Maternity- High Risk Nb- Slides

Front 1

MAS

Back 1

-before the infant is born, if late or variable deccelerations are noted drunig labor, neonatal asphyixa may occur
-birth asphyixia causes the anal sphincter to relax, meonium to be excreted into amniotic fluid
-the amniotic fluid may be inhaled during the first breath
-the amniotic fluid may be inhaled duing the birthing process

Front 2

Birth injuries

Back 2

- older and larger babies may have great difficulty being delivered vaginally
-attempting to deliver older and larger babies may cause birth trauma
--facial paralyisis
-Erb Ducheenne paralyisis with broken clavicle
--asphyxia

Front 3

Hypoglycemia

Back 3

-blood glucose less than 40-50
-done via heel stick
-feedings include formula or breast milk; D5W or D10W is not given becasue this will increase the baby's insulin production

Front 4

SGA infant

Back 4

-birth weight below 10 %
- due to placental insufficency. infections, smoking, malnutrition, HTN
- assessment
--skin: loos and dry, little fat
--little scalp hair
--hypoglycemia
--weak cry

Front 5

LGA infant

Back 5

-birth weight above 90%
-IDM's:hypoglycemia
-Macrosomia:birth trauma
-Assessment
--poor muscle tone
--may have some lanugo and vernix present, usually it is absesnt
--hypoglycemic
--well defined breast tissue, and ear lobes

Front 6

Hyperbilirubinemia
overview

Back 6

-cause from breakdoewn of red blood cells
-2 types
--direct(conjugated)- water soluble, easy to eliminate
--indircect(uncongugated)- fat soluble and difficult yo eliminate and can cross teh blood brain barrier

Front 7

Kernicterus

Back 7

a potential complication of hyperbilirubinemia that occurs when unconjugated bilirubin deposits into the brain

Front 8

Hyperbilirubinemia
causes

Back 8

RH incomatibility
ABO incompatibitly

Front 9

Hyperbilirubinemia
RH incomatibility

Back 9

- mother Rh - father is rh +
-first preg is no problem. Sensitizes the maternal blood stream if Rhogam is not given
- indirect coombs- done on mother blood detects presence of antibodies
-Direct coombs- done on cord blood detects presence of antibodies
-fatal without rhogam

Front 10

LGA infant

Back 10

-birth weight above 90%
-IDM's:hypoglycemia
-Macrosomia:birth trauma
-Assessment
--poor muscle tone
--may have some lanugo and vernix present, usually it is absesnt
--hypoglycemic
--well defined breast tissue, and ear lobes

Front 11

Hyperbilirubinemia
ABO incompatibility

Back 11

- mothers blood is O and has a fetus with A or B
-mother may form antibodies that can lead to hemolyisis in the fetus' blood.
-rareley fatal. Requires monitonring of the bili level

Front 12

Hyperbilirubinemia
physiologic
Causes

Back 12

-Considereed normal
-levels up to 10
-occurs during the third to fourth day of life
-causitive facotrs
--breakdown of immature RBC and imature liver unable to excretet this
--breast milk jaundice
---occurs o the third to fourth day. usually needs no inturruption of breastfeeding
---late onset occurs on 6th to 14th day and may have higher levels of 12-20
- Tx
--increase feedings
--may need phototherapy

Front 13

Hyperbilirubinemia
managemtn

Back 13

-asessment
--coombs test, direct coombs, bili levels biimeter
- phototherapy
--NB's are palced under the lights with protective eyewear
--monitor I and O. Premies are placed inder when bili levles reach ahlf their wieght (gms)
-exchange trannsfusions
--done for excessivley high levels with donor blood

Front 14

Hyperbilirubinemia
monitoring

Back 14

- asses jaundice levels
- prevent cold stress
-prevent overheating
- prevent dehydration
-avoid hypoglycemia

Front 15

Infants exposed to infections
overview

Back 15

-Vertical infections
--aquired before birth
---Rubella, syphyillis, gonrrhea
--during birth
----group b strep, HSV
-Horizontil infections
--aquire after delivery ie staph
-TORCH

