Preterm & Post Term SGA & LGA PDF

PRETERM & POST TERM | SGA & LGA Preterm 42 weeks Music box/Low-tuned radio 1. Hyperbilirubinemia...

PRETERM & POST TERM | SGA & LGA Preterm 42 weeks Music box/Low-tuned radio 1. Hyperbilirubinemia o High bilirubin levels in the blood o Neonate is jaundiced (due to liver immaturity) NURSE INTERVENTIONS o Kernicterus – staining of brain cells with bilirubin 1. Monitor vital signs PRETERM NEWBORN - Irreversible brain damage 2. Administer O2 2. Infection o As prescribed o Lack of IgG o Nurses can give O2 with a limit: 2 L/min via - Immaturity of all body systems 3. Cold Stress nasal cannula - Cause is unknown however there are factors that o Less SQ fat pads 3. I&O may contribute 4. Daily weight monitoring 4. Anemia - Maternal factors: o Iron deficiency 5. Warming device o Age 6. Reposition the baby every 1-2 hrs o Smoking o Poor nutrition MANAGEMENT: o Handle with care o Placental problems 1. Improve respiratory function 7. Avoid exposure to infections o Preeclampsia/Eclampsia o O2 Therapy 8. Appropriate stimulation o Multiple pregnancies o Mechanical Ventilator 9. Suctioning of secretions as needed 2. Maintenance of body temperature 10. Monitor for signs of infection ASSESSMENT: o Humidity and O2 concentration o Fever for children and young adults - Respirations - to prevent newborn from acquiring o Delirium for older adults because the body is o Irregular infection incapable of generating heat and then the o Irregular with episodes of apnea o Kangaroo Care – skin to skin infection reaches their brain - Temperature 3. Prevent infection 11. Skin care – Unscented! o Below normal o Handwashing – best way 12. Complete explanations for parents for necessary - Skin 4. Nutrition information o Thin o Visible blood vessels o Gavage feeding o Minimal SQ o Milk feeding (subcutaneous) fat pads o Make sure reflexes are intact o Jaundiced (some cases) - Poor sucking and swallowing reflex 5. Sensory Stimulation - Bowel sounds are diminished Gentle touch PANA, ANGEL RIKKA  PRETERM & POST TERM | SGA & LGA 2. Suctioning PROBLEMS WITH GESTATIONAL WEIGHT: POST TERM NEWBORN o Where? Mouth and nose 1. Small for Gestation Age o When? Delivery of the head of the newborn & 2. Large for Gestation Age Before baby takes their first breath - 12% of total population of infants are Post-term - Primary cause of delayed birth is unknown NURSING INTERVENTIONS: SGA: - Maternal factors: o Closely monitor cardiopulmonary status SMALL FOR GESTATION AGE o Multiple pregnancies o Administer O2 (As prescribed or as needed) o 15-19 y.o. – primigravida o Monitor blood sugar o Heel of the foot o Maintain thermoregulation ASSESSMENT: - Applicable to premature, full term, and post term o Monitor for signs of MAS 1. Depleted SQ Fats - Common condition why SGA is present: IUGR Preterm Full Term o Old-looking (Intrauterine Growth Restriction) Posture Extended limbs Flexed attitude o Old man face - Maternal Factors: 2. Parchment-like skin o Dry, wrinkled, cracked “Relaxed” o High blood pressure 3. Fingernails attitude o CKD – Chronic Kidney Disease 4. Abundant scalp Ears Cartilage: Cartilage: well- o Diabetes o Uncontrolled o Advanced 5. Long, thin body poorly formed o Heart/Respiratory Diseases 6. Meconium Staining developed o Infection 7. Umbilical cord (Yellow to green) o Substance use Folds easily - Alcohol COMPLICATIONS: Sole Fine wrinkles Well and deep - Drugs 1. Intrauterine hypoxia creases o Cigarette smoking o