ncma219 p2

Cards (89)

  • Premature infant
    Less than 38 weeks gestation
  • Premature infant
    • Birth: more than 3 weeks before due date
    • Occurs before pregnancy's 37th week
    • LANUGO covers entire back & face
    • SOLES few creases
    • SCROTUM little rugae
    • Thin, pinkish skin, plenty lanugo, relaxed posture
  • Postmature infant
    More than 42 weeks gestation
  • Postmature infant
    • Birth after 42 weeks gestation
    • Abundant scalp hair
    • Visible creases on palms and soles of feet
    • Minimal fat deposits
    • Absence of lanugo
  • IUGR
    Small for Gestational Age Infants
  • IUGR
    • Slow rate of intrauterine growth of infant
    • Birthweight: falls below 10th percentile on intrauterine growth chart
  • Causes of IUGR
    • Poor nutrition during pregnancy
    • Placental defects & complications
    • Teenage pregnancies
    • Hypertensive mother
  • Priority nursing care in first few days of life
    1. Initiation and maintenance of respirations
    2. Maintenance of hydration & normal glucose (glucose IVF, thermoregulation, correct IVF rate, BREASTFEED every 3-4 hrs, monitor GLUCOSE every 4 hrs)
    3. Control body temperature (infant under radiant warmers: monitor vital signs, keep hydrated, assess skin integrity)
  • Maintaining neutral thermal environment permits neonate to maintain normal core temp w/ minimal oxygen consumption
  • Causes of IUGR & SGA newborn
    • AGE (under 18 or over 35 yrs old)
    • POOR NUTRITION during pregnancy
    • PLACENTAL DEFECTS (perinatal hypoxia)
    • MATERNAL CONDITION (HPN, anemia, DM)
  • Respiratory Distress Syndrome (Hyaline Membrane Disease)

    Condition of surfactant deficiency & physiologic immaturity of thorax
  • Respiratory Distress Syndrome
    • Diagnostic exam: x-ray, blood glucose, ABG, fetal lung maturity assay (FASTEST)
    • Diagnostic findings: (radiographic) diffuse granular pattern, (x-ray) like broken glass pattern, hypoxemia, (ABG) increased carbon dioxide & respiratory acidosis
  • Medications for Respiratory Distress Syndrome
    Artificial surfactant, nitric oxide (will dilate pulmonary bronchus)
  • Clinical manifestations of Respiratory Distress Syndrome

    • Tachypnea (60>)
    • Flaring nares
    • Expiratory grunting, dyspnea
    • Chest retractions (sternal & subcostal)
    • Seesaw respirations
  • Meconium Aspiration Syndrome
    Aspiration of amniotic fluid containing meconium into fetal trachea (in utero or at 1st breath)
  • Meconium Aspiration Syndrome
    • Occurs in full-term & post-term infants (during relaxation of anal sphincter - passage of meconium into amniotic fluid due to intrauterine stress)
    • Assessment: widened anteroposterior diameter of chest (barrel-chest), greenish stains (on skin, umbilical cord, & nails)
  • Nursing care for Meconium Aspiration Syndrome
    1. Suctioning - oropharyngeal & tracheal
    2. O2 support (SEVERE: extracorporeal membrane oxygenation)
    3. Exogenous surfactant administration
    4. IV fluid administration
    5. Administer systemic antibiotics as prescribed (ampicillin, gentamycin, amikacin)
  • Sepsis
    • Early onset - occurs less than 3 days after birth (caused by maternal infection)
    • Late onset - occurs on 4th to 7th day after birth (nosocomial infection)
  • Clinical manifestations of Sepsis
    • Pallor, cyanosis, mottling
    • Hypotension
    • Tachycardia
    • Irregular respirations
    • Jaundice
    • Dehydration
    • Temperature instability
  • Laboratory & diagnostic studies for Sepsis
    • Blood culture
    • Urine and blood culture and CSF analysis
    • CBC - WBC increased
    • ESR and C-reactive protein - increased
  • Hyperbilirubinemia
    Excessive level of accumulated bilirubin in blood
  • Hyperbilirubinemia
    • Characterized by jaundice
    • Pathologic jaundice: first 24 hrs of life
    • Physiologic jaundice: after 24 hrs of life
    • Complications - kernicterus
  • Nursing care for Hyperbilirubinemia
    1. Cover eyes, genitalia
    2. Check skin turgor for hydration
    3. Turn infant every 2 hrs
    4. Instruct mother to continue breastfeeding every 2-4 hrs
  • Sudden Infant Death Syndrome (SIDS)

    Unexpected death of any infant younger than 1 year old
  • Sudden Infant Death Syndrome (SIDS)

    • Death usually occurs during sleep - "CRIB DEATH"
    • Most common cause of death in children ages 1 month to 1 year
    • Peak: 2-4 months, 90% before 6th month
  • Nursing management for SIDS
    1. Teach parents how to minimize risks of SIDS
    2. Avoid smoking during & after pregnancy
    3. Encourage supine or side-lying position
  • Causes of SIDS
    • Co-sleeping
    • Soft beddings
    • Use of pillows, blankets on crib
    • Maternal smoking
  • Necrotizing Enterocolitis
    Acute inflammatory disease of bowel
  • Necrotizing Enterocolitis
    • Preterm neonates manifests abdominal distention and vomiting
    • Signs: poor feeding, distended abdomen, blood in stool, vomiting, apnea
  • Nursing management for Necrotizing Enterocolitis
    1. Assess PT for presence of abdominal distention
    2. Report to doctor for any episode of gastric residuals
    3. Place PT on NPO as per doctor's order if symptoms of NEC is observed
  • Newborn screening
    Procedure to determine if newborn infant has heritable congenital metabolic disorder
  • Congenital Hypothyroidism
    Results from absence or lack of development of thyroid gland causing absence or lack of thyroxine needed for metabolism and growth of body & brain
  • Congenital Hypothyroidism
    • Signs and symptoms: short stature, macroglossia, delayed closure of fontanelles, hypotonia
  • Management of Congenital Hypothyroidism
    1. Medication (Synthroid) throughout child's lifetime
    2. Administration of thyroid hormone will prevent problems
    3. If managed early (will NOT cause mental retardation)
  • Phenylketonuria
    Deficiency or absence of enzyme needed to metabolize essential amino acid (PHENYLALANINE)
  • Phenylketonuria
    • Diagnostic test - Guthrie test
    • If managed early, will prevent mental retardation or cognitive impairment
    • Goal of treatment: meeting child's nutritional needs for optimal growth
    • If untreated - results to FTT, absence of adequate melanin pigmentation, unpredictable and erratic behavior
  • G6PD Deficiency

    Lack of enzyme resulting to premature destruction of RBC leading to hemolytic anemia
  • G6PD Deficiency

    • Without G6PD, RBC's undergo hemolysis when exposed to oxidative stress
    • Symptoms: jaundice, dark colored urine, back pain, anemia
    • Complications: severe anemia, hyperbilirubinemia
  • Management of G6PD Deficiency
    Avoid food, drugs, chemicals that cause oxidative stress
  • Congenital Heart Disorders
    • ASD (Atrial Septal Defect)
    • VSD (Ventricular Septal Defect)
    • PDA (Patent Ductus Arteriosus)
    • TOF (Tetralogy of Fallot)