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NEWBORN AT RISK

PRETERM NEWBORN
• A neonate born before 38 weeks of gestation
• The primary concern relates to immaturity of
all body systems
CLINICAL FINDINGS
• respirations are irregular with periods of apnea
• body temp. is below normal
• poor suck and swallow reflexes
• diminished bowel sounds
• increased/decreased UO
• extremities are thin, with minimal creasing on soles and palms
• extends extremities & does not maintain flexion
• Lanugo present in wooly patches
• skin thin, with visible bld. vessels & minimal SQ fat pads
• skin may appear jaundiced
• testes undescended in boys
• labia narrow in girls
PRETERM NEWBORN
NURSING INTERVENTIONS
• Monitor V/S q2h
• Maintain cardiopulmonary functions
• Administer O2 & humidification as prescribed
• Monitor I&O and electrolyte balance
• Monitor daily weight
• Maintain in a warming device
• Position q 1-2 h and handle newborn carefully
•Provide newborn with appropriate stimulation, such as
touch
• Avoid exposure to infections
Best Procedure
• Resuscitation

NOTE: resuscitation becomes important for infant who fails to take


first breath or difficulty maintaining adequate respiratory
movements on his own.

• Suctioning

NOTE: allows removing mucus and prevents aspiration of any


mucus and amniotic fluid present in the mouth and nose of the
newborn to establish clear airway.

Intubations

• NOTE: head of the infant in neutral position with towel under


shoulder.
POSTTERM NEWBORN
• A neonate born after 42 weeks of gestation

CLINICAL FINDINGS
• Hypoglycemia
• Parchment-like skin (dry & cracked) without lanugo
• Fingernails long & extended over ends of fingers
• profuse scalp hair
• body is long & thin
• extremities show wasting of fat & muscle
• meconium-staining may be present on nails & umbilical
cord
POSTTERM NEWBORN

NURSING INTERVENTIONS
• Providenormal newborn care.
• Monitor for hypoglycemia.
• Maintain newborn’s temperature.
• Monitor I&O and electrolyte balance
• Monitor for meconium aspiration.
RH INCOMPATIBILTY

• In each pregnancy, an Rh(-) mother who carries an Rh (+)


fetus receives Rhogam if both the mother and infant is (-)
to both direct & indirect Coombs’ test.

• If mother is has been sensitized:


- anti-Rh(+) Ab are present
- Rhogam is not indicated

• Rhogam must be injected into unsensitized mother’s system


within 72 hours of delivery of Rh(+) infant
ABO INCOMPATIBILTY

• Reaction less severe than Rh incompatibility


• First born may be affected
- mother may have anti-A & anti-B Ab even before
pregnancy
• Fetal RBCs with A, B, or AB Ag evoke less severe reaction on
part of mother
- fewer anti-A, anti-B or anti-AB Ab are produced
• Clinical manifestations of ABO incompatibility are milder &
of shorter duration than those of Rh incompatibility
• Care must be taken to observe for hemolysis & jaundice
HYPERBILIRUBINEMIA
A. Increase serum bilirubin in the blood
more than 12-13mg%
B. Etiologic factors:
1. Prematurity
2. Polycythemia
3. Infection
4. Blood incompatibilities
C. S/Sx
1. Pathologic jaundice – present in the first 24
hrs
2. Lethargy, pallor
3. Enlarge liver
Management
a. Phototherapy
Guidelines:
-done for bilirubin level > 7mg/dl
a. unclothed the baby
-continued
b. baby’s for
eye5-7 days
shielded
c. ten 20-watt daylight or blue
b. Exchange Transfusion
fluorescent at 45 cm from skin
surface OR 16- 18 INCHES
-fullterm bilirubin : 20 mg/dl
d. monitor side effects:
-pre 1. dehydration
term bilirubin : 10-15 mg/dl
2.”bronze-baby syndrome”
• The goal of phototherapy is to decrease the serum unconjugated
bilirubin level because a high level may lead to bilirubin
encephalopathy (kernicterus). Phototherapy doesn't prevent
hypothermia or promote respiratory stability. It has no effect on
conjugated bilirubin, a water-soluble substance easily excreted in
urine and stool.

