe for signs of cold stressMaintain NTEWarm baby slowlyFrequent monitoring of skin temperatureWarming IV fluidsTreat accompanying hypoglycemia
Hypoglycemia Symptoms Lethargy or jitterinessPoor feeding and suckingVomitingHypothermia and pallorHypotonia, tremorsSeizure activity, high pitched cry,
exaggerated moro reflex
Hypoglycemia: Nursing Care
Routine screening for all at risk infantsEarly feedingsD10W infusion
Physiologic Hyperbilirubinemia
Appears after first 24 hours of lifeDisappears within 14 daysDue to an increase in red cell mass
Pathologic Hyperbilirubinemia Appears within first 24 hours of lifeSerum bilirubin concentration rises by more
than 0.2 mg/dL per hourBilirubin concentrations exceed the 95th
percentileConjugated bilirubin concentrations are
greater than 2 mg/dL Clinical jaundice persists for more than 2
weeks in a term newborn
Causes of Pathologic Hyperbilirubinemia
Hemolytic disease of the newbornErythroblastosis fetalisHydrops fetalisABO incompatibility
Treatment of Pathologic Hyperbilirubinemia
Resolving anemiaRemoving maternal antibodies and sensitized
erythrocytesIncreasing serum albumin levelsReducing serum bilirubin levelsMinimizing the consequences of
hyperbilirubinemia
Maternal-Fetal Blood Incompatibility
Rh incompatibilityRh-negative motherRh-positive fetus
ABO incompatibilityO motherA or B fetus
Phototherapy: Nursing Care Maximize exposure of the skin surface to the
lightPeriodic assessment of serum bilirubin levelsProtect the newborn’s eyes with patchesMeasure irradiance levels with a photometerGood skin care and reposition infant at least
every 2 hoursMaintain an NTE and adequate hydration and
nutrition
AnemiaHemoglobin of less than 14 mg/dL (term)Hemoglobin of less than 13 mg/dL (preterm)Nursing management
Observe for symptomsInitiate interventions for shock
Polycythemia Increase in blood volume and hematocritNursing management:
Assessment of hematocritMonitor for signs of distressAssist with exchange transfusion
Clinical Manifestations of SepsisIncrease in blood volume and hematocritNursing management:
Assessment of hematocritMonitor for signs of distressAssist with exchange transfusion
Temperature instabilityFeeding intoleranceHyperbilirubinemiaTachycardia followed by apnea/bradycardia
Clinical Manifestations of Syphilis RhinitisRed rash around the mouth and anusIrritabilityGeneralized edema and hepatosplenomegalyCongenital cataractsSGA and failure to thrive
Syphilis: Nursing Management
Initiate isolation Administer penicillinProvide emotional support for the family
Gonorrhea Clinical Manifestations
ConjunctivitisCorneal ulcerations
Nursing managementAdministration of ophthalmic antibiotic
ointmentReferral for follow-up
Clinical Manifestationfs of Herpes Small cluster vesicular skin lesions over the
entire bodyDICPneumoniaHepatitisHepatosplenomegalyNeurologic abnormalities
Herpes: Nursing Management
Careful hand washing and gown and glove isolation
Administration of IV vidarabine or acyclovirInitiation of follow-up referralSupport and education of parents
ChlamydiaClinical Manifestations
PneumoniaConjunctivitis
Nursing managementAdministration of ophthalmic antibiotic
ointmentReferral for follow-up
Needs of Parents of At-risk Infants
Realistically perceiving the infant’s medical condition and needs
Adapting to the infant’s hospital environmentAssuming primary caretaking roleAssuming total responsibility for the infant
upon dischargePossibly coping with the death of the infant if
it occurs
Facilitating Parental Attachment
Facilitating family visitsAllowing the family to hold and touch the
babyGiving the family a picture of the babyLiberal visiting hoursEncouraging the family to get involved in the
care
Cont. to Study other conditions from the Text