High Risk Newborn2

8/2/2019 High Risk Newborn2

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HIGH RISK NEWBORNCATHERINE V. STA. MONICA, RN


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Preterm Newborn Description

Primary concern is immaturity of allbody systems

Assessment Respirations irregular, with periods of

apnea Body temperature below normal

Poor suck and swallow reflexes

Diminished bowel sounds

Thin extremities, with minimalcreasing on soles and palms

No maintenance of flexion inextremities

Lanugo present


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Preterm Newborn (continued)

Assessment

Thin skin, with visible blood vessels and minimal subcutaneous fatpads; skin may appear jaundiced

Undescended testes in boys, narrow labia in girls

Interventions

Monitor vital signs every 2 to 4 hours

Maintain cardiopulmonary function; administer oxygen as prescribed Monitor intake, output, electrolyte balance, daily weight

Maintain neutral thermal environment

Handle newborn carefully, changing position every 1 to 2 hours

Avoid exposure to infections


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Post-term Newborn Description

Neonate born after 42 weeks gestation

Assessment

Hypoglycemia; parchment-like skin without lanugo; long

fingernails, extended over fingers; profuse scalp hair;long, thin body; wasting of fat and muscle in extremities;meconium staining on nails and umbilical cord

Interventions

Provide normal newborn care Monitor for meconium aspiration

Monitor for hypoglycemia

Maintain newborns temperature


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Small for Gestational Age Description

Neonate plotted at or below tenthpercentile on intrauterine growthcurve

Assessment Fetal distress; irregular temperature;

hypoglycemia; signs ofpolycythemia, including ruddyappearance, cyanosis, jaundice;signs of infection; signs of aspirationof meconium; physical abnormalities

Interventions Monitor for signs of respiratorydistress

Initiate early feedings, monitor forsigns of aspiration

Provide stimulation


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Large for Gestational Age Description

Neonate plotted at or above the ninetiethpercentile on intrauterine growth curve

Assessment

Birth trauma or injury, respiratorydistress, hypoglycemia

Interventions

Monitor for signs of hypoglycemia

Initiate early feedings

Monitor for infection; initiate measures toprevent sepsis

Provide stimulation, such as touch andcuddling


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Respiratory Distress Syndrome(RDS)

Description Serious lung disorder caused by immaturity and inability

to produce surfactant, resulting in hypoxia and acidosis

Assessment

Tachypnea Flaring nares Expiratory grunting Retractions

Decreased breath sounds Apnea Pallor and cyanosis Hypothermia Poor muscle tone


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Respiratory Distress Syndrome (RDS)(continued)

Interventions Monitor color, respiratory rate, degree of effort in

breathing, arterial blood gases, oxygen saturation Support respirations as prescribed; suction every 2 hours

and PRN

Position newborn on side or back, with neck slightlyextended

Administer surfactant replacement therapy intoendotracheal tube

Administer respiratory therapy as prescribed

Provide nutrition as prescribed Encourage mother to pump breasts for future nutrition Encourage bonding of parents and newborn


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Meconium Aspiration Syndrome Description

Aspiration can occur in uteroor with first breath

Assessment

Signs of respiratory distress

Yellow-stained nails, skin,umbilical cord

Interventions

Suctioning immediately afterhead is delivered


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Sepsis

Description

Generalized infection resulting from presence ofbacteria in blood

Assessment Pallor

Tachypnea

Tachycardia

Poor feeding

Abdominal distention

Temperature instability


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Sepsis (continued)

Interventions

Assess for periods of apnea or irregularrespirations

Administer oxygen as prescribed Monitor vital signs

Maintain neutral thermal environment

Monitor intake and output, daily weights

Monitor for diarrhea

Assess feeding and suck reflex

Assess for jaundice

Administer antibiotics as prescribed


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Hyperbilirubinemia

Description

At any serum bilirubin level, appearance ofjaundice during first day of life indicatespathological process

Assessment

Jaundice; elevated serum bilirubin levels;hepatomegaly; poor muscle tone; lethargy; poorsuck reflex

Interventions

Monitor for presence of jaundice

Maintain well-hydrated status

Administer early, frequent feedings as prescribed

Report any signs of jaundice in first 24 hours tophysician


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Hyperbilirubinemia (continued) Phototherapy

Expose as much of newborns skin as

possible, except for shielding eyesand genital area

Remove shields, patches at leastonce per shift and assess eyes forinfection or irritation

Monitor skin temperature frequently

Increase fluid intake as prescribed

Educate parents that stools and urine

may be green Reposition newborn every 2 hours

Provide stimulation to newborn


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SIDS Sudden Infant Death Syndrome

Known as CRIB death Causes: Hypoxemia theory and Apnea

theoryAssessment:

Autopsy: mottled complexion and extremelycyanotic lips and fingertipsDiagnostic: (autopsy) petechiae over the

visceral surfaces of the pleura,edematous pulmonary artery , congestedlungs fully expanded , stomach curdinside the stomach


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SIDS Nursing mgt.: provide emotional support

Other measures to prevent SIDS : infant on his back when sleeping No smoking anywhere near the infant Remove pillows, stuffed toys in crib

Use a firm mattress with a snug-fitting sheet Make sure the infants head remains uncovered

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High Risk Newborn2