NCMA219 Midterm Review

• Premature Infant


  Infant born less than 38 weeks gestation
• Premature Infant


  • Lanugo covers the entire back and face, soles few creases, scrotum little rugae
  • Thin and pinkish skin, plenty of lanugo and relaxed posture
• 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
• SGA

  Infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on the intrauterine growth chart
• Causes of SGA

  • Poor nutrition during pregnancy
  • Placental defects and complications
  • Teenage pregnancies
  • Hypertensive mother
• Priority nursing care for IUGR in the first few days of life

  1. Initiation and maintenance of respirations

  2. Maintenance of hydration and normal glucose - glucose IVF, thermoregulation, correct IVF rate, breastfeeding every 3-4 hours

  3. Monitor glucose level every 4 hours

  4. Control of body temperature

  5. For newborns under radiant warmers – monitor vital signs, keep the newborn hydrated, assess integrity of the skin

  6. Maintaining neutral thermal environment permits the neonate to maintain a normal core temperature with minimal oxygen consumption
• Causes of IUGR and SGA newborn


  • Age – under 18 or over 35 years of age
  • Poor nutrition during pregnancy
  • Placental defects – perinatal hypoxia
  • Maternal condition – HPN, anemia, DM
• Respiratory Distress Syndrome (Hyaline Membrane Disease)


  Condition of surfactant deficiency and physiologic immaturity of the thorax
• Diagnostic exams for RDS

  1. X-ray

  2. Blood glucose

  3. ABG

  4. 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


  Aspiration of amniotic fluid containing meconium into fetal or newborn trachea in utero or at first breath
• Meconium Aspiration Syndrome


  • Occurs primarily in full-term and post term infants during relaxation of the anal sphincter and passage of meconium into amniotic fluid due to intrauterine stress
  • Widened anteroposterior diameter of the chest (barrel-chest)
  • Greenish stains on the skin, umbilical cord and nails

  
• Nursing care for Meconium Aspiration Syndrome

  1. Suctioning – oropharyngeal and 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


  Infection in the bloodstream
• Types of 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
• Diagnostic tests 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 the blood, characterized by jaundice
• Types of Hyperbilirubinemia


  • Pathologic jaundice - Jaundice in the first 24 hours of life
  • Physiologic jaundice - Jaundice after 24 hours of life
• Management of Hyperbilirubinemia


  Phototherapy
• Nursing care for Hyperbilirubinemia

  1. Cover the eyes and genitalia

  2. Check skin turgor for hydration

  3. Turn the infant every 2 hours

  4. 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 of age, death usually occurs during sleep

  
• SIDS


  • Most common cause of death in children ages 1 months to 1 year
  • Peak: 2-4 mos., 90% before 6th mos.

  
• Nursing management for SIDS

  1. Teach parents how to minimize the risk of SIDS

  2. Avoid smoking during and after pregnancy

  3. Encourage supine position or side-lying position

  4. Avoid co-sleeping, soft beddings, use of pillows, blankets on the crib
• Necrotizing Enterocolitis


  Acute inflammatory disease of the bowel, preterm neonates manifesting abdominal distention and vomiting
• Signs of Necrotizing Enterocolitis

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

  1. Assessing patient for presence of abdominal distention

  2. Reporting to the doctor any episodes of gastric residuals

  3. Placing the patient on NPO as per doctor's order if symptoms of NEC is observed

  
• Newborn Screening


  • Congenital hypothyroidism
  • Phenylketonuria
  • G6PD Deficiency
• Newborn Screening


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


  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 and symptoms of Congenital Hypothyroidism


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

  1. Medication will be needed throughout the child's lifetime

  2. Administration of thyroid hormone will prevent problems

  3. If managed early it will not cause mental retardation

  4. Medication – Synthroid – taken in the morning, report signs of tremors (toxicity)
• Phenylketonuria


  Deficiency or absence of enzyme needed to metabolize essential amino acid like phenylalanine
• Diagnostic test for Phenylketonuria

  Guthrie test
• Management of Phenylketonuria


  1. If managed early it will prevent mental retardation or cognitive impairment

  2. The goal of treatment - meeting the child's nutritional needs for optimal growth

  3. 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
• Symptoms of G6PD Deficiency


  • Jaundice
  • Dark colored urine
  • Back pain
  • Anemia