Chapter 25 High-Risk Newborn Acquired & Congenital Conditions PDF

Chapter 25 High-Risk Newborn: Acquired and Congenital Conditions 1  Objectives  Describe causes of neonatal infection, s/s, and nursing care.  Describe the risk factors for MAS, and how do we treat?  What is the most import...

Chapter 25 High-Risk Newborn: Acquired and Congenital Conditions 1  Objectives  Describe causes of neonatal infection, s/s, and nursing care.  Describe the risk factors for MAS, and how do we treat?  What is the most important education piece for phototherapy?  How do we care for the infant of a diabetic mother, and what are the s/s?  Describe the effect of prenatal substance abuse on the newborn & the nursing care needed. 2  Newborn Resuscitation  Problem: Asphyxia  Lack of oxygen -increase of carbon dioxide  Occurs in utero, at birth or after birth  Many causes Maternal factors: HBP, infection or drug use, narcotics given during labor Placental conditions: Previa, abruption, post-maturity Fetal causes: Cord problems, infection, prematurity, multifetal gestation  Transient Tachypnea of the Newborn (TTN)  Problem  Rapid respirations soon after birth  Usually resolves within 12-72 hours  Risk factors: C/S without labor, asphyxia, macrosomia, multiples, long labors, maternal sedation, DM, asthma, male gender  Cause unknown, maybe delay in absorption of lung fluid  Assessment  S/S of respiratory distress, pulse oximetry  CXR-hyperinflation  Nursing intervention  Oxygen as ordered, IV’s, Gavage feeding,  Respiratory Complications: Meconium Aspiration Syndrome (MAS)  Causes-  hypoxia causing increased peristalsis and meconium passage before or during delivery  Manifestations-  respiratory distress at birth (tachypnea, cyanosis, grunting, retractions, nasal flaring, crackles, barrel-shape chest/hyperinflation)  Therapeutic management-  suctioning at birth, thermoregulation, humidified oxygen, respiratory support/ventilation, surfactant replacement, ECMO  Nursing considerations  During labor, notify Dr. if meconium present  NICU RN, Neonatologist may be needed  Resuscitate if needed 5  Infection  Sepsis neonatorum  Causes- GBS; E coli; Staph; Haemophilus influenza; Candida  Therapeutic management- diagnostic testing  Nursing considerations Assessment – Risk factors: – Prematurity/LBW, prolonged ROM or labor, GBS, being in NICU – S/S of infection: – Subtle! Hyper or hypothermia, respiratory changes, poor feeding, tachy or bradycardia, lethargy, apnea – Usually low temp. Nursing Interventions – Preventing infection: handwashing and incubator – Providing antibiotics: Labs, supportive care – Support parents 6  Prenatal Drug Exposure  Signs of exposure/neonatal abstinence syndrome symptoms (NAS)  hyperactive muscle tone; high-pitched cry; tremors; vigorous suck on fists but poor suck/swallow coordination; frequent regurgitation/vomiting; diarrhea, yawning, hyperthermia  Nursing considerations  Feeding Assess ability to coordinate sucking and swallowing Gavage if infant is agitated or breathing rapidly (if ordered) Increased need for extra calories Quiet, low-activity area for feedings Extra time and patience  Rest tremors and muscle tone, watch for seizures Infant needs quiet, dark room and swaddling (flexed) Cluster all care Give pacifier  Bonding-teach parents how to care for infant 7  Drug Exposure Alterations in Behavioral States Periods of activity delayed for several days Disorganized in sleep/wake patterns Unable to attend as well to human face and objects Exhibits gaze aversion with over-stimulation Neurologically weaker responses – Suck – Muscle tone – States of arousal