High Risk Neonatal Nursing Care

Report
Developed by D. Ann Currie, RN, MSN
High Risk Newborn Nursing
Care
Fetal/Neonatal Risk
Factors for Resuscitation
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Nonreassuring fetal heart rate pattern
Difficult birth
Fetal scalp/capillary blood sample-acidosis pH<7.20
Meconium in amniotic fluid
Prematurity
Macrosomia or SGA
Male infant
Significant intrapartum bleeding
Structural lung abnormality or oligohydramnios
Congenital heart disease
Maternal infection
Narcotic use in labor
Fetal/Neonatal Risk Factors
for Resuscitation (continued)
 An infant of a diabetic mother
 Arrhythmias
 Cardiomyopathy
 Fetal anemia
Respiratory Distress
Syndrome (RDS)
 Deficiency or absence of surfactant
 Atelectasis
 Hypoxemia, hypercarbia, academia
 May be due to prematurity or surfactant deficiency
RDS: Nursing Care
 Maintain adequate respiratory status
 Maintain adequate nutritional status
 Maintain adequate hydration
 Education and support of family
Transient Tachypnea of
the Newborn (TTN)
 Failure to clear lung fluid, mucus, debris
 Exhibit signs of distress shortly after birth
 Symptoms
 Expiratory grunting and nasal flaring
 Subcostal retractions
 Slight cyanosis
TTN: Nursing Care
 Maintain adequate respiratory status
 Maintain adequate nutritional status
 Maintain adequate hydration
 Support and educate family
Meconium Aspiration
Syndrome (MAS)
 Mechanical obstruction of the airways
 Chemical pneumonitis
 Vasoconstriction of the pulmonary vessels
 Inactivation of natural surfactant
MAS: Nursing Care
 Assess for complications related to MAS
 Maintain adequate respiratory status
 Maintain adequate nutritional status
 Maintain adequate hydration
Persistent Pulmonary
Hypertension (PPHN
 Blood shunted away from lungs
 Increased pulmonary vascular resistance (PVR)
 Primary
 Pulmonary vascular changes before birth resulting in
PVR
 Secondary
 Pulmonary vascular changes after birth resulting in PVR
PPHN: Nursing Care
 Minimize stimulation
 Maintain adequate respiratory status
 Observe for signs of pneumothorax
 Maintain adequate nutritional status
 Maintain adequate hydration status
 Support and educate family
Cold Stress
 Increase in oxygen requirements
 Increase in utilization of glucose
 Acids are released in the bloodstream
 Surfactant production decrease
Cold Stress: Nursing Care
 Observe for signs of cold stress
 Maintain NTE
 Warm baby slowly
 Frequent monitoring of skin temperature
 Warming IV fluids
 Treat accompanying hypoglycemia
Hypoglycemia Symptoms
 Lethargy or jitteriness
 Poor feeding and sucking
 Vomiting
 Hypothermia and pallor
 Hypotonia, tremors
 Seizure activity, high pitched cry, exaggerated moro
reflex
Hypoglycemia:
Nursing Care
 Routine screening for all at risk infants
 Early feedings
 D10W infusion
Physiologic
Hyperbilirubinemia
 Appears after first 24 hours of life
 Disappears within 14 days
 Due to an increase in red cell mass
Pathologic
Hyperbilirubinemia
 Appears within first 24 hours of life
 Serum bilirubin concentration rises by more than 0.2
mg/dL per hour
 Bilirubin concentrations exceed the 95th percentile
 Conjugated bilirubin concentrations are greater than 2
mg/dL
 Clinical jaundice persists for more than 2 weeks in a
term newborn
Causes of Pathologic
Hyperbilirubinemia
 Hemolytic disease of the newborn
 Erythroblastosis fetalis
 Hydrops fetalis
 ABO incompatibility
Treatment of Pathologic
Hyperbilirubinemia
 Resolving anemia
 Removing maternal antibodies and sensitized
erythrocytes
 Increasing serum albumin levels
 Reducing serum bilirubin levels
 Minimizing the consequences of hyperbilirubinemia
Maternal-Fetal
Blood Incompatibility
 Rh incompatibility
 Rh-negative mother
 Rh-positive fetus
 ABO incompatibility
 O mother
 A or B fetus
Phototherapy: Nursing Care
 Maximize exposure of the skin surface to the light
 Periodic assessment of serum bilirubin levels
 Protect the newborn’s eyes with patches
 Measure irradiance levels with a photometer
 Good skin care and reposition infant at least every 2 hours
 Maintain an NTE and adequate hydration and nutrition
Anemia
 Hemoglobin of less than 14 mg/dL (term)
 Hemoglobin of less than 13 mg/dL (preterm)
 Nursing management
 Observe for symptoms
 Initiate interventions for shock
Polycythemia
 Increase in blood volume and hematocrit
 Nursing management:
 Assessment of hematocrit
 Monitor for signs of distress
 Assist with exchange transfusion
Clinical Manifestations of Sepsis
 Increase in blood volume and hematocrit
 Nursing management:
 Assessment of hematocrit
 Monitor for signs of distress
 Assist with exchange transfusion
 Temperature instability
 Feeding intolerance
 Hyperbilirubinemia
 Tachycardia followed by apnea/bradycardia
Clinical Manifestations of Syphilis
 Rhinitis
 Red rash around the mouth and anus
 Irritability
 Generalized edema and hepatosplenomegaly
 Congenital cataracts
 SGA and failure to thrive
Syphilis: Nursing
Management
 Initiate isolation
 Administer penicillin
 Provide emotional support for the family
Gonorrhea
 Clinical Manifestations
 Conjunctivitis
 Corneal ulcerations
 Nursing management
 Administration of ophthalmic antibiotic ointment
 Referral for follow-up
Clinical Manifestationfs of Herpes
 Small cluster vesicular skin lesions over the entire body
 DIC
 Pneumonia
 Hepatitis
 Hepatosplenomegaly
 Neurologic abnormalities
Herpes: Nursing
Management
 Careful hand washing and gown and glove isolation
 Administration of IV vidarabine or acyclovir
 Initiation of follow-up referral
 Support and education of parents
Chlamydia
 Clinical Manifestations
 Pneumonia
 Conjunctivitis
 Nursing management
 Administration of ophthalmic antibiotic ointment
 Referral for follow-up
Needs of Parents of
At-risk Infants
 Realistically perceiving the infant’s medical condition
and needs
 Adapting to the infant’s hospital environment
 Assuming primary caretaking role
 Assuming total responsibility for the infant upon
discharge
 Possibly coping with the death of the infant if it occurs
Facilitating Parental
Attachment
 Facilitating family visits
 Allowing the family to hold and touch the baby
 Giving the family a picture of the baby
 Liberal visiting hours
 Encouraging the family to get involved in the care
 Cont. to Study other conditions from the Text

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