Aging placenta = oxygen deprivation Female Clitoris: Clitoris: not 2. MAS genitalia prominent prominent ASSESSMENT: o Meconium Aspiration Syndrome Labia majora: Labia majora: 3. Hypoglycemia 1. Respiratory Distress o Hypoxic episodes poorly prominent o Nutritional deprivation due to poor storage of developed 2. Loose and dry skin, little fat, little muscle mass glycogen Male genitalia Scrotum: poorly Scrotum: fully 3. Wasted appearance MANAGEMENT: developed developed 4. Head is larger compared to body 1. Ultrasound Grasping reflex Weak Strong 5. Widened skull sutures o Fetal development 6. Poor skin turgor o Amount of amniotic fluid 7. Sunken abdomen o Placental signs of aging PANA, ANGEL RIKKA  PRETERM & POST TERM | SGA & LGA INTERVENTIONS: o Evidence of molding o Capput succedaneum 1. Assess/observe signs of respiratory distress 2. Maintain body temperature PROBLEMS OF LGA: 3. Avoid exposure to infection to avoid sepsis 1. Hypoglycemia 4. Monitor blood sugar - During delivery 5. Provide stimulation - Administer D10W 2. Respiratory Distress COMPLICATIONS: 3. Hyperbilirubinemia 1. Respiratory Distress 4. Fractured skull, clavicles o Asphyxia o Brachial plexus injury o Shoulder dystocia 2. MAS o Breech 3. Hypoglycemia 4. Inability to maintain regular body temperature NURSING INTERVENTIONS: 1. Frequent VS monitoring LGA: o Prioritize respiration LARGE FOR GESTATION AGE 2. Blood glucose/sugar levels monitoring 3. Initiate early feedings 4. Note for signs of trauma/injury (BEC) - “Fetal macrosomia” 5. Monitor for signs of infection - Weighs more than 4000g - Primary cause is unknown 6. Provide stimulation - Maternal factor: o GDM ASSESSMENT: 1. Large/obese for the baby’s age 2. Lethargic, limp 3. May feed poorly 4. Birth trauma o Bruising o Broken clavicle PANA, ANGEL RIKKA  COMMON ACUTE CONDITIONS OF THE NEWBORN 3 ways to remember when assessing: Hypoxia 3. Give Nitric Acid ABC vs CAB - Causes Pulmonary Vasodilation MASLOW’S Increased Capillary Permeability - Vasodilation: increased blood flow to the alveoli. GORDON FUNCTIONAL HEALTH PATTERNS Extension of Alveoli & Terminal Bronchi NURSING INTERVENTIONS: 1. Monitor Vital Signs ACUTE RESPIRATORY DISTRESS Hyaline like membrane formation o Respiratory Rate SYNDROME o 02 Saturation 2. Monitor/ Check for Skin Color ASSESSMENT: 3. Check for the Degree of Effort - Lungs: Airways 1. Expiratory Grunting 4. ABG / Arterial Blood Gas - Immaturity & Inability to produce surfactants 2. Fast Breathing / Tachypnea - Common Site: Radial Artery 3. Seesaw like Respiration - 2 Methods: Surfactants- reduces tension inside the air sac According to PILLITTERI, the chest wall retracts, and the o ROME Method abdomen protrudes. o Tic Tac Toe Method Results to Lung Collapse 4. Decreased Breath Sounds 5. Cyanosis / Pallor *Review - Common Problem: 6. Hypothermia 2 Types of Blood: o Hypoxia 1. Oxygenated Blood – hemoglobin: bright or scarlet o Respiratory Acidosis red color of the blood being extracted. MANAGEMENT: 2. Deoxygenated Blood – negative or lesser 1. O2 Therapy hemoglobin: dark or dull color of the blood being ATELACTASIS o Endotracheal Tube extracted. o Nasal Prong o CPAC / Continuous Positive Airway Pressure Decreased Pulmonary Surfactant 2. Give Muscle Relaxant - Drug Chosen in the ER: Pancuronium Bromide Increased Surface Tension (Brand Name: Pavulon) - Purpose: Lack of Alveoli Expansion o Reduce Muscular Resistance o Reduce Possibility of Pneumothorax Decreased Alveoli Ventilation - Pneumothorax: air is outside the lungs but is present in the pleural cavity, that accumulates in the Inadequate Gas Exchange (O2 & Co2) parietal and visceral pleura that results to collapse. PANA, ANGEL RIKKA R.  COMMON ACUTE CONDITIONS OF THE NEWBORN MANAGEMENT: 1. Phototherapy HYPERBILIRUBINEMIA o Natural - sunrise 8. Check for Serum Bilirubin levels o Artificial – intense fluorescent blue light - Serum -> Blood Extraction According to the book... - Check for bilirubin levels in the blood - First Site: Sclera - You must wrap the baby with a WALLABY - Before extraction, make sure to turn off the - Target Management: Prevent Kernicterus to BLANKET. phototherapy lights. happen; irreversible brain damage. - Cover the Eyes and the Genitals of the baby 9. Examine the baby’s skin color - 2 Types: - Natural light 1. Pathological Jaundice Injuries: - Frequency: middle of warm and cold lights o Disease / Illness o Eye Damage 10. Check for the ff: o Appear in the first 24 hours o Dehydration o Sclera o Significant Lab Findings: >12mg/dL of o Sensory Deprivation o Head bilirubin. o Chest 2. Physiological Jaundice 2. Blood Transfusion o Abdomen o Appears in the first 7 days (2nd – 7th day) - Gauge 26 for babies o Arms & Legs o Lab Findings: average increased of 2mg/dL - Gauge 18-20 for adults o Hands & Feet and not >12mg/dL of bilirubin. - Done via Umbilical Cord - Frequency: 5-10mL at a time 11. Report adverse effects to the physician CAUSES OF BILURUBENEMIA: 1. Immaturity of liver Side Note: 2. Infection Refampin- orange urine MAS: 3. Maternal Diabetes NURSING INTERVENTIONS: MECONIUM ASPIRATION SYNDROME 4. Medications (bad for the mother; pregnancy 1. Expose the necessary skin category of the drug) 2. Check for skin irritation 3. Cover the eyes and genitals of the baby - Occurs when infants take meconium into their ASSESSMENT: 4. Give fluids (IV Fluids; as prescribed) lungs, before and/ or during labor. 1. Skin Color: Jaundice 5. Expect green stools and/ or urine - Post Term / Term 2. Enlarged Liver: present abdominal discomfort 6. Reposition the baby every 2 hours - Fetal Distress: 3. Lethargy 7. Bronze Body Syndrome (Grayish Color) o Increased intestinal peristalsis 4. Poor Muscle Tone - Increased photo isomers of the bilirubin; there will o Relaxed anal sphincter 5. Poor Sucking Reflex be copper-poryphyrin complex o Meconium is relaxed o Released in the amniotic fluid PANA, ANGEL RIKKA R.  COMMON ACUTE CONDITIONS OF THE NEWBORN - Reason: MANAGEMENT: o Prolonged ruptured of membranes 1. Antibacterial Therapy ASSESSMENT: o Prolonged / Difficult labor - Through IV 1. Respiratory Distress o Maternal Infection 2. Replenish IV Fluids - Cyanosis o Cross Contamination - D53NaCl / 5% Dextrose in 0.3% NaCl (light blue) - Tachypnea - Crackles lung sounds ASSESSMENT: NURSING INTERVENTIONS: - Yellow / Green / Brown pigments on the baby’s nails, 1. Poor Nutrition / Poor Feeding 1. Monitor Vital Signs skin & umbilical cord. 2. Irritability 2. O2 Therapy as prescribed 3. Lethargy 3. Isolate the baby MANAGEMENT: 4. Pallor - Do handwashing 1. Suctioning 5. Tachypnea - Wear PPE o When head is being delivered 6. Tachycardia o Before the first breath 7. Temperature Instability 2. Asess Vocal Cords FTT: - check if airway is clear DIAGNOSE: FAILURE TO THRIVE 1. CBC NURSING INTERVENTIONS: - WBCs; Elevated Neutrophils 1. Monitor Vital Signs *Review o Respiratory Rate WHITE BLOOD CELLS - Fails to gain weight o O2 Saturation GRANULATED AGRUNULATED [Pillitteri: 5th percentile of standard growth chart] 2. Ensure adequate oxygenation 1. Eosinophils - Causes: 3. Load with antibiotics / antibacterial (as prescribed) ➔ Parasite Infection o Delay of physical growth 2. Basophils o Cognitive impairment 4. Maintain Thermoregulation ➔ Breathing - Human Growth: ➔ Allergic Reactions o Food ➔ Histamine 1 o Rest & Activity 3. Neutrophils ➔ “Nana” / Puss o Adequate secretion of hormones NEONATAL SEPSIS ➔ Bacterial Infection o Satisfactory relationship with the care giver - 3 types of FTT: 2. Urinalysis & Fecalysis 1. Organic (OFTT) - This is a generalized bacterial infection that 3. Culture of CSF / Cerebrospinal Fluid - Pathological Conditions happens in the blood.- o Absorption - Major Common Cause: Group B Hemolytic o Hormonal Dysfunction Steptococci. 2. Non Organic (NFTT) PANA, ANGEL RIKKA R.  COMMON ACUTE CONDITIONS OF THE NEWBORN - Psychosocial Factor o Eye to eye contact ASSESSMENT: - [Pillitteri] disrupted maternal and child o Maintain calm & soothing environment 1. Pyrexia, chills, cephalgia relationship o Quiet, non-stimulating environment (light & 2. Most prominent sign: high pitch cry + irritability 3. Idiopathic (IFTT) sound) 3. Bulging of the anterior fontanel - Unknown causes o Praise the infant for eating - Unexplained o Increase stimulation MENINGEAL IRRITATIONS: - Appropriate to the child’s developmental 1. Nuchal Rigidity – stiff neck ASSESSMENT: level 2. Opisthotonos 1. Integumentary: poor muscle tone, loss of SQ fats & o Educate the caregiver o Arching of back skin breakdown - Demonstrate caregiving or proper infant o Head, heels are bent backward 2. Regurgitation care o And body arched forward 3. Lethargic - Foster dependency 3. Positive Kernig Sign 4. Diminished / non existent crying o Severe stiffness that happens in the hamstring 5. Radar gaze- continuous scanning of environment muscle MENINGITIS o Inability to straighten leg when hip is flexed to CARING: 90 degree 1. Assess the infant’s needs 4. Brudzinki Sign 2. Address frustration & anger at the infant’s o [Pillitteri] flexion at the hip in response to forward dissatisfaction response - Inflammation of meningitis flexion of the neck 3. Stress & Crisis o Brain o Spinal Cord NURSING INTERVENTIONS: - Causative Agents: 1. Provide isolation for 24 hours CATCH UP: o Bacteria 2. Administer antibacterials and antipyretics 1. OFTT; treatment of the condition depending in the o Virus 3. Neurological assessment cause - 2 types of Meningitis: o Seizure precautions: lower the height of the bed 2. NFTT; family counselling- parent & child relationship 1. Bacterial Meningitis and raise bed side rails 3. High caloric diet (nutritious) o Haemophilus Influenza B o Streptococcus 4. LOC – level of consciousness NURSING INTERVENTIONS: o Neisserian Meningitidis 5. Monitor intake & output 1. Provide consistent care 2. Viral Meningitis 6. Start contract tracing 2. Provide sufficient nutrients o Mumps 7. Meningococcal Vaccine o Feeding is a priority o Weigh daily o Herpes Virus o Introduce positive feeding environment o Enterovirus - Feeding is in structured routine - Hold infant during feeding to promote trust PANA, ANGEL RIKKA R.  