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50 Cards in this Set
- Front
- Back
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At how many weeks gestation is an infant considered preterm?
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Born prior to 37 weeks gestation
All organ systems are immature |
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What does the respiratory system of an infant at 27 weeks gestation look like?
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The alveoli are present, but weak and under-developed
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What does the respiratory system of an infant at 36 weeks gestation look like?
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There may not be enough surfactant to keep the air sacs open
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What does the respiratory system of an infant at 40 weeks gestation look like?
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Only 10% of alveoli they will have as adults
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What kind of respiratory alterations does the preterm infant have?
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Unable to produce adequate surfactant
(Needed for lung compliance) Decreased # of functional alveoli (Needed to exchange O2 and CO2) Smaller lumen in the respiratory system Greater collapsibility or obstruction of passages Insufficient calcification of the bony thorax Weak or absent gag reflex Immature or friable capillaries in the lungs |
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What can the respiratory alterations in the preterm infant result in?
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Hypoxia
Inefficient pulmonary blood flow Respiratory distress or apnea Energy depletion |
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What is the early physical assessment of respiratory distress caused by prematurity?
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Respirations greater than 60
Nasal flaring Grunting Retractions (Supracostal, Suprasternal, Supraclavicular) |
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What is the late physical assessment of respiratory distress caused by prematurity?
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Nasal flaring
Grunting Retractions Seesaw breathing Apneic spells Circumoral cyanosis to generalized cyanosis |
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What is the difference between periodic breathing in preterm newborns and apnea?
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Periodic breathing in preterm newborns is normal and not to be confused with apnea
i.e. 5-10 second respiratory pauses followed by 10-15 seconds of compensatory rapid respirations Apnea is a 15-20 second cessation of respirations |
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When does the preterm infant have a need for prescribed oxygen?
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Arterial oxygen pressure (PaO2) is less than 60mm Hg
As this decreases, less O2 is released from the hemoglobin, increasing risk for cellular hypoxia Oxygen saturation of less than 92% |
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When is hood therapy used as an oxygenation intervention?
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O2 through a hood when mechanical vent not required
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What is nasal cannula used for as an oxygenation intervention?
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Low flow continuous O2
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What is continuous positive airway pressure used for as an oxygenation intervention?
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Infuses O2 at a preset pressure by means of nasal cannula, face mask, or ET tube
Orogastric tube should be used to decompress stomach with use of nasal cannula May cause vascular shunting in pulmonary beds, leading to persistent pulmonary HTN & severe RDS |
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What is mechanical ventilation used for as an oxygenation intervention?
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Set to provide a predetermined amount of O2 during spontaneous respirations and also to provide mechanical ventilation in the absence of spontaneous respirations
Dexamethasone may be administered to prevent chronic lung disease |
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Why is nitric oxide used as an oxygenation intervention?
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Inhaled NO gas causes potent, sustained pulmonary vasodilation
Binds with hemoglobin in RBCs and is inactivated after metabolism |
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When is surfactant administered for an oxygenation intervention and what are the side effects?
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Administered usually within 15 minutes up to 8 hours after birth for the first dose. May receive 2 doses. Reduces amount of time on ventilator.
Side effects: PDA, pulmonary hemorrhage |
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What does high frequency ventilation (Oscillator) do as an oxygenation intervention?
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Provide high-frequency ventilation work by providing smaller amounts of O2 at a significantly more rapid rate
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What does extracorporeal membrane oxygenation (ECMO) do as an oxygenation intervention?
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Uses cardiopulmonary bypass to oxygenate the blood outside the body through a membrane oxygenator (artificial lung)
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What is done to the oxygen to prevent cold stress and drying of the respiratory mucosa?
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Oxygen is warmed and humidified
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How often should the ABG and pulse oximetry reading performed?
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1-2 hours for accurate measure of oxygenation
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What is broncopulmonary dysplasia (BPD)?
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Chronic pulmonary condition caused by barotrauma from ventilator pressure and oxygen toxicity
Symptoms: Tachypnea Retractions Nasal flaring Increased work of breathing Exercise intolerance to handling and feeding Tachycardia Lung field ausculation indicates: Crackles Decreased air movement Occasional expiratory wheezing Treatment: O2 therapy Nutrition Fluid restriction Meds Maternal steroids while pregnant |
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What is retinopathy of prematurity (ROP)?
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Disorder that affects the deveoloping retinal vessels, multifactorial in origin, causing visual impairment
Oxygen tensions that are too hgih for the level of retinal maturity initially result in vasoconstriction May take as long as 5 months to evolve Need for ophthalmology exams imperative |
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What is Respiratory Distress Syndrome?
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Caused by a lack of pulmonary surfactant, leading to progressive atelectasis, loss of functional residual capacity, and a ventilation/perfusion imbalance
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What are the signs and symptoms of Respiratory Distress Syndrome?
