prof. carole a. devine rn.msn. 1 normal and the high risk ne w born transition to extra- uterine...

Prof. Carole A. Devine RN.MSN. 1

Normal and The Normal and The High Risk NeHigh Risk Newwbornborn

Transition to Transition to Extra-Uterine LifeExtra-Uterine Life

2Prof. Carole A. Devine RN.MSN.

A.A. Respiratory System:Respiratory System:Initiation of BreathingInitiation of Breathing

Successful Transition:Successful Transition: Pressure Changes in LungsPressure Changes in Lungs

S/S of Respiratory DistressS/S of Respiratory Distress

Prevention of Aspiration Prevention of Aspiration /Airway Management/Airway Management


Meconium Aspiration Meconium Aspiration SyndromeSyndrome

Can Cause Severe Respiratory Can Cause Severe Respiratory Distress in Three Ways:Distress in Three Ways:

1.1. InflammationInflammation2.2. ObstructionObstruction3.3. Decreased Surfactant ProductionDecreased Surfactant Production

Outcome= Hypoxia and CO2 Outcome= Hypoxia and CO2 Retention and Possible Retention and Possible PneumonitisPneumonitis


Meconium Aspiration Meconium Aspiration Syndrome ContSyndrome Cont..

AssessmentAssessment

Therapeutic ManagementTherapeutic Management

PrognosisPrognosis

ComplicationComplication


Immune Immune System/Integumentary System/Integumentary

SystemSystem

Prevention of Prevention of InfectionInfection

Safety Safety Issues/NewborIssues/Newborn Caren Care


Sepsis NeonatorumSepsis Neonatorum

Definition:Definition: Transmission/EtiologyTransmission/Etiology Types:Types: Early Onset vs Late OnsetEarly Onset vs Late Onset S/SS/S ManagementManagement


THERMOREGULATIONTHERMOREGULATION Necessity of A Neutral Thermal EnvironmentNecessity of A Neutral Thermal Environment

Too Hot = Must decrease metabolism to cool their bodyToo Hot = Must decrease metabolism to cool their body Too Cool =Must Increase Metabolism to stay warmToo Cool =Must Increase Metabolism to stay warm

This effects the Preterm Baby especially Because:This effects the Preterm Baby especially Because: Has a large surface area per pound of body Wt.Has a large surface area per pound of body Wt. Extended body rather than flexedExtended body rather than flexed Decreased subcutaneous fatDecreased subcutaneous fat Poor Muscular DevelopmentPoor Muscular Development Limited amt. of brownLimited amt. of brown fatfat


Thermoregulation Cont.Thermoregulation Cont.

Maintain a Neutral Thermal Maintain a Neutral Thermal Environment/Prevent Environment/Prevent HypothermiaHypothermia

Newborn CareNewborn Care:: Drying Infant after BirthDrying Infant after Birth Cover HeadCover Head Use A Heated Radiant WarmerUse A Heated Radiant Warmer Kangaroo CareKangaroo Care Breast Feeding !!!!Breast Feeding !!!!


Endocrine System

Potential Risk for Potential Risk for HypoglycemiaHypoglycemia

Definition of Hypoglycemia Definition of Hypoglycemia for a Newborn: Glucose for a Newborn: Glucose < 30-< 30-4040 during first 72 hrs. of life in during first 72 hrs. of life in full term infantfull term infant

Problem/S/SProblem/S/S Newborn Care:Newborn Care:


Cardiovascular /Hematopoietic Cardiovascular /Hematopoietic SystemSystem

Potential Risk For Hemorrhage/ Potential Risk For Hemorrhage/ Cardiovascular CompromiseCardiovascular Compromise

Newborn care:Newborn care: Administer Administer Vitamin KVitamin K

(Phytonadione) give(Phytonadione) give 0.5mg -1.0 mg0.5mg -1.0 mg IM in the Vastus IM in the Vastus

Lateralis Muscle at birth Lateralis Muscle at birth V.S. every 15 min. after birth for V.S. every 15 min. after birth for

one hour, then every ½ hour x one hour, then every ½ hour x 2,then every two hours until stable2,then every two hours until stable