COMMON ACUTE CONDITIONS OF THE NEWBORN 5. Nausea & Vomiting PRE-OP NURSING INTERVENTION: HYDROCEPHALUS 6. Ataxia 1. Small, frequent feeding (SFF) o Lack of coordination of the muscle movement o If NPO, then stop {NPO: Nil Per Os | Nothing by Mouth Parasthesia – pins & needles - [Pillitteri] imbalance of CSF 2. Reposition head frequently Diabetic neuropathy - Imbalance of absorption and or production o Prevent pressure sores 7. “Sunset” eyes / Sunsetting eyes o Malformation o “Egg crate mattress” 8. Nystagmus o Infections 3. Health teachings o Involuntary movement of the eyes o Tumor o Prepare family before the surgery 9. Late signs: o Hemorrhage o High pitch, shrill cry o Trauma PACU: o Seizures - Prominent sign: 1. After Surgery o Head enlargement DIAGNOSTIC TESTS: o Vital signs o Increase ICP / Intracranial Pressure 1. Xrays 2. Neurological Assessment - 2 types of Hydrocephalus: 2. CT Scan o Consciousness 1. Communicating 3. MRI o RLS/ Reaction Level Scale o Occurs because of the impaired o GCS/ absorption within the subarachnoid Transillumination—darkened room hold a bright light 3. Place Px on non separative site or unoperated side space *chun gun 4. Signs of increased ICP 2. Non Communicating o Cushing’s Triad: o Because of the blockage in the SURGICAL MANAGEMENT: - Increased BP ventricular system 1. Prevent further CSF accumulation - Decreased HR o Failure of CSF to enter into the o Bypass the blockage - Respiratory depression subarachnoid space o Drain the CSF from the ventricles at any location 5. Elevate the head where it may be reabsorbed 6. Measure Head Circumference 7. Meds SHUNT: o Diuretics ASSESSMENT: 1. Ventriculoperitoneal Shunt o Antibiotics 1. Increased head circumference 2. Anterior fontanel o CSF drains into the peritoneal cavity o Anti-Convulsant o Tense 2. Atrioventricular Shunt o CSF drains into the right atrium of the hear SHUNT REVISION o Bulging o Drug choice: Acetazolamide (Diamox) 1. Infant o Non pulsating 3. Irritability / Lethargic Provide the excretion of excess fluids o Irritable o Lethargic 4. Headache upon waking up o Poor feeding PANA, ANGEL RIKKA R.  COMMON ACUTE CONDITIONS OF THE NEWBORN 2. Toddler ASSESSMENT: 2. Prevent complication o Headache o Aseptic technique 1. Visible spinal deficit o Lack of Appetite o Clean intermittent catheterization 2. Motor / sensory involvement 3. Older Children o Always check for neurological status o Complications: o LOC/ Level of consciousness 3. Provide adequate nutrition - Flaccid paralysis; legs 4. Sensory stimulation - Altered bladder and bowel function 5. Discharge teachings: - Hip & joint deformities o Wound care - Hydrocephalus SPINA BIFIDA o ROM/ Range of motion’ physical therapy o Proper positions DIAGNOSIS: 1. Prenatal - Spine o Ultrasound - Splint o Amniocentesis - Affected area is the lower back / 2. Postnatal lumbosacral region o Xray of the spine - Neural tube defect o CT Scan - Neural Tube: o Myelogram o Spinal cord - Fluoroscopy dye to have a detailed o Brain photo of the spinal cord & spinal column o Meninges - Cause: Idiopathic but genetics may be one MEDICAL MANAGEMENT: of the reasons 1. Surgery - 2 types of SB: o Close the sac within 48 hours 1. SB Occulta: 2. Drugs o “posterior vertebral arches” o Antibiotics Spinal cord & meninges remains in o Anticholinergic (parasympathetic nervous normal anatomical position system) o [Pillitteri] Defect- “tuft of hair” o Asymptomatic NURSING INTERVENTIONS: 2. Myelomeningocele / 1. Prevent trauma to the sac Meningomyelocele o Cover sac with sterile dressing o Spinal nerve roots involved o Change dressing 2Q-Q4 (as prescribed) o 80%; multiple handicaps o Put baby in a prone position o Head is turned one side when feeding PANA, ANGEL RIKKA R.