Health Deviations Of Neonate

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HYPERBILLIRUBINERMIA
2 Types

Back 1

physiologic Jaundice-most common 50-80%

Conjugation of Bilirubin

Front 2

patho of physiologic jaundice

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due to increased RBC count and immature liver. Immature liver means less protein binding sites for RBC to attach to, to be brought to liver to be excreted.

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what is the difference b/w conjugated and unconjugated bilirubin

Back 3

unconj- (indirect) is free flowing and accumulated outside the liver. it is fat souluable and toxic
conj-(direct)in liver, not toxice, h2o soulable. exreted in hepatic ducts goes through urine/stool

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criteria for physiologic jaundice

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well/term infant-evident after 24h end about 7th day
preterm infant-evident after 48h end is 9-10d
serum concentrations almost exclusively unconjugated

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criteria for pathologic jaundice

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serum bilirubin >4mg/dl in cord blood
JAUNDICE IS EVIDENT WITHIN 24H OF BIRTH

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Potential causes of pathologic hyperbillirubinemia

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maternal- Rh/ABO incompatibility. mom has infection, DM, oxytocin may cause, Valium, ASA, sulphas
Newborn-preemie, structural hepatic damage, hyperthyroidism, billiary obstruction

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Rh imcompatibility

Back 7

mom is Rh- and baby Rh+
fetal cells pass through placenta to mom, mom forms antibodies against fetal blood causing hemolysis of fetal RBC. usually not problem in first preg but later ones

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Treatment of Rh imcompatibility

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Rhogam which supresses the immune response. get IM injection at 28wks and w/i 72h of delvery

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ABO imcompatibility

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maternal blood type O
fetal blood is A, B, or AB
anti A and B anitbodies are transferred from mom across placenta to baby.
these babies show jaundice right away

Front 10

COOMBS TEST
Indirect

Back 10

performed on Rh neg mom to identify antibodies to Rh. If ot sensitive give rhogam. If sensitive no rhogam
the titer indicates degree of maternal sensitization

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COOMBS TEST
Direct

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perfomred on neonatal cord blood (gives rh status and blood type) looks for antibodies. If found treat right away b/c of hemeolysis. Do an exchange transfusion if titer is 1:64

Front 12

KERNICTERUS

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Billirubin encephalopthy
level of bilirubing accumulates in brain. 50% survial rate. baby with a bili rate higher than 25ml/dl at risk

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Assessment for hyperbilirubinemia

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cephalocaudal progression
conjunctiva/buccal mucosa(esp in those with dark skin)
Blanch test-done over bony prominences DO IN NATURAL LIGHT

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Nursing diagnosis
hyperbilirubinemia

Back 14

thrmoregulation, ineffective
injury, risk for (both tx and bili)
fluid volume deficient-phototherapy causes fluid loss
skin integrity, impaired-loose stools
risk for impaired parent/infant attachment

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Hyperbilirubinemia
Goals

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all babies assessed at 24h and at D/C
early prediciton/detection
trancutaneous bilirubinomerty
nomogram for designation of risk

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Hyperbilirubinemia
Treatment

Back 16

early feeding
phototherapy lights of fibrooptic blanket or both

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Hyperbilirubinemia
nursing care

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monitor temp
monitor I&O
assess for signs of lethargy

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Phototherapy

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make sure eyes and genitals are covered. when feeding no lights, take off eye shield and assess eyes

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classification of high risk infants

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size-birth wt
gestational age

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Preterm infants

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increased mortality
possible etiologies
associated factores
ethics-when do you not treat

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Assessment
Resp

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always gestational age
exogenous surfactant-two types one given to mom (betamethidone) and other given to infant via ETT

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signs of respiratory distress

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early
increased effort
compromised infant
should NOT see flaring, grunting, seesaw, retractions, rate > 60

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Cardiovascular assessment on preemie

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HR and rhythm
skin color/cyanosis
BP-last thing to change
perfusion
pulses
o2 sat >93%
ABGS
these are the same for term

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Assess for hypovolemic shock

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hypotension-late sign
slow capillary refill
continued resp distress despite O2 and ventilation

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Assess thermoregulatory status

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preemies at high risk for temp instability due to less brown fat, muscle mass and tone.
keep environmental at a temp which O2 consumption is minimal but adeqyate to maintain body temp.

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CNS assessment

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susceptible to injury- thin skin, push fluid carefully
predictive signs of neurologic abnormality

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Integumentary assess

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increase skin sensitivity, fragility, and permeabilty
assess for irritation/breaks in skin

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RENAL assessment

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immature renal system, decreased ability to concentrate urine.
monitor I&O and medication levels

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Hematologic assessment

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predisposed to hematologic problems. capillaries are fragile. tend to have high blood loss due to procedures. monitor H&H weekly

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Nutritonal assessment

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caloric, nutrients, fluid rq are greater than term infant.
problems w/ intake or metabolism
assess and intervene

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Assess for Infection

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risk R/T
compromised integumentary sys
decreased maternal immunoglobins b/c born early
impaired ability to produce antibodies
SIGNS ARE NON SPECIFIC IN PREEMIES

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S/S OF INFECTION

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temp instability
CNS changes
changes in color
metabolic acidosis
cardiovascular instability
resp distress
GI problems

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Assess parental adaptation

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anticipatory grieving over potential loss of infant or what you thought infant would be. acceptance of preterm birth, develping attachment, support of extended family.

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Discharge planning

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very extensive. d/c is based on specific criteria;parental readiness, cpr educations, C/A monitoring, adq home environment, knowledge of infant care, safety, some home with O2 or apnea monitor

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POSTMATURE INFANT

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prolonged gestation >42wks
at risk for Meconium Aspiration syndrome

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Assessment for meconium aspiration syndrome

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>42
close monitoring for fetal distress
resuscitation team
SUCTION MOUTH/NARES ON PERINEUM TO PREVENT ASPIRATION(before first breath of air) chemical pnumonitis

Front 37

Infant of a diabetic mother

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baby at risk for hypoglycemia b/c produced high amt of insulin in utero because high amt of glucose from mom, once born high amt of insulin not needed so BS crashes.

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Does maternal glucose cross placenta? does maternal insulin

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Yes glucose crossess
NO maternal insulin does not.

Front 39

What are some important assessments and interventions for infants born to diabetic mom

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assess BS right away and then freq. infants need to be fed right away

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Infants of diabetic mom
Appearance

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macrosmic-large
but physcially immature

Front 41

Infants of diabetic mom
congenital anomalies

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cardiac
CNS
musculoskeletal-caudal regression syndrome agenesis of scarum, weak and deformed extremities

Front 42

Types of birth traums and examples
soft tissue

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soft tissue-caput,cephalahemotoma, eye hemorrage, petichie, bruises

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Types of birth traums and examples
Skeletal injury

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skull fx, clavicle fx, abscence of moro reflex, humerous fx

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Types of birth traums and examples
CNS
PNS

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no example of CNS
PNS: Erb-duchenne paralysis- cronchial plexus fx, no moro, intact grasp reflex
Phrenic nerve injury-serious, diaphragm paralysis
Facial paralysis-presents like a stroke