NCMA219 - Midterms

• Pointers to Review


  • High risk newborn
  • IUGR/ SGA/ LGA/ Preterm
  • RDS
  • MAS
  • SIDS
  • Hyperbilirubinemia
  • Neonatal Sepsis
  • Necrotizing enterocolitis
  • G6PD/Congenital Hypothyroidism
  • Phenylketonuria
  • Galactosemia
  • Tetralogy of Fallot
  • Rheumatic fever/ RHD
  • ASD/ VSD/ PDA
  • Kawasaki Disease
  • Streptococcal pharyngitis
  • Tonsillitis
  • Sickle Cell Anemia/IDA
  • CROUP syndrome /LTB/ Epiglottitis
• Premature Infant


  Infant born < 38 weeks gestation
• Premature Infant


  • Birth that takes place more than three weeks before the baby's estimated due date
  • Occurs before the start of the 37th week of pregnancy
  • Lanugo covers the entire back and face, soles a few creases, scrotum little rugae
  • Thin and pinkish skin, plenty of lanugo and relaxed posture
• Full Term Infant


  Infant born between the beginning of 38 weeks and the completion of 42 weeks of gestation regardless of birth weight
• Postmature Infant


  Baby delivered after 42 weeks of gestation
• Postmature Infant


  • Abundant scalp hair
  • Visible creases on palms and soles of feet
  • Minimal fat deposits
  • Absence of lanugo
• IUGR


  Small for Gestational Age Infants
• Infants whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on the intrauterine growth chart
• Causes of IUGR


  • Poor nutrition during pregnancy
  • Placental defects and complications
  • Teenage pregnancies
  • Hypertensive mother
• Nursing Management for IUGR/SGA Newborn

  • Priority nursing care in the first few days of life
  • Initiation and maintenance of respirations
  • Maintenance of hydration and normal glucose – glucose IVF, thermoregulation, correct IVF rate, breastfeeding every 3-4 hours
  • Monitor glucose level every 4 hours
  • Control of body temperature
  • For newborns under radiant warmers – monitor vital signs, keep the newborn hydrated, assess integrity of the skin
  • Maintaining a neutral thermal environment permits the neonate to maintain a normal core temperature with minimal oxygen consumption
• Large for Gestational Age Infants

  Infant whose birth weight falls ABOVE 90th percentile on intrauterine growth charts
• Respiratory Distress Syndrome (Hyaline Membrane Disease)


  Refers to a condition of surfactant deficiency and physiologic immaturity of the thorax
• Diagnostic exams for RDS

  • X-ray blood glucose
  • ABG
  • Fetal Lung Maturity Assay (the fastest)
• Diagnostic Findings for RDS

  • Radiographic findings – diffuse granular pattern like broken glass appearance on chest x-ray
  • Hypoxemia
  • Increased carbon dioxide and respiratory acidosis on ABG
• Medications for RDS


  • Artificial surfactant
  • Nitric Oxide (It will dilate pulmonary bronchus)
• Major Signs of RDS

  • Tachypnea 60>
  • Flaring nares
  • Expiratory grunting, Dyspnea
  • Chest Retractions – sternal and subcostal
  • Seesaw respirations
• Meconium Aspiration Syndrome


  Is the aspiration of amniotic fluid containing meconium into fetal or newborn trachea in utero or at first breath
• Occurs primarily in full-term and post-term infants during relaxation of the anal sphincter and passage of meconium in amniotic fluid due to intrauterine stress
• Assessment of MAS


  • Widened anteroposterior diameter of the chest (barrel-chest)
  • Greenish stains on the skin, umbilical cord and nails
• Nursing Management for MAS

  • Suctioning - oropharyngeal and tracheal
  • O2 support (Severe: Extracorporeal Membrane Oxygenation)
  • Exogenous surfactant administration
  • IV fluid administration
  • Administer systemic antibiotics as prescribed (Ampicillin, Gentamicin, Amikacin)
• Sepsis


  • Early onset – occurs less than 3 days after birth, caused by maternal infection
  • Late onset - occurs on the 4th up to 7th days after birth, nosocomial infection
• Clinical Manifestations of Sepsis

  • Pallor, Cyanosis, or Mottling
  • Hypotension
  • Tachycardia
  • Irregular respirations
  • Jaundice
  • Dehydration
  • Temperature instability
• Laboratory and Diagnostic Studies for Sepsis

  • Blood culture
  • Urine, blood culture and CSF (Cerebrospinal Fluid) analysis
  • CBC – WBC increased
  • ESR and C–reactive protein - increased
• Hyperbilirubinemia


  Refers to an excessive level of accumulated bilirubin the blood and characterized by jaundice
• Types of Hyperbilirubinemia


  • Pathologic Jaundice - appears in the first 24 hours of life
  • Physiologic Jaundice - appears after 24 hours of life
• Complication of Hyperbilirubinemia is Kernicterus
• Nursing Management for Hyperbilirubinemia

  • Cover the eyes (opaque eye covers) and genitalia
  • Check skin turgor for hydration
  • Turn the infant every 2 hours
  • Instruct the mother to continue breastfeeding every 2-4 hours
• Sudden Infant Death Syndrome (SIDS)


  Sudden unexpected death of any infant younger than 1 year old age
• 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 months
• Nursing Management for SIDS

  • Teach parents how to minimize the risk of SIDS
  • Avoid smoking during and after pregnancy
  • Encourage supine position or side-lying position
  • Avoid co-sleeping
  • Avoid soft beddings, use of pillows, blankets on the crib
  • Avoid maternal smoking
• Necrotizing Enterocolitis


  An acute inflammatory disease of the bowel
• Signs of Necrotizing Enterocolitis

  • Poor feeding
  • Distended abdomen
  • Blood in the stool
  • Vomiting
  • Apnea
• Nursing Management for Necrotizing Enterocolitis

  • Assessing patient for presence of abdominal distention
  • Reporting to the doctor any episodes of gastric residuals
  • Placing the patient on NPO as per doctor's order if symptoms of NEC are observed
• Newborn Screening


  Procedure to determine if the newborn infant has a heritable congenital metabolic disorder
• Congenital Hypothyroidism


  Results from the absence or lack of development of thyroid gland causing absence or lack of thyroxine needed for metabolism and growth of the body and the brain
• Signs & Symptoms of Congenital Hypothyroidism

  • Short stature
  • Macroglossia
  • Delayed closure of the fontanelles
  • Hypotonia
• Management of Congenital Hypothyroidism

  • Medication will be needed throughout the child's lifetime
  • Administration of thyroid hormone will prevent problems, if managed early it will not cause mental retardation
  • Synthroid – taken in the morning (report signs of tremors, toxicity)
• Phenylketonuria


  Deficiency or absence of enzyme needed to metabolize essential amino acid like phenylalanine