PDF Newborn with Perinatal Injury or Congenital Malformation Chapter 14

8/22/2024 The Newborn with a Perinatal Injury or Congenital Malformation Chapter 14 Niomi Quinteros, BSN, RN 1  8/22/2024 Hydrocephalus Se...

8/22/2024 The Newborn with a Perinatal Injury or Congenital Malformation Chapter 14 Niomi Quinteros, BSN, RN 1  8/22/2024 Hydrocephalus Setting Sun Eyes Manifestations: Large Head Delayed Development Lack of Appetite Tendency to Vomit Easily Poor resistance to infection Hydrocephalus Nursing Care: Measure Head DAILY Frequent position changes supporting the head Skin breakdown: prevent and treat Feeding Side –lying after feeding Record observations furosemide S/Sx Increased ICP: Increased B/P; Decreased HR & RR acetazolamide 2  8/22/2024 Pre-Op Nursing Care: Measure Head DAILY Frequent position changes Hydrocephalus supporting the head Treatment Usually Surgical Skin breakdown: prevent and treat Feeding Record /report observations Food taken Vomiting Skin condition Motor abilities Restless / irritability Vital Sign Changes S/Sx Increased ICP: Increased B/P; Decreased HR & RR Fontanelles / Head Circumference Report immediately signs of cold or infection Hydrocephalus Post-Op Nursing Care: Routine care Monitor for S/Sx Increased ICP Monitor for S/Sx Infection Check operative area for inflammation Positioning dependent on fontanelle Skin assessment Head, chest, abdomen measurements Pain control Strict Intake and Output Observe for fluid overload Feeding when active bowel sounds auscultated Surgical Suture Line kept clean & dry NO diaper contamination Parent education, support, guidance Community resources: National Hydrocephalus Foundation 3  8/22/2024 Prevention: Spina bifida Folic Acid Surgery (Nursing Tip) Required Nursing Care: Prevent injury / After surgery, infection to sac Prevent development of Legs paralyzed contractures Incontinent Good skin care Nutrition (urine & feces) Observations: recording & reporting Educate parents Habilitation Habilitation Continued medical goals / training supervision Pre-Op Nursing Spina Bifida Post-Op Nursing Care: Care: Prevent injury / Neurological infection to sac Assessments Cover with sterile Prevent infection dressing Urological monitoring Keep moist Skin care Routine NB care Feeding AND Latex – free Record observations environment Positioning: Prone: Bonding with parents prevent pressure on Community Resource: sac Spina Bifida Association of America 4  8/22/2024 Pre-Op Nursing Care: Cleft Lip Monitor for signs of oral, respiratory, or Cheiloplasty systemic infection – before 6 months report to RN Elbow restraints Post-Op Nursing Care: Feeding to avoid sucking motions Prevent sucking / crying Positioning Prevent infection Prevent injury Emotional needs Pain relief / sedation Goals of Care: Union of cleft Cleft Palate Improved feeding Post-Op Nursing Improved speech Care: Improved dental development Nutrition Nurturing positive Oral hygiene self image Speech Instruct parents to Diversion report s/s of Complications infection Pre-Op Nursing Care: Multidisciplinary approach Issues / problems Safety Alert! 5  8/22/2024 Club Foot Nursing Care: Splinting / Casting starts early Passive stretching exercises Parent teaching / Anticipatory Guidance PKU: Phenylketonuria 6  8/22/2024 Down Syndrome Down Syndrome 7  8/22/2024 Down Syndrome Nursing Care: Counseling parents Grieve loss of “perfect child” Involve parents in care Involve parents in care planning Warm concern Counseling siblings Inform and include Open communication Social support Support groups for family National Association for Down Syndrome Erythroblastosis Fetalis RhoGam administration has decreased incidence: 72 hrs after delivery of Rh + infant Administer at 28th week of pregnancy After spontaneous / therapeutic abortion, amniocentesis, etc. Manifestations Hyperbilirubinemia (results in jaundice) Safety Alert! 8  8/22/2024 Care Plan Risk for Injury to eyes and gonads related to phototherapy Impaired skin integrity related to immature structure and function; immobility Risk for deficient fluid volume related to increased water loss through skin and loose stools Risk for hyperthermia or hypothermia Risk for injury (neurological) related to nature of hyperbilirubinemia Imbalanced nutrition: less than body requirements Parental anxiety related to deficient knowledge crisis of having an infant with jaundice Nursing Tips: Assessing jaundice Phototherapy Tips 9  8/22/2024 Meconium Aspiration Syndrome Meconium Aspiration Syndrome Nursing Care: Assist with amnioinfusion Assess for respiratory distress Supportive care Warmth Supplemental oxygen Energy conserving plan of care NICU: intubation / mechanical ventilation 10  8/22/2024 Infant of Diabetic Mother Nursing Care: Close monitoring of vital signs Early feeding Frequent assessment of blood glucose levels for first 2 days of life (must be above 40 mg/dl) Monitor for signs of irritability, tremors, and respiratory distress (hypoglycemia) Transient Tachypnea TTN Respiratory Distress Syndrome Type II Resolves in 3 days Characteristics Tachypnea Chest retractions Grunting Cyanosis Treatment and Nursing Care Close observation O2 11  8/22/2024 Neonatal Nursing Care Abstinence Swaddling Syndrome Quiet environment/reduce external stimuli NAS Observation for seizures 12