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83 Cards in this Set
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LBW
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2500 grams or less at birth
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Surfactant:
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Produced by choline pathway in type II cells between 28 to 32 weeks gestation and peaks at 35 weeks gestation.
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Periodic breathing:
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cessation of breathing for 5-10 seconds, with no other changes
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Apneic spell:
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lasts more than 20 seconds, with cyanosis and bradycardia
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Prone position
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increases oxygenation and lung compliance and reduces energy.
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Thermoregulation Complications (if they get cold)
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Hypoglycemia, metabolic acidosis, pulmonary vasoconstriction, and impaired surfactant production
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Inadequate Thermoregulation
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Hypoglycemia, resp. distress, poor feeding/intolerance to feedings, lethargy, irritability, poor muscle tone, cool skin temp., mottled skin.
BAbies may be septic. |
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Weaning off warmer
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Up to 3lbs. 7 oz.
Consistent weight gain for 5 days No medical complications Tolerating enteral feedings (don't want them to get to hot) |
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Radiant warmer water loss
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40-50% more than incubator
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Development of kidneys
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not complete until 35 weeks gest.
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Fluid needs of preemie:
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80-120 ml/kg per day
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Normal urinary output:
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2-5ml/kg per hour
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Measuring Urinary Output
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Weighing diapers
1 gram = 1ml of urine Specific gravity: 1.002-1.010 |
Always weigh butt naked, same time, same scale
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Signs of Dehydration
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Urinary output <2ml/kg/hr
Urine specific gravity > 1.010 Wt. loss greater than expected Dry skin and mucous membranes Sunken anterior fontanel IV 1ml/kg/hr Poor tissue turgor Blood: elevated Na, protein, and Hct resulting from decreased plasma volume |
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Signs of Overhydration
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Urine output >5ml/kg/hr
Urine specific gravity <1.002 Edema Wt. gain greater than expected Bulging fontanels Blood: decreased Na, protein, and Hct Moist breath sounds Difficulty breathing |
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Skin
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Fragile, permeable, easily damaged
ETT, IV, electrodes, etc. can be very damaging Assess frequently Avoid tape if possible Semi permeable dressings and products are better Change position q 2-3 hours Iodine used often, cleaned with water No alcohol! Sterile water for bathwater if <32 weeks Frequent position changes |
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Infection
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Lack of transfer of immunoglobulin G from mother in 3rd trimester, exposed to mothers infection, immature immune system. Endotrachael cord, catheter in place transfer from one baby to another. Any visitor must wash hands.
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Common signs of pain
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High-pitched, intense, harsh cry, whimpering
Cry face Eyes squeezed shut Mouth open Grimacing, bulging or furrowing of the brow Tense, rigid muscles or flaccid muscle tone Rigidity or flailing of extremities Color changes: red, dusky, pale Increased or decreased HR Increased resp. or apnea Increased BP Decreased oxygen sat. |
Sometimes they just want someone to pick them up.
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Preemies need (nutrition)
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105 to 130 kcal/kg/day (stomaches are small cant take a lot). Thru TPN or IV fluid
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Preemies should gain
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15 to 20 g/kg/day Be sure to aspirate stomaches contents before feeding, give back to them.
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Gavage Feedings
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used for less than 32 weeks- lack coordniation, are ill, are ventilator dependant
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Small for Gestational Age Infants (SGA)
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<2500 grams (5 ½ lbs)
Commonly due to placenta abnormalities, decreased blood flow, smoking, narcotics, alcohol abuse. Also related to congenital anomalies, chromosomal anomalies, severe maternal malnutrition |
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SGA Appearance
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Symmetric IUGR – body proportionate, occurred early
Asymmetric IUGR – occurred late, head and length normal, body small, sparse hair, thin cord, dry skin, wide-eyed look |
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IUGR:
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Intrauterine growth restriction refers to the poor growth of a baby while in the womb. Specifically, it refers to a fetus whose weight is below the 10th percentile for its gestational age.
