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7/30/2019 High Risk Neonatal Nursing Care
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Developed by D. Ann Currie, RN, MSN
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High Risk Newborn Nursing
Care
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Fetal/Neonatal Risk
Factors for Resuscitation Nonreassuring fetal heart rate pattern Difficult birth Fetal scalp/capillary blood sample-acidosis pH
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Fetal/Neonatal Risk Factors
for Resuscitation (continued)An infant of a diabetic mother
Arrhythmias
Cardiomyopathy Fetal anemia
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Respiratory Distress
Syndrome (RDS) Deficiency or absence of surfactant
Atelectasis
Hypoxemia, hypercarbia, academia May be due to prematurity or surfactant deficiency
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RDS: Nursing Care Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration Education and support of family
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Transient Tachypnea of
the Newborn (TTN) Failure to clear lung fluid, mucus, debris
Exhibit signs of distress shortly after birth
Symptoms Expiratory grunting and nasal f laring
Subcostal retractions
Slight cyanosis
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TTN: Nursing Care Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration Support and educate family
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MAS: Nursing CareAssess for complications related to MAS
Maintain adequate respiratory status
Maintain adequate nutritional status Maintain adequate hydration
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Persistent Pulmonary
Hypertension (PPHN Blood shunted away from lungs
Increased pulmonary vascular resistance (PVR)
Primary Pulmonary vascular changes before birth resulting in
PVR
Secondary
Pulmonary vascular changes after birth resulting in PVR
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PPHN: Nursing Care Minimize stimulation
Maintain adequate respiratory status
Observe for signs of pneumothorax Maintain adequate nutritional status
Maintain adequate hydration status
Support and educate family
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Cold Stress Increase in oxygen requirements
Increase in utilization of glucose
Acids are released in the bloodstream Surfactant production decrease
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Cold Stress: Nursing Care Observe for signs of cold stress
Maintain NTE
Warm baby slowly Frequent monitoring of skin temperature
Warming IV fluids
Treat accompanying hypoglycemia
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Hypoglycemia Symptoms Lethargy or jitteriness
Poor feeding and sucking
Vomiting Hypothermia and pallor
Hypotonia, tremors
Seizure activity, high pitched cry, exaggerated moro
reflex
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Hypoglycemia:
Nursing Care Routine screening for all at risk infants
Early feedings
D10W infusion
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Physiologic
HyperbilirubinemiaAppears after first 24 hours of life
Disappears within 14 days
Due to an increase in red cell mass
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Pathologic
HyperbilirubinemiaAppears within first 24 hours of life
Serum bilirubin concentration rises by more than 0.2mg/dL per hour
Bilirubin concentrations exceed the 95th percentile
Conjugated bilirubin concentrations are greater than 2mg/dL
Clinical jaundice persists for more than 2 weeks in aterm newborn
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Causes of Pathologic
Hyperbilirubinemia Hemolytic disease of the newborn
Erythroblastosis fetalis
Hydrops fetalisABO incompatibility
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Treatment of Pathologic
Hyperbilirubinemia Resolving anemia
Removing maternal antibodies and sensitizederythrocytes
Increasing serum albumin levels
Reducing serum bilirubin levels
Minimizing the consequences of hyperbilirubinemia
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Maternal-Fetal
Blood Incompatibility Rh incompatibility
Rh-negative mother
Rh-positive fetus
ABO incompatibility
O mother
A or B fetus
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Phototherapy: Nursing Care Maximize exposure of the skin surface to the light
Periodic assessment of serum bilirubin levels
Protect the newborns eyes with patches
Measure irradiance levels with a photometer
Good skin care and reposition infant at least every 2 hours
Maintain an NTE and adequate hydration and nutrition
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Anemia Hemoglobin of less than 14 mg/dL (term)
Hemoglobin of less than 13 mg/dL (preterm)
Nursing management Observe for symptoms
Initiate interventions for shock
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Polycythemia Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit Monitor for signs of distress
Assist with exchange transfusion
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Clinical Manifestations of Sepsis Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit Monitor for signs of distress
Assist with exchange transfusion
Temperature instability
Feeding intolerance Hyperbilirubinemia
Tachycardia followed by apnea/bradycardia
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Clinical Manifestations of Syphilis Rhinitis
Red rash around the mouth and anus
Irritability Generalized edema and hepatosplenomegaly
Congenital cataracts
SGA and failure to thrive
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Syphilis: Nursing
Management Initiate isolation
Administer penicillin
Provide emotional support for the family
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Gonorrhea Clinical Manifestations
Conjunctivitis
Corneal ulcerations
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up
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Clinical Manifestationfs of Herpes Small cluster vesicular skin lesions over the entire body
DIC
Pneumonia Hepatitis
Hepatosplenomegaly
Neurologic abnormalities
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Herpes: Nursing
Management Careful hand washing and gown and glove isolation
Administration of IV vidarabine or acyclovir
Initiation of follow-up referral Support and education of parents
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Chlamydia Clinical Manifestations
Pneumonia
Conjunctivitis
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up
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Needs of Parents of
At-risk Infants Realistically perceiving the infants medical condition
and needs
Adapting to the infants hospital environment
Assuming primary caretaking role
Assuming total responsibility for the infant upondischarge
Possibly coping with the death of the infant if it occurs
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Facilitating Parental
Attachment Facilitating family visits
Allowing the family to hold and touch the baby
Giving the family a picture of the baby Liberal visiting hours
Encouraging the family to get involved in the care
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Cont. to Study other conditions from the Text