2 -PRELIMS

• • SGA (Small for Gestational Age)
  • LGA (Large for Gestational Age)
  • Preterm related to maturity:
  • Preterm infant
  • Post-term infant
  • Problems related to gestational weight:
  • Low birth weight
  • Very low birth weight
  • Extremely very low birth weight
• Identification of at-risk newborn:

  • High-risk neonate is a newborn, regardless of gestational age or birth weight, who has a greater-than-average chance of morbidity or mortality due to conditions or circumstances superimposed on the normal course of events associated with birth and the adjustments to extrauterine existence
  • Signs of a high-risk newborn include being dehydrated, having visible ribs, wrinkled skin, connected to a mechanical ventilator, or having leathery-like skin
  • Classification based on gestational age:
  • AGA (Appropriate for Gestational Age)
• Acute conditions of neonates:

  • Respiratory distress syndrome
  • Transient tachypnea of newborn
  • Meconium aspiration syndrome
  • Apnea
  • Sudden infant death syndrome
  • Hyperbilirubinemia
  • Hemolytic disease of the newborn
• Care of pediatric client with Respiratory Disorder:

  • Upper respiratory tract disorders:
  • Choanal atresia
  • Acute nasopharyngitis
  • Pharyngitis
  • Tonsillitis
  • Epistaxis
  • Laryngitis
  • Croup
  • Epiglottis
  • Lower respiratory tract disorders:
  • Bronchitis
  • Cystic fibrosis
  • Asthma
  • Complications of Acute Respiratory Infection:
  • Otitis media
• High-risk neonates are regardless of age of gestation, birth weight, or who has a greater than average chance of morbidity due to conditions or circumstances during birth, delivery, or after delivery, and adjustment to extrauterine life
• Nursing care of the high-risk newborn to maturity:

  • Appropriate for Gestational Age (AGA) infant
  • Small for Gestational Age (SGA) infant
  • Large for Gestational Age (LGA) infant
  • Small for Date (SFD) or Small-for-Gestational-Age (SGA) infant
  • Causes of SGA include intrauterine growth retardation (IUGR) due to maternal nutrition, placental anomalies, systemic diseases, and maternal habits like smoking
  • Assessment includes prenatal assessment, sonogram, appearance, and laboratory findings
  • Common problems include hypoglycemia, birth asphyxia, and fetal hypoxia
• Nursing Diagnosis:

  • Ineffective breathing pattern related to underdeveloped body systems at birth
  • Risk for ineffective thermoregulation related to lack of subcutaneous fat
  • Outcome identification and evaluation for maintaining normal respirations, body temperature, and thermoregulation in newborns
• Infant's temperature should be maintained within normal limits at 36.5C or 97.8F
• Risk for impaired parenting due to the child's high-risk status and possible cognitive impairment from lack of nutrients in utero
• Parents should demonstrate beginning bonding behavior with infants while in the hospital
• Adequate stimulation should be provided, including toys suitable for their chronological age
• Care of Large for Gestational Age (LGA) infants is similar in many instances to care of preterm infants
• LGA infants have a birth weight above the 90th percentile or more than expected on an intrauterine growth chart for the specific gestational age
• Causes of LGA include overproduction of growth hormone in utero, diabetic mothers with poorly controlled glucose levels, multiparous women, transposition of the great vessels, Beckwith Syndrome, and congenital anomalies like omphalocele
• Assessment of LGA includes checking for signs like skin color changes, motion of extremities, symmetry of the chest, and symptoms like unresponsive pupils, vomiting, and high-pitched cry
• LGA infants may show signs of cardiovascular dysfunction, polycythemia, hyperbilirubinemia, hypoglycemia, and may require cesarean delivery
• LGA infants may have difficulty establishing respiration due to birth trauma and may be at risk for imbalanced nutrition
• Parents should demonstrate adequate bonding behavior during the neonatal period
• Appropriate for Gestational Age (AGA) infants are born before the end of 37 weeks of gestation with a weight of less than 2500g at birth
• Maternal factors contributing to low birth weight include age, smoking, poor nutrition, placental problems, and preeclampsia/eclampsia
• Fetal factors contributing to low birth weight include multiple pregnancies, infection, and intrauterine growth retardation
• Characteristics of premature infants include small size, underdeveloped appearance, disproportionately large head, ruddy skin, extensive lanugo, and immature ear cartilage
• Sucking & swallowing is weak & immature
• Fed with nasogastric tube until above 34 weeks, can be fed orally
• Deep tendon reflexes such as Achilles tendon are markedly diminished
• Cry is weak & high-pitched
• General activity is feebler & weaker; often assume frog-like position
• Scarf sign - elbow passes the midline of the body
• Square window - wrist at a 90 degrees angle
• Assess posture for degree of flexion
• Term - legs & arms are moderately flexed at rest
• Preterm - lesser degrees of flexion
• Assess square window by grasping the NB’s forearm & gently flexing the wrist toward the inner arm
• Term - the hand should touch the wrist resulting in a 0-degree angle
• Preterm - greater angles of flexion
• Measure arm recoil by first flexing & holding both forearms for 5 sec. then extending the hands & arms fully at the NB’s side
• Term full recoil to a position of flexion
• Preterm less flexion
• Measure the popliteal angle by moving the foot gently toward the head until you meet resistance
• Preterm - the leg straightens to 180 degrees angle