NCMA219 MIDTERMS (QUIZLET)

• High-risk neonate


  is a NB, regardless of gestational age or birth weight, who has a greater-than-average chance of mortality or morbidity, usually because of conditions beyond the normal events related to birth and the adjustment to extrauterine life.
• High-risk period


  begins at the time of viability up to 28 days after birth and includes threats to life and health that occur during the prenatal, perinatal, and postnatal periods
• Low-birth-weight (LBW) infant


  whose BW is less than 2,500 g (5.5 lb), regardless of GA
• Very-low-birth-weight (VLBW) infant


  whose BW is less than 1,500 g (3.3 lb)
• Extremely low-birth-weight (ELBW) infant


  whose BW is less than 1000 g (2.2 lb)
• Appropriate-for-gestational age (AGA) infant


  whose weight fall between the 10th and 90th percentiles on intrauterine growth curves
• Small-for-date (SFD) or small-forgestational age (SGA) infant


  whose rate of intrauterine growth was slowed and whose BW falls below the 10th percentile on intrauterine growth curves
• Intrauterine growth restriction (IUGR)


  found in infants whose intrauterine growth is restricted (sometimes used as a more descriptive term for the SGA infant)
• Large-for-gestational age (LGA)


  infant whose BW falls above the 90th percentile on intrauterine growth charts
• Preterm (premature) infant


  An infant born before completion of 37 weeks of gestation, regardless of birth weight.
• Full-term infant


  An infant born between the beginning of 38 weeks and the completion of 42 weeks of gestation, regardless of birth weight.
• Post-term (post mature) infant

  An infant born after 42 weeks of gestational age, regardless of birth weight.
• Late-preterm infant


  An infant born between 34 and 36 weeks of gestation, regardless of birth weight.
• Live birth


  Birth in which the neonate manifests any heartbeat, breathes, or displays voluntary movement, regardless of gestational age.
• Fetal death


  Death of the fetus after 20 weeks of gestation and before delivery, with absence of any signs of life after birth.
• Neonatal death


  Death that occurs in the first 27 days of life; early neonatal death occurs in the first week of life; late neonatal death occurs at 7 to 27 days
• Perinatal mortality


  Describes the total number of fetal and early neonatal deaths per 1000 live births.
• Postnatal death


  Death that occurs at 28 days to 1 year after birth.
• APGAR score of 8-10 indicates?

  No intervention required except to support NB's spontaneous efforts

  
• APGAR score of 4-7 indicates?

  Stimulate; rub NB's back; administer oxygen to NB; rescore at specific intervals

  
• APGAR score of 0-3 indicates?


  NB requires full resuscitation at specific

  intervals

  
• PRETERM NURSING INTERVENTION


  Monitor VS q2- q3 hours.

  Maintain airway and cardiopulmonary functions. Administer oxygen and humidification as prescribed. Monitor I and O and electrolyte balance. Monitor daily weight.

  Maintain the NB in a warming device. Avoid exposure to infections.
• Post term infant characteristics

  absence of lanugo

  little if any vernix caseosa

  abundant scalp hair

  and long fingernails.

  The skin is often cracked, parchmentlike, and peeling.
• Preterm infant characteristics


  Very small and appear thin because they have little to no subcutaneous fat deposits.

  They also have a proportionately large head in relation to the body, which reflects the cephalocaudal direction of growth. The skin is bright pink, smooth, and shiny, with small blood vessels clearly visible.

  The fine lanugo is abundant over the body but is sparse, fine, and fuzzy on the head.

  The ear cartilage is soft and pliable, and the soles and palms have minimum creases, resulting in smooth appearance. The bones of the skull and ribs feel soft, and before 26 weeks the eyes may be fused.

  Male infants have few scrotal rugae, and the testes are undescended; the labia minora and clitoris are prominent in females.
• SONOGRAM


  can then demonstrate the decreased size. A biophysical profile including a nonstress test, placental grading, amniotic fluid amount, and ultrasound examination can provide additional information on placental function.
• SGA interventions


  Maintain airway and cardiopulmonary function

  Maintain body temperature

  Observe for signs of respiratory distress

  Monitor infection and initiate measures to prevent sepsis

  Monitor for hypoglycemia Initiate early feeding and monitor of signs of aspiration
• LGA assessment


  Immature reflexes and low scores on gestational age examinations Birth trauma Respiratory distress Hypoglycemia Signs of hyperbilirubinemia (which may result from absorption of blood from bruising) Polycythemia vera
• LGA intervention


  Monitor VS and for respiratory distress. Cyanosis is a sign of transposition of the great vessels. Monitor for hypoglycemia. Initiate early feedings. Monitor infection and initiate measures to prevent sepsis. Provide stimulation, such as touch and cuddling.
• The primary objective in the care of high risk infants

  is to establish and maintain respiration.
• Resuscitation


  becomes important for infants who fail to take a first breath or have difficulty.
• RESUSITATION ORGANIZED PROCESS


  Establish an airway

  Expand the lungs

  Initiate and maintain effective ventilation
• airway (INITIATING AND MAINTAINING RESPIRATION)


  Warming, drying, and stimulating the baby by rubbing the back is enough to stimulate respirations. If the NB does not initiate spontaneous breathing, place in the radiant warmer in a sniffing position and rub and dry the back and hair to see if the NB will be stimulated; attach pulse ox and 3-lead cardiac monitor. Still no spontaneous respiration, insertion of ET tube to be certain the airway is not obstructed so air can be effectively administered. O
• lung expansion (INITIATING AND MAINTAINING RESPIRATION)


  Once the airway is established, a newborn's lungs needed to be expanded. If an infant needs air or oxygen by bag and mask to aid lung expansion, be certain the mask covers both the mouth and the nose
• VENTILATION MAINTENANCE (INITIATING AND MAINTAINING RESPIRATION)


  Steadily increasing RR, grunting, nasal flaring are often signs of obstruction or resp compromise in NB. Place a NB who is having difficulty maintaining respiration under an infant radiant warmer. Remove clothing for better observation while keeping him warm. Suction - "Bagging" the infant with a mask and PPV for a minute before suctioning will prevent desat. Determine the cause and manage.
• ESTABLISHING EXTRAUTERINE CIRCULATION


  Hold an infant with fingers supporting the back and depress the sternum with two fingers. Depress the sternum approximately one third of its depth (1 or 2 cm) at a rate of 100 times per minute. Lung ventilation at a rate of 30 times per minute should be coordinated with chest compressions at a rate of 90 compressions per minute at a ratio of three compressions to one ventilation. If a newborn's heart rate is greater than 60 but less 100 beats/min, chest compressions can be stopped but ventilations should be continued. Ensuring adequate ventilation is the major priority and should continue until the heart rate is greater than 100 beats/min.
• Dehydration


  may result from increased insensible water loss from rapid respirations.
• MAINTAINING FLUID AND ELECTROLYTE BALANCE

  After an initial resuscitation attempt, hypoglycemia (decreased blood glucose) may result from the effort the newborn expended to begin breathing.
• hypoglycemia


  Infants with ------ are treated initially with 10% dextrose in water to restore their blood glucose level.
• Ringer's lactate or 5% dextrose in water


  Fluids such as --- are commonly used to maintain fluid and electrolyte levels. Electrolytes (particularly sodium and potassium) and glucose are added as necessary,
• patent ductus arteriosus or heart failure.


  The rate of fluid administration must be carefully monitored because a high fluid intake can lead to