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LGA:
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Causes:
Diabetic mother Large mother Multiparous Mothers More likely to have congenital heart defects Complications: long labor, Higher C-section rate, shoulder dystocia, fractured clavicle, damage to brachial plexus or facial nerve, bruising, cephalohematoma |
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IUGR Maternal Factors
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primiparity, grand multiparity, multiple-gestation, smoking, no PNC, age extremes <16 or >40, & low socioeconomic status
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IUGR Maternal disease-
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heart disease, substance abuse, sickle cell, PKU (fetal ketone urenia), asymptomatic pyelonephritis.
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IUGR Environmental
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high altitide, x-ray exposure, toxin exposure, excessive exercise, maternal use of teratogenic drugs (dilantin)
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IUGR Placenta
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small placenta, infarcted areas, abnormal cord insertions, placenta previa, thrombus
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IUGR Fetal- congenital infections
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rubella, toxoplasmosis, syphilis, discordant twins, inborn errors or metabolism
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PRETERM NEONATE
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BORN AFTER 20 WEEKS AND BEFORE 37 WEEKS OF GESTATION
CLASSIFIED AS AGA SGA LGA IUGR |
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PHYSICAL CHARACTERISTICS OF THE PRETERM INFANT
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DECREASED SUB-Q FAT
LARGE HEAD AS COMPARED TO REST OF BODY DECREASED BROWN FAT DECREASED IMMUNE SYSTEM (G antibody from mom) DECREASED SURFACTANT DECREASED LUNG COMPLIANCE DECREASED SUB-Q FAT LARGE HEAD AS COMPARED TO REST OF BODY DECREASED BROWN FAT DECREASED IMMUNE SYSTEM DECREASED SURFACTANT DECREASED LUNG COMPLIANCE DECREASED SUB-Q FAT LARGE HEAD AS COMPARED TO REST OF BODY DECREASED BROWN FAT DECREASED IMMUNE SYSTEM DECREASED SURFACTANT DECREASED LUNG COMPLIANCE DECREASED MUSCLE TONE DECREASED REFLEXES DECREASED BREAST TISSUE INCREASED LANUGO FEW PLANTAR CREASES NO CARTILAGE IN EAR THIN, TRANSPARENT SKIN IMMATURE GENITALIA |
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Polycythemia due to
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hyperglycemia which stimulates production of erythropoietin and rbcs
infants have Hgb>22 or Hct >65 |
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Increased viscosity of the blood causes ?
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resistance of blood flow= hyperbilirubinemia
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Macrasomia
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insulin acts as growth hormone and accelerated protein synthesis and deposit of fat and glycogen result.
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Higher risk of asphixia and RDS due to
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increased levels on insulin interfere with surfactant production
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RDS same as Highland Membrane Diseas
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Caused by insufficient surfactant production
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Risk:
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<2500 grams, <34 weeks, male, c-section
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Infant at 26 weeks with ability of gas exchange may not be able to ventilate because there is lack of:
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surfactant
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Surfactant is a lipoprotein composed of
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protein, fats, and other substances) that is synthesized by Type II alveolar cells
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Surfactant acts as a soap on alveoli to decrease
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surface tension
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SIGNS AND SYMPTOMS OF RDS
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Grunting—establishing end-expiratory pressure (EEP) in an effort to keep alveoli open
Nasal flaring—increases the diameter of conducting airway Retractions—increased work of breathing Apnea—loss of respirations for >20 seconds Tachypnea—respiratory rate >60 per minute Increasing oxygen requirements to maintain oxygen sats Increasing carbon dioxide levels Cyanosis—a late sign; paO2 is <40 before cyanosis is seen |
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TREATMENT OF RDS
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Minimal stimulation to decrease oxygen requirements
Keep him warm! IV fluids/parenteral nutrition Mechanical ventilation with end expiratory pressure (PEEP). When older, continuous positive airway pressure (CPAP) is used to keep the alveoli open. Exogenous surfactant—Survanta, Exosurf |
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TRANSIENT TACHYPNEA is
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Possibly related to poor fetal lung fluid absorption
Respirations can be as high as 150/min with grunting, nasal flaring, retractions and mild cyanosis |
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MECONIUM ASPIRATION is
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Causes airway obstruction, pneumonitis, and air trapping. Can lead to pulmonary hypertension
Because of air trapping, may be at risk for pneumothorax and/or pneumomediastinum Infant most at risk has thick meconium in the amniotic fluid. Meconiam staining below the vocal cords they have aspirated. Prevention of aspiration is key |
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Pneumomediastinum is
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air in the mediastinum. The mediastinum is the space in the middle of the chest, between the lungs.