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Tachypnea
Grunting, flaring Retractions Cyanosis Increased work of breathing Hypercapnia Respiratory acidosis Hypotension and shock |
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What is usually seen during the physical exam of an infant with Respiratory Distress Syndrome?
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Crackles
Poor air exchange Pallor Accessory muscle use Possible apnea Respiratory signs usually appear immediately after birth or within 6 hours |
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What kind of nursing interventions are used with Respiratory Distress Syndrome?
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Adequate ventilation/oxygenation
Possibly surfactant Monitoring of acid base balance (Blood gases, pulse ox, pH, PCO2) Fluid and nutrition (Urine output, specific gravity, weight) |
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What does the cardiac system look like in the preterm infant?
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Pulmonary blood vessels don't constrict well in response to lower levels of O2 due to immature musculature of these vessels, leading to left-to-right shunting of blood through the ductus arteriosus back to the lungs
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What is the assessment of the cardiac system caused by prematurity?
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Heart rate & rhythm
Skin color B/P, pulses Perfusion Oxygen saturation Acid-base status Assess for: Hypovolemia & shock (Hyptension, slow cap refill longer than 3 seconds) (Continued respiratory distress despite O2 and ventilation) |
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Why to preterm infants have ineffective thermoregulation?
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Have a higher ratio of body surfact to body weight
Little subcutaneous fat Limited brown fat stores Has thinner, more permeable skin causing greater insensible water loss & heat loss Extension of extremities (frog-like posture) increases the amount of surface exposed to the environment due to inadequate musculature Decreased ability to vasoconstrict suerpficial blood vessels & conserve heat |
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What is a thermoneutral environment and why is it used for a preterm infant?
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Environmental temperature at which O2 consumption is minimal & adequate maintainence of temperature
Utilizes a heat source, himidify Monitored with a heat probe attached to the infant Determined by the gestational age & weight of the baby Maintenance between 36.5 C- 37.2 C causes decreased O2 consumption Rapid changes in body temperature can cause apnea & acidosis |
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What are the signs of cold stress?
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Skin temperature will decrease first
Respiratory rate will initially increase, then apneic spells occur Heart rate initially increases, then bradycardia Skin mottled with acrocyanosis increasing to cyanosis Physical activity decreased in preemies Unstable thermoregulation in preemies |
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What are the nursing interventions for a preterm infant with ineffective thermoregulation?
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Avoid cold surfaces
Use warmed ambient humidity (Maintain TNE between 36.5 C-37.2C) Keep the skin dry Avoid drafts Warm formula/breast milk Use reflector pad on skin probe when using radiant warmer bed Allow kangarooing Double wrap & cap when out of warmer/isolette |
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What kind of renal alterations are seen in the preterm infant?
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Premature infant is unable to:
Adequately excrete metabolites and drugs (Can cause drugs to be at toxic levels) Concentrate urine Maintain acid-base balance, fluid, or electrolyte balance |
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What is the nursing assessment for the renal system in a preterm infant?
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Intake and output
Specific gravity Acid-base balance Serum medication levels |
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What kind of GI alterations are seen in the preterm infant?
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Maturation of the early-developed GI structures is variable causing ingestion, digestive and absorption problems
Goal: Maintain adequate nutrition to promote growth and development Weak or absent suck, swallow, gag reflex Small stomach capacity Weak abdominal muscles Limited store of nutrients Decreased ability to digest proteins & absorb nutrients Immature enzyme systems |
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What is the nursing assessment for the GI system in a preterm infant?
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Continuously assess:
Fluid and electrolyte status Ability to take in and digest nutrients Adequate weight gain (20-30g/day) |
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What type of feedings are given to a preterm infant with GI alterations?
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High caloric, high protein, supplemental vitamins, calcium and vitamin D (prevents rickets, bone deminieralization)
Oral (no suck reflex until += 34 weeks) Gavage (must have bowel sounds, check residual & return) Intravenous Gastrostomy |
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What assessments for hydration are made for the preterm infant?
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For dehydration:
Sunken fontanel, weight loss Poor skin turgor Dry oral mucous membranes Decreased urine output Increased specific gravity (>1.013) For overhydration: Edema Excessive weight gain Compare urine output to fluid intake ***Weight change is one of the most important indicators of fluid balance*** |
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What are the nursing interventions for hydration in the preterm infant?
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Monitor elimination patterns, characteristic
Maintain strict intake and output (Weigh diapers) Accurately calculate IV solutions Aspiration precautions |
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What is seen in the central nervous system of the preterm infant?
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Injury may be R/T:
Birth trauma Bleeding capillaries Impaired coagulation Recurrent anoxic episodes Predisposition to hypoglycemia Signs of future impairment: Hypotonia Decreