Preterm and Postterm Newborn PDF

THE NEWBORN 081-NP03L008 ELO B · VERSION 2.0 THE PRETERM AND POSTTERM NEWBORN Introduction to Maternity and Pediatric Nursing, 8th Ed., pp. 311 - 327 TERMINAL LEARNING OBJECTIVE Perform safe and effective nursing care for a term newborn ENABLING LEARNING OBJECTIVE: B Perform nursing care on the pret...

THE NEWBORN 081-NP03L008 ELO B · VERSION 2.0 THE PRETERM AND POSTTERM NEWBORN Introduction to Maternity and Pediatric Nursing, 8th Ed., pp. 311 - 327 TERMINAL LEARNING OBJECTIVE Perform safe and effective nursing care for a term newborn ENABLING LEARNING OBJECTIVE: B Perform nursing care on the preterm and post-term newborn THE PRETERM NEWBORN THE PRETERM NEWBORN Low birth weight infant 2500 grams or less (5.8 lbs.) Preterm birth is the cause of more deaths during the first year of life than any other single factor Higher percentage of birth defects The less a preterm weighs at birth, the greater the risks to life during delivery and immediately after GESTATIONAL AGE Actual time from conception to birth that the fetus remains in the uterus Preterm infant is less than 37 weeks Early term infant: between 37 weeks, 0 days and 38 weeks, 6 days Full term infant: between 39 weeks, 0 days and 40 weeks, 6 days Late term infant: between 41 weeks, 0 days and 41 weeks, 6 Post term infant: between 42 weeks, 0 days and beyond days CAUSES OF PRETERM BIRTH Multiple births Maternal illness Hazards of actual pregnancy Placental abnormalities Placenta previa Premature separation of the placenta from uterine wall Studies indicate relationship between prematurity and: Poverty Smoking Alcohol consumption Abuse of cocaine and/or other drugs PHYSICAL CHARACTERISTICS Transparent loose skin Short extremities Visible superficial veins Few creases on soles of feet Lack of subcutaneous fat Protruding abdomen Lanugo Short nails Small genitalia Forehead Shoulders Arms Abundant vernix caseosa Labia majora may be open in girls CHECK ON LEARNING Which physical characteristic should make the nurse think an infant’s gestational age may be preterm? a. Square window sign assessed at 0 degrees b. Small amount of lanugo and vernix present c. Labia majora cover labia minora in the female d. Superficial scalp and abdominal veins easily seen CHECK ON LEARNING Gestational age is best determined by _____________. a. Weight of the infant at birth b. Stability of the blood glucose c. The age at which the infant reaches developmental milestones d. Assessment of physical and neurologic characteristics RELATED PROBLEMS INADEQUATE RESPIRATORY FUNCTION Structural changes of lungs Previability Chest muscles Abdomen Brain unable to stimulate respirations Weak gag and cough reflex Supplemental oxygen delivery may be required RESPIRATORY DISTRESS SYNDROME Hyaline membrane disease Type 1 Lung immaturity Reduced gas exchange 30% of all neonatal deaths Pathophysiology Surfactant deficiency Test for lecithin/sphingomyelin ratio Results  amount surfactant in amniotic fluid Etiologies of RDS CLINICAL MANIFESTATIONS Increased respirations > 60 bpm Tachypnea Nasal flaring Cyanosis Intercostal and sternal retractions Edema Apnea MEDICAL MANAGEMENT Corticosteroids Surfactant Birth RDS 72 hours NURSING IMPLICATIONS Vital signs ABGs Cluster care IV fluids Oxygen therapy APNEA Cessation of breathing 20 minutes or longer Accompanied by bradycardia Stimulate breathing Suctions nose and mouth Positioning Ambu bag NEONATAL HYPOXIA Inadequate oxygenation Cellular level Monitor pulse oximetry Risk factors Anemic infants Infants with abnormal RBCs Can present even with normal pulse oximetry Proper application of pulse oximeter for accurate reading SEPSIS IN THE PRETERM INFANT Generalized infection of the bloodstream At risk because of immaturity of many body systems Liver is immature; poor formation of antibodies Body enzymes are inefficient Some symptoms include Low temperature Lethargy or irritability Poor feeding Respiratory distress TREATMENT OF SEPSIS Administration of intravenous antimicrobials Maintenance of warmth and nutrition Close monitoring of vital signs Care should be organized to help infant conserve as much energy as possible Following standard precautions, including strict hand hygiene, is essential POOR CONTROL OF BODY TEMPERATURE Heat loss results from Lack of brown fat Excessive heat loss Immature brain heat-regulating center Sweat gland not functioning Weak muscles High metabolism CLINICAL MANIFESTATIONS Skin temperature Respiratory rate Periods of apnea Bradycardia Skin mottling Lethargy Skin mottling on 540g baby born at 27 weeks NURSING IMPLICATIONS Skin probe Do not place over bony prominence Place on right upper quadrant of abdomen Place infant in radiant warmer or incubator HYPOGLYCEMIA Plasma glucose levels