• Phototherapy increases gastric motility, causing the infant to


have many green, watery stools. The increased gastric motility
also causes the infant to be irritable. There is no evidence that
the newborn has a lactose intolerance or malabsorption problem,
nor is there evidence that the newborn's bilirubin levels are rising
to dangerous levels.
E. Nursing care:
1. Early detection
2. Early and frequent feeding
3. Monitor color, urine, stools, serum bilirubin
4. Regular turning
5. Promote bonding
NEWBORN OF DIABETIC
MOTHER
• A neonate born to an insulin-dependent mother or gestational diabetic
mother
• High incidence of congenital anomalies
• High incidences of hypoglycemia, respiratory distress, hypocalcemia, and
hyperbilirubinemia

CLINICAL FINDINGS
• Excessive size and weight as a result of excess fat & glycogen in
tissues
• Edema or puffiness in the face & cheeks hypocalcemia,
hyperbilirubenemia
• Signs of hypoglycemia such as: twitching, difficulty in feeding,
lethargy, apnea, seizures, & cyanosis
• Hyperbilirubinemia
• Signs of respiratory distress such as: tachypnea, cyanosis,
retractions, grunting, & nasal flaring
NEWBORN OF DIABETIC
MOTHER
NURSING INTERVENTIONS
• Monitor for signs of respiratory distress.
• Monitor bilirubin and blood glucose levels.
• Monitor weight.
• Feed early with 10% glucose in water, breast milk,
or formula as prescribed.
• Administer IV glucose to treat hypoglycemia if
necessary and as prescribed.
• Monitor for edema.
• Monitor for tremors, seizures, apnea, and acidosis.
HYPOGLYCEMIA
• Abnormally low level of glucose in the blood (less than
30 mg/dl in the first 72 hours or below 40mg/dl after
thefirst 3 days of life
• Normal: 40-60 mg/dl

CLINICAL FINDINGS
• Increased RR
• Twitching, nervousness, or tremors
• Unstable temp.
• Cyanosis
HYPOGLYCEMIA
NURSING INTERVENTIONS

• Provide low blood glucose through early feedings.


• Administer glucose orally or by IV as prescribed.
• Initiate early feedings.
• Monitor blood glucose as prescribed.
• Monitor for feeding problems.
• Monitor for apneic episodes.
• Monitor for shrill or intermittent cries.
• Evaluate lethargy & poor muscle tone..
FETAL ALCOHOL
SYNDROME
• Caused by maternal alcohol use during pregnancy
• Most serious cause of teratogenesis
• Causes mental & physical retardation

CLINICAL FINDINGS
FACIAL CHANGES
• Short palpebral fissures
• Hypoplastic philtrum
• Short upturned nose
• Flat midface
• Thin upper lip
• Low nasal bridge
FETAL ALCOHOL
SYNDROME
NURSING INTERVENTIONS
• Monitor for respiratory distress.
• Position newborn at the sides to facilitate drainage of secretions.

• Keep resuscitation equipment at the bedside.


• Monitor for hypoglycemia.
• Assess suck & swallow reflex.
• Administer small feedings & burp well.
• Suction as necessary.
• Monitor I&O.
• Monitor weight & head circumference.
• Decrease environmental stimuli.
Cleft Lip/Palate
1:1000 births
Cleft lip Cleft Palate
Malformation bet.
Maxillary and median nasal Malformation of
process on 5 to 8 wks IUL palatal process on 9
Common in boys to 12 weeks IUL
Genetic tendency
Common in girls
Deficient intake of Folic
Acid
Cleft Lip/Palate
• Treatment
– Chelloplasty- closure of cleft lip
• Patient should be ten weeks old, weighs 10 lbs
and hemoglobin of at least 10 g (RULE OF 10)
– Palatoplasty- closure of cleft palate (not done if
patient is not yet 10-12 months old
– Positioning: prone on abdomen
– Use paper cup to feed
– Feeding resume 3-4 weeks after repair
CheiloPlasty
REASONS FOR SURGERY
1. Prevention of nursing and feeding
problems that can retard normal growth.
2. Rearrangement of the distorted tissues
to make the lip and palate function
normally
Treatment
CHEILOPLASTY PALATOPLASTY
PreOperative PreOperative
a. feed in high fowler’s a. prepare parents
b. use large-hole nipple b. teach on feeding
or rubber-tipped syringe methods
c. burp frequently PostOperative
PostOperative a. position: side lying
a. maintain patent airway b. prevent trauma or
b. don’t strain suture line injury to suture line
c. prevent crying c. diet : liquid soft
Hydrocephalus
TYPES: Choroid plexus
a. communicating Lateral ventricle
b. non-communicating Foramen monroe

CAUSES: 3rd ventricle


1. injury Aqueduct of Sylvius
2. infection 4th ventricle
3. tumor
Luscka Magendie
4. congenital
Base of Brain
Diagnosis:
CT Scan
Treatment:
Extracranial Shunt
Nursing Care:
a. maintain patency
b. neuro checks
c. WOF:
-infection
-increase ICP
Spina Bifida
(Myelodysplasia)
• 2/1000 live births
• multifactorial
• 85% occurs in
- lower thoracic
- lumbar
- Sacral
Spina Bifida

Diagnosis
a. Prenatal
1. Amniocentesis
2. Ultrasound
3. CT Scan
Treatment
a. Sac Closure in 48 hours
PREOP
• Prone or placed on their side with
support above and below the defect
• Sterile wet compress of saline,
antiseptic, or antibiotic gauze over
lesion
• Provide warmth
• Observe for seepage of clear fluid
(check for presence of glucose)
• Urine and feces must not touch the
lesion
• Measure HC
POST-OP
• Prone (7-14 days)
• Urine and feces must not touch the
incision area
• Feeding
• Observe for signs of increased ICP
• Turn to sides every 2 hours
• Provide normal stimulation
Nursing Care Spina Bifida

*a. Prevent trauma to the sac


b. Provide adequate
nutrition
c. Provide sensory
stimulation
d. Emotional support
e. Refer for rehabilitation
The primary reason for surgical
repair of a myelomenigocele is to
do which of the following?
a. Correct the neurologic deficits
b. Prevent hydrocephalus
c. Prevent seizure disorders
d. Decrease the risk of infection
RESPIRATORY DISTRESS
SYNDROME (RDS)

• A serious lung disorder caused by immaturity and


inability to produce surfactant resulting in hypoxia and
acidosis
• Symptoms found most exclusively in the preterm infant
• Also known as Hyaline Membrane Disease (HMD)
• When premature labor cannot be arrested, Betamethasone
may be administered to enhance surfactant.
• Additional factors are: hypoxia, hypothermia & acidosis
RESPIRATORY DISTRESS
SYNDROME (RDS)
NURSING INTERVENTIONS
• Monitor for color, RR, and degree of effort in
breathing.
• Support respirations as prescribed.
• Monitor ABG and O2 sat. levels q2-4H.
• Monitor ABG so that O2 administered is at the
lowest possible concentration to maintain
adequate arterial oxygenation.
- less than 40% concentration if possible
• Schedule any premature newborn who required O2
support for an eye examination before discharge to
assess retinal damage.
RESPIRATORY DISTRESS
SYNDROME (RDS)
NURSING INTERVENTIONS
• Suction q2H or more often as necessary.
- suction less than 5 sec.using sterile catheter
• Position on side or back, with neck slightly
extended/neutral
• Prepare to administer surfactant replacement
therapy via E-tube
• Administer respiratory therapy (percussion &
vibration) as prescribed.
- use padded cup or small O2 mask for percussion
- use padded electric toothbrush for vibration
• Provide nutrition.
RESPIRATORY DISTRESS
SYNDROME (RDS)
NURSING INTERVENTIONS
• Maintain infant temp at 97.6 °F (36.2°C)
• Support bonding.
• Continuous positive air pressure (CPAP) or
POSITIVE END EXPIRATORY PRESSURE (PEEP)
may be used.
• Prepare parents for short- to long-term period of
O2 dependency if necessary
• Encourage mother to pump breasts for future
breastfeeding if she so desires
• Encourage as much parental participation in
newborn’s care as condition allows

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