Front 16

Infants exposed to infections
gonorrhea

Back 16

-bacterial
-untreated baby will develop the inf in eyes
- tx immediatly after birth with erythromycin

Front 17

Infants exposed to infections
Rubella

Back 17

- virus
- causes cardiac defects, blindness, cataracts, deafness, and MR

Front 18

Infants exposed to infections
HSV

Back 18

-Systemic HSV ininfant prvokes a vesicular rash mainly on the head and neck

Front 19

Infants exposed to infections
HIV
overvier

Back 19

- can cross through placenta or breast milk
-maternal to newborn rates are 20-30 %. Decreases when mother takes ZDV and is given to infant immediatly
-infants take upto 15 months to develop antibodies
-

Front 20

Infants exposed to infections
HIV
assessments

Back 20

- asymtpomatic at birth
-by age 1 will manifest thos s/s of adults
- failure to thrive
- recurrant infections: persistant thrush
- chronic diarrhea

Front 21

Infants exposed to infections
HIV
RN interventions

Back 21

- unversal percautions
- increase calorie value to bottle feeds
- should rcv all immunizations except oral polio
-excelleant skin and mouth care
- admin meds, ZDV as ordered

Front 22

Infants exposed to sepsis
sesis neonatorium

Back 22

- generalized infection that has spread rapidly through the baby's blood stream
-usually caused by group b strep
blood cxs taken
-0 treated vigourously with ampicillin and gentamycin for 10-4 days

Front 23

Infant of Diabetic MotherIDM

Back 23

•Two causes of uncontrolled maternal glucose levels:
–Hormones of pregnancy increase maternal resistance to insulin.
–In some mothers, the pancreas cannot secrete enough insulin to meet the demands of the pregnancy.
•Maternal insulin cannot cross placenta, but glucose can causing fetal glucose levels to rise and increasing insulin production in response to the rise; which metabolizes the glucose and acts as a growth hormone.
•Increased insulin decreases surfactant production.

Front 24

Infant of Diabetic Mother
•Assessment

Back 24

:
–LGA, may have birth trauma, enlarged internal organs: cardiac, liver and spleen.
–Hypoglycemia and hypocalcemia
–Respiratory Distress Syndrome
–Congenital anomalies: cardiac and spine
•Assessment:
–Blood glucose at 30 minutes, and at 1,2,4,6,9,12, and 24 hours after birth (per protocol).
–Encourage mother to breast feed, or provide formula. Do not feed with sugar water.
–May need IV supplementation along with feeds.

Front 25

Infant that is exposed to drugs

Back 25

•Fetal alcohol syndrome:
–Alcohol easily crosses over the placenta increasing the risk for congenital anomalies and IUGR
•Assessment:
–SGA, long thin upper lip
–Irritable, high pitched cry
•Nursing interventions:
–Reduce environment stimuli, swaddle
–Administer sedatives and score on Neonatal abstinence score sheet (NAS).

Front 26

Infant that is exposed to drugs
•Neonatal Abstinence syndrome

Back 26

:
–Fetal dependency upon drugs either from drug use during pregnancy or from sedatives used in the neonatal period.
•Assessment:
–Hyperactivity, jitteriness, arching of back
–High pitches cry, inconsolable, sweating
–Yawning, sneezing, feeding difficulties
–Developmental delays

Front 27

Infant that is exposed to drugs
•Nursing interventions:

Back 27

–Position child on side to facilitate drainage of mucous, suction as needed.
–Parents should be taught to place baby on back for sleeping.
–Decrease external stimuli, swaddle
–Obtain meconium or first void for drug screening.
–Increase calories in feedings.
–Score on Neonatal Abstinence Score (NAS) sheet
–Administer medications as ordered:
•Dilute tincture of opium (DTO)
•Phenobarbitol
•Methadone

Front 28

How to calculate 10% weight loss in newborns:

Back 28

–Convert pounds to ounces.
–Add additional ounces to this amount which is the total weight in ounces.
–Multiply total weight in ounces by 0.1, which is 10%.
–Subtract this from the total weight.
–Convert ounces back to pounds by dividing answer by 16.
–Your answer will be in pounds with the remaining number in ounces.