Renal /G.I.SystemRenal /G.I.System Potential for Inadequate Elimination PatternsPotential for Inadequate Elimination Patterns Newborn Care:Newborn Care: Daily Wt.Daily Wt. Nutrition /Fluid and Electrolyte BalanceNutrition /Fluid and Electrolyte Balance Premie.Vs Full Term:Premie.Vs Full Term: Calorie Concentration in formula fed Infants Calorie Concentration in formula fed Infants

will be different i.e.will be different i.e. Full Term = Full Term = 20 cal./fl. ounce20 cal./fl. ounce Premie. = Premie. = 24 cal./fl. ounce24 cal./fl. ounce Breast Feeding:Breast Feeding: Advantages Advantages


Hepatic System BilirubinBilirubin Hyperbilirubinemia ( Jaundice):Hyperbilirubinemia ( Jaundice): Definition: Definition: Conjugated vs. Unconjugated:Conjugated vs. Unconjugated: Unconjugated =Unconjugated =Fat soluble=IndirectFat soluble=Indirect Conjugated = Conjugated = H2O soluble=DirectH2O soluble=Direct Etiology/Normal Conjugation of Bilirubin:Etiology/Normal Conjugation of Bilirubin: S/SS/S ComplicationsComplications


Types of JaundiceTypes of Jaundice

Physiologic

Onset : occurs on the Onset : occurs on the 2-3rd 2-3rd day of lifeday of life

Cause:Cause: Bili. Level: Bili. Level: <10-12<10-12 Tx. Encourage feeding Tx. Encourage feeding

and eliminationand elimination

Pathologic:Pathologic: Onset: during Onset: during firstfirst

24 hrs. of life24 hrs. of life Cause:Cause: Bili. Level: Bili. Level: 13 and>13 and> in in

full term; full term; 1515 in Premie in Premie Tx. Phototherapy i.e. Tx. Phototherapy i.e.

(Bili-lights)(Bili-lights) Exchange Exchange

TransfusionsTransfusions


Jaundice (Cont.)Jaundice (Cont.)

Breast Milk Jaundice: Onset: Between Onset: Between the 4 -7the 4 -7thth day day after Birth after Birth Bilirubin Levels Can peak at two weeks up Bilirubin Levels Can peak at two weeks up

to to 15-2015-20 Causes:Causes: Tx. D/C Breast Feeding temporarily for 24-Tx. D/C Breast Feeding temporarily for 24-

48 hrs48 hrs. . and place infant in a sunny windowand place infant in a sunny window


Gestational Age AssessmentGestational Age Assessment

Indicators of Maturity in the Indicators of Maturity in the NewbornNewborn

Dubowitz and Ballard ScalesDubowitz and Ballard Scales are are used to Determineused to Determine

Categories:Categories: SGASGA (small for Gestational Age) (small for Gestational Age) IUGRIUGR (Intrauterine Growth Restriction) (Intrauterine Growth Restriction)

VSVS LGALGA (Large for Gestational Age)(Large for Gestational Age) (Macrosomia)(Macrosomia)


Small for Gestational Age Small for Gestational Age Neonates (SGA)Neonates (SGA)

Definition/Appearance:Definition/Appearance: Etiology:Etiology: Diagnosis:Diagnosis: Risk Factors/Common Cause:Risk Factors/Common Cause: Nursing Management:Nursing Management: Developmental Outcome:Developmental Outcome:


Large For Gestational Age Large For Gestational Age Neonate (LGA)Neonate (LGA)

Definition/Appearance:Definition/Appearance: Etiology:Etiology: Diagnosis:Diagnosis: Risk Factors/Common Cause:Risk Factors/Common Cause: Nursing Management:Nursing Management: Developmental Outcome:Developmental Outcome:


The Premature (Preterm) The Premature (Preterm) InfantInfant

Criteria/Criteria/Definition:Definition:

Wt. <2500G ( 5 1/2 Wt. <2500G ( 5 1/2 lbs ) at Birthlbs ) at Birth

Infant born between Infant born between the the 2020thth week and week and <end of <end of 3737thth week week GestationGestation

General Appearance: General Appearance: Small and Small and

underdevelopedunderdeveloped Head is largeHead is large

General General Appearance cont:Appearance cont:

Ruddy skin-little Ruddy skin-little subcutaneous fatsubcutaneous fat

Veins are readily Veins are readily noticeablenoticeable

Extensive lanugo Extensive lanugo with little vernixwith little vernix

Little or no Little or no creases on sole creases on sole of footof foot


Collaborative Problems of Collaborative Problems of the Preterm Infantthe Preterm Infant

Respiratory Distress Syndrome (RDS)Respiratory Distress Syndrome (RDS) Definition/EtiologyDefinition/Etiology

Underdevelopment of lungsUnderdevelopment of lungs Chief feature= fibrous membrane formed by Chief feature= fibrous membrane formed by

exudate of infant’s blood that forms lining of exudate of infant’s blood that forms lining of respiratory tract (prevents exchange of CO2 and respiratory tract (prevents exchange of CO2 and O2)O2)

Problem: decrease production of SurfactantProblem: decrease production of Surfactant L/S ratio is low (Lecithin/Sphingomyelin)L/S ratio is low (Lecithin/Sphingomyelin) Management Management PreventionPrevention


Collaborative Problems Collaborative Problems Cont.Cont.

Broncopulmonary Dysplasia Broncopulmonary Dysplasia (BPD)(BPD)

Etiology/IncidenceEtiology/Incidence

S/SS/S

ManagementManagement


Peri/Intraventricular Peri/Intraventricular Hemorrhage (PVH)(IVH)Hemorrhage (PVH)(IVH)

EtiologyEtiology

Incidence:Incidence:

S/SS/S

DiagnosisDiagnosis

ManagementManagement

Prof. Carole A. Devine RN.MSN.

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Necrotizing Entercolitis

Etiology/Incidence

S/S

Diagnosis

Management


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Retinopathy of Prematurity (ROP)

Definition/Etiology:

S/S:

Management: Prevention:

L/T. Consequences

Prof. Carole A. Devine RN.MSN.Prof. Carole A. Devine RN.MSN. 2424

Post Term InfantPost Term Infant Definition: Gestational age > Definition: Gestational age >

than 42 weeksthan 42 weeks

Factors assoc. with Post Factors assoc. with Post Term:Term:

Aging PlacentaAging Placenta OligohydramniosOligohydramnios CPD (Cephalopelvic CPD (Cephalopelvic

Disproportion)Disproportion) MASMAS

Factors Cont.Factors Cont. HypoglycemiaHypoglycemia PolycythemiaPolycythemia ThermoregulationThermoregulation Appearance Appearance Therapeutic ManagementTherapeutic Management


Infant of a Diabetic Infant of a Diabetic MotherMother

Appearance:Appearance:

Etiology:Etiology:

Complications:Complications:

ManagementManagement::


Prenatal Drug ExposurePrenatal Drug Exposure

Risk Factors:Risk Factors: Effect on Effect on

Fetus/Newborn:Fetus/Newborn: Neonatal Abstinence Neonatal Abstinence

SyndromeSyndrome Management/Nursing Management/Nursing

Care Care

1.1. AlcoholAlcohol

2.2. HeroinHeroin

3.3. CocaineCocaine

4.4. PCPPCP

5.5. MarijuanaMarijuana

6.6. CaffeineCaffeine

7.7. NicotineNicotine


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Torch Infections That Effect The Fetus/Newborn

S/S; Nursing Dx.; Management (see handout)

T=Toxoplasmosis O=Other: Gonorrhea Syphilis Varicella Hepatitis B Virus HIV R= Rubella C=Cytomegalovirus (CMV) H=Herpes Simplex Virus (HSV)

Prof. Carole A. Devine RN.MSN. 28

Parenting Issues with a High Risk Newborn

NSG.DX. High Risk for Altered Parenting R/T Impaired Parent/Infant Bonding

Promote Bonding

Emotional support

Fetal Demise

Nursing Responsibilities

Care of Infant

Care of Family


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THE END Of THE STORY ! !For Now……

prof. carole a. devine rn.msn. 1 normal and the high risk ne w born transition to extra- uterine...

Documents

brown fat slide

possible pneumonitis

uterine life slide

respiratory system

hypoglycemia potential

pound of body

extended body

severe respiratory distress