NCMA 219 CU6A

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JOHN CLIFFORD TIANES

Cards (168)

  • High-risk neonate - Has a greater chance of mortality or morbidity
  • High-risk period - Begins at the time of viability up to 28 days after birth
  • Classification of high-risk newborn
    • Size
    • Gestational Age
    • Mortality
  • Intrauterine growth restriction (IUGR)

    Infant whose intrauterine growth is restricted, used as a more descriptive term for the SGA infant
  • CLASSIFICATION ACCORDING TO SIZE : LOW BIRTH WEIGHT INFANT -  Less than 2,500 g (5.5 lb).
  • CLASSIFICATION ACCORDING TO SIZE: 1. VERY LOW BIRTH WEIGHT INFANT -  Less than 1,500 g (3.3 lb).
     
  • CLASSIFICATION ACCORDING TO SIZE: EXTREMELY LOW BIRTH WEIGHT INFANT - Less than 1000 g (2.2 lb).
  • CLASSIFICATION ACCORDING TO SIZE: APPROPRIATE FOR GESTATIONAL AGE  -  Birth weight fall between the 10th and 90th percentile.
  • CLASSIFICATION ACCORDING TO SIZE:  LARGE-FOR-GESTATIONAL AGE INFANT – Birth weight falls above the 90th percentile.
  • CLASSIFICATION ACCORDING TO SIZE:  SMALL-FOR GESTATIONAL AGE  INFANT – Birth weight falls below the 10th percentile.
  • Classification of high risk newborn according to size regardless of gestational age.
  • CLASSIFICATION ACCORDING TO GESTATIONAL AGE - LATE-PRETERM INFANT – Born between 34 0/7 and 36 6/7 weeks of gestation.
  • CLASSIFICATION ACCORDING TO GESTATIONAL AGE:  PRETERM (PREMATURE) INFANT – Born before completion of 37 weeks of gestation.
  • CLASSIFICATION ACCORDING TO SIZE: FULL-TERM INFANT – Born between  38 weeks and  42 weeks of gestation.
  • CLASSIFICATION ACCORDING TO GESTATIONAL AGE: POSTTERM (POSTMATURE) infant – Born after 42 weeks of gestational age.
  • CLASSIFICATION OF HIGH RISK NEWBORN ACCORDING TO GESTATIONAL AGE REGARDLESS OF BIRTH WEIGHT.
  • CLASSIFICATION ACCORDING TO MORTALITY - LIVE BIRTH – Neonates is alive and manifests heartbeat, breathing and movement.  
  • CLASSIFICATION ACCORDING TO MORTALITY - FETAL DEATH – Death of the fetus after 20 weeks of gestation and before delivery.
  • CLASSIFICATION ACCORDING TO MORTALITY - NEONATAL DEATH – occurs in the first 27 days of life.
  • CLASSIFICATION ACCORDING TO MORTALITY - EARLY NEONATAL DEATH - Occurs in the first week of life. (1-7).
  • CLASSIFICATION ACCORDING TO MORTALITY - LATE NEONATAL DEATH occurs at 7 to 27 days.
  • CLASSIFICATION ACCORDING TO MORTALITY - PERINATAL MORTALITY – Describes the total number of fetal and early neonatal deaths per 1000 live births.
  • CLASSIFICATION ACCORDING TO MORTALITY - POSTNATAL DEATH – Death that occurs at 28 days to 1 year after birth.
     
  • CLASSIFICATION ACCORDING TO MORTALITY Regardless of gestational age.
  • BALLARD SCORING SYSTEM
    • Commonly used to determine gestational age.
    • Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity.
    •  The scores for each may range from -1 to 5.
    • The scores are added together to determine the baby's gestational age.
    •  The normal score is 35 to 45.
  • Prematurity / Preterm infants
    Born before 37 weeks of gestation
  • Preterm infants
    • Primary concern is immaturity of body system
    • Physical appearance changes as the fetus progress to maturity
    • Inactive and listless
    • Have a higher extracellular water content - more vulnerable to fluid and electrolyte imbalance
  • When preterm delivery is anticipated
    1. NICU is alerted
    2. Preterm who don't need resuscitation is transferred to heated incubator
    3. Resuscitation is conducted in the delivery room until infant can be transported to NICU
  • Complications of prematurity
    • Hyperbilirubinemia
    • Hypoglycemia
  • Predisposing factors for preterm birth
    • Women with low socioeconomic status
    • Multiple pregnancy
    • Gestational hypertension
    • Placental problems
  • ASSESSMENT: PREMATURE
    l Irregular RR with periods of apnea
    l Body temperature below normal
    l Poor suck and swallow reflexes
    l Diminished bowel sounds
    l Very small and thin
    l Ear cartilage is soft and pliable, minimum creases
    l Extends extremities and no flexion
    l Abundant lanugo and present in woolly patches.
    l Visible blood vessels with minimal subcutaneous fats.
    l Jaundiced
    l Male preterm has undescended testes (cryptorchidism)
    l Female preterm has large clitoris and narrow labia.
  • NURSING INTERVENTION: PREMATURE
    l Monitor vital signs every 2 - 3 hours.
    l Maintain airway and cardiopulmonary functions.
    l Administer oxygen if prescribed.
    l Monitor I & O.
    l Monitor daily weight.
    l Maintain newborn in warming device.
    l Avoid infection.
  • Infant born after 42 weeks of gestation
    Post-term infant
  • Fetal distress

    • Associated with the decreasing efficiency of the placenta
  • Macrosomia

    Large body size of the newborn
  • Meconium aspiration syndrome (MAS)

    Inhalation of meconium-stained amniotic fluid
  • Nursing Intervention: MAS
    1. Provide normal newborn care
    2. Monitor for hypoglycemia
    3. Maintain newborn temperature
    4. Monitor for meconium aspiration
  • ASSESSMENT: POST TERM
    l Hypoglycemia
    l Parchment-like skin (dry and cracked) without lanugo
    l Profuse scalp hair
    l Hard nails extending beyond the fingertips
    l Long and thin body; old looking
    l Depleted subcutaneous fats
    l Wasting of fat and muscle in extremities.
    l Meconium staining
  • Birthweight influences mortality - The lower the birthweight, the higher the mortality
  • Small for Gestational Age (SGA) - Newborn who is plotted at or below the 10th percentile on the intrauterine growth curve.