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Pneumothorax is
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a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. ...
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JAUNDICE is
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Hyperbilirubinemia (Pathologic Jaundice)
Occurs within 1ST 24 hours of life May lead to kernicterus. (buildup of bili in brain) Bili levels go above 95% Treatment: Rh incmpatibility- Rh negative mom forms antibodies when blood from Rh positive fetus enters her circulation- antibodies cross placenta amd destroy fetal rbcs ABO incompatibility- O+ moms with natural antibodies to type A or B blood – less severe |
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Kernicterus
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is a rare neurological condition that occurs in some newborns with severe jaundice. Bilirubin in the brain.
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SIGNS AND SYMPTOMS OF INFECTION
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Temperature instability
Apnea and bradycardia Poor feeding Lethargy Poor sucking Decreased muscle tone Mottling Increased bleeding time |
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Symptoms of Infection
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Temperature instability
Apnea and bradycardia Poor feeding Lethargy Poor sucking Decreased muscle tone Mottling (skin looks like red splotches with white boarders) Increased bleeding time |
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COMPLICATIONS OF PREMATURITY
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BRONCHOPULMONARY DYSPLASIA
PERIVENTRICULAR-INTRAVENTRICULAR HEMORRHAGE RETINOPATHY OF PREMATURITY NECREOTIZING ENTEROCOLITIS |
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BRONCHOPULMONARY DYSPLASIA
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Complication of oxygen therapy and positive pressure mechanical ventilation
Epithelial lining of bronchi and alveolar walls becomes necrotic and scar tissue forms The higher percentage of oxygen required, the longer the period of ventilation, and the higher the ventilatory pressures, the greater the risk of scarring of alveoli Scarred alveoli cannot exchange gas Infant may become ventilator dependent Infant who requires oxygen after 28 days of life is considered to have BPD Also called chronic lung disease Mortality rate of 10-25% |
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Periventricular-Intraventricular Hemorrhage is
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Rupture of fragile blood vessels in the germinal matrix, located around ventricles of brain
Handle Gently! |
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Periventricular-Intraventricular Hemorrhage Causes:
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hypoxic injury to vessels, increased or fluctuating cerebral blood flow, rapid volume expansion, hypercarbia, anemia, hypoglycemia
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Periventricular-Intraventricular Hemorrhage Grade 1
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very small, outside ventricle walls, few clinical changes
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Periventricular-Intraventricular Hemorrhage Grade 2
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hemorrhage extends into ventricles, (some distention) not a lot
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Periventricular-Intraventricular Hemorrhage Grade 3
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distention of at least one ventricle
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Periventricular-Intraventricular Hemorrhage Grade 4
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ventricular distention and brain damage
Mortality rate increases with severity of bleed |
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Periventricular-Intraventricular Hemorrhage signs:
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lethargy, poor muscle tone, apnea, decreased Hct, decreased reflexes, full or bulging fontanels, seizures
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Periventricular-Intraventricular Hemorrhage TX:
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– support and maintain respiratory function, avoid excessive handling, shunt
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RETINOPATHY OF PREMATURITY (ROP) is
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Damage to immature blood vessels in the retina
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RETINOPATHY OF PREMATURITY (ROP) Patho:
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High concentration of oxygen causes retinal vasoconstriction
Vessels in portions of retina become ischemic To compensate for ischemia, new capillaries develop to provide oxygen and nutrients to damaged tissue But new vessels rupture and hemorrhage Scar tissue forms which grows rigid and shortens causing traction Results in retinal detachment and eventual blindness |
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NECROTIZING ENTEROCOLITIS (NEC) is
(what happens when baby is fed too early) |
Acute inflammatory bowel disease
Develops after hypoxic injury to the bowel at birth or during the early neonatal period Most commonly arises within the first 2 weeks |
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NEC =
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a gangrenous bowel
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NECROTIZING ENTEROCOLITIS (NEC) Predisposing factors:
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Necrotic areas resulting from hypoxia
Sterile bowel becomes colonized with bacteria Immature immune system to fight infection Immature peristaltic activity |
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SIGNS AND SYMPTOMS OF NEC
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Absent bowel sounds
Blood in the stool Diarrhea Increasing abdominal girth Residuals in feeding Signs of infection |
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TREATMENT OF NEC
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Close observation of infants known to be at risk
Early recognition is most important Keep NPO x 10 days to allow bowel time to rest and heal IV fluids, hyperalimentation and intralipids Antibiotics OG tube with continuous low Gomco suction Surgery to remove the necrosed area Colostomy, ileostomy, or jejunostomy If total bowel is necrosed, surgery becomes an “open and close” case because nothing can be done and the infant will die |
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OMPHALOCELE
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Herniation of abdominal contents into base of umbilical cord
Maintain hydration Place a sterile bag over area Prevent infection |
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FAS
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Alcohol freely passes through the placenta
Delay in feeding, persistent vomiting until 6-7 months of age Poor tone May be severely mentally retarded or have normal intelligence The worse the facial abnormalities the worse the IQ score Symptoms: small head, epicanthal folds, flat midface, smooth philtrum, low nasal bridge, small eye openings, short nose, thin upper lip |
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Infants of a Drug Dependent Mother
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Withdrawal – within 48-72 hours
Autonomic Nervous System – Hyperirritability, suck vigorously but poor suckers Treatment – Sedative/hypnotic, Anti-anxiety Prognosis – Neuro and growth problems, shrill cry Nursing – Decrease stimuli, nutrition, snuggle, protect skin |
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If on oxygen or Hood
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lying on side or stomaches. Require suctioning. change positions every 2-4 hours
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Normal Respiratory Rate
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30-60 *ask fawn*
normal resp rate 80 |
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Daily Measurement around:
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umbilical cord
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Readiness for Nipple feeding:
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Coordination of suck-swallow-breath= between 32-34 weeks corrected gestational age
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Give Parenteral Feedings
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For very immature infants because of resp. problems, limited gastric capacity, and reduced peristalsis
IV infusion of solutions with calories, amino acids, fatty acids, vitamins, and minerals |
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Enteral
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Feedings given orally
A little at a time GI tract, orally or by feeding tube.. Oral Occurs when infant would be 32-34 weeks They have the ability to coordinate sucking, swallowing, and breathing Start off small |
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Postterm Infants
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Absent lanugo
Little vernix caseosa Abundant scalp hair Skin cracked Wasted appearance |
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Postterm Infants Risks:
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Concern is for the status of the placenta, can result in hypoxia and malnourishment in the fetus
Risk of meconium aspiration( respiratory distress) polycythemia Con’t glucose checks for 8-12 and up to 24 hrs of age Observe for wide-eyed, hyper-alert state Tx: observe for respiratory distress, check blood glucose after birth and at one hour, early and frequent feedings, temperature maintenance, observe for jaundice |
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Characteristics of Infant of Diabetic Mother
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SGA vs. LGA
Risk of heart, kidney and neural tube anomalies Hypoglycemia Hypocalcemia from decreased parathyroid production Polycythemia and possible organ damage because of Hyperglycemia in eutero. |
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Tobacco Dependent
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Biggest danger: carbon monoxide
Carbon monoxide binds to hemoglobin—reduces oxygen carrying capacity of the blood Carbon monoxide also increase binding of hemoglobin to oxygen, which impairs the oxygen from getting into tissues |
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CARE OF FAMILY
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Extended hospitalization causes stress and separation
Expect parents to be fearful Watch for bonding Talking positively about infant Pointing out physical characteristics Calling infant by name Increase in comfort Frequent visits |
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Care of Family Parenting
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Make advance preparations
Assisting parents at birth Support parents during visits Provide Info. Institute kangaroo care Facilitating interaction Increase parental decision making Alleviate concerns Help with ongoing problems Prepare for discharge |
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