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44 Cards in this Set

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HYPERBILLIRUBINERMIA
2 Types
physiologic Jaundice-most common 50-80%

Conjugation of Bilirubin
patho of physiologic jaundice
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.
what is the difference b/w conjugated and unconjugated bilirubin
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
criteria for physiologic jaundice
well/term infant-evident after 24h end about 7th day
preterm infant-evident after 48h end is 9-10d
serum concentrations almost exclusively unconjugated
criteria for pathologic jaundice
serum bilirubin >4mg/dl in cord blood
JAUNDICE IS EVIDENT WITHIN 24H OF BIRTH
Potential causes of pathologic hyperbillirubinemia
maternal- Rh/ABO incompatibility. mom has infection, DM, oxytocin may cause, Valium, ASA, sulphas
Newborn-preemie, structural hepatic damage, hyperthyroidism, billiary obstruction
Rh imcompatibility
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
Treatment of Rh imcompatibility
Rhogam which supresses the immune response. get IM injection at 28wks and w/i 72h of delvery
ABO imcompatibility
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
COOMBS TEST
Indirect
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
COOMBS TEST
Direct
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
KERNICTERUS
Billirubin encephalopthy
level of bilirubing accumulates in brain. 50% survial rate. baby with a bili rate higher than 25ml/dl at risk
Assessment for hyperbilirubinemia
cephalocaudal progression
conjunctiva/buccal mucosa(esp in those with dark skin)
Blanch test-done over bony prominences DO IN NATURAL LIGHT
Nursing diagnosis
hyperbilirubinemia
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
Hyperbilirubinemia
Goals
all babies assessed at 24h and at D/C
early prediciton/detection
trancutaneous bilirubinomerty
nomogram for designation of risk
Hyperbilirubinemia
Treatment
early feeding
phototherapy lights of fibrooptic blanket or both
Hyperbilirubinemia
nursing care
monitor temp
monitor I&O
assess for signs of lethargy
Phototherapy
make sure eyes and genitals are covered. when feeding no lights, take off eye shield and assess eyes
classification of high risk infants
size-birth wt
gestational age
Preterm infants
increased mortality
possible etiologies
associated factores
ethics-when do you not treat
Assessment
Resp
always gestational age
exogenous surfactant-two types one given to mom (betamethidone) and other given to infant via ETT
signs of respiratory distress
early
increased effort
compromised infant
should NOT see flaring, grunting, seesaw, retractions, rate > 60
Cardiovascular assessment on preemie
HR and rhythm
skin color/cyanosis
BP-last thing to change
perfusion
pulses
o2 sat >93%
ABGS
these are the same for term
Assess for hypovolemic shock
hypotension-late sign
slow capillary refill
continued resp distress despite O2 and ventilation
Assess thermoregulatory status
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.
CNS assessment
susceptible to injury- thin skin, push fluid carefully
predictive signs of neurologic abnormality
Integumentary assess
increase skin sensitivity, fragility, and permeabilty
assess for irritation/breaks in skin
RENAL assessment
immature renal system, decreased ability to concentrate urine.
monitor I&O and medication levels
Hematologic assessment
predisposed to hematologic problems. capillaries are fragile. tend to have high blood loss due to procedures. monitor H&H weekly
Nutritonal assessment
caloric, nutrients, fluid rq are greater than term infant.
problems w/ intake or metabolism
assess and intervene
Assess for Infection
risk R/T
compromised integumentary sys
decreased maternal immunoglobins b/c born early
impaired ability to produce antibodies
SIGNS ARE NON SPECIFIC IN PREEMIES
S/S OF INFECTION
temp instability
CNS changes
changes in color
metabolic acidosis
cardiovascular instability
resp distress
GI problems
Assess parental adaptation
anticipatory grieving over potential loss of infant or what you thought infant would be. acceptance of preterm birth, develping attachment, support of extended family.
Discharge planning
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
POSTMATURE INFANT
prolonged gestation >42wks
at risk for Meconium Aspiration syndrome
Assessment for meconium aspiration syndrome
>42
close monitoring for fetal distress
resuscitation team
SUCTION MOUTH/NARES ON PERINEUM TO PREVENT ASPIRATION(before first breath of air) chemical pnumonitis
Infant of a diabetic mother
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.
Does maternal glucose cross placenta? does maternal insulin
Yes glucose crossess
NO maternal insulin does not.
What are some important assessments and interventions for infants born to diabetic mom
assess BS right away and then freq. infants need to be fed right away
Infants of diabetic mom
Appearance
macrosmic-large
but physcially immature
Infants of diabetic mom
congenital anomalies
cardiac
CNS
musculoskeletal-caudal regression syndrome agenesis of scarum, weak and deformed extremities
Types of birth traums and examples
soft tissue
soft tissue-caput,cephalahemotoma, eye hemorrage, petichie, bruises
Types of birth traums and examples
Skeletal injury
skull fx, clavicle fx, abscence of moro reflex, humerous fx
Types of birth traums and examples
CNS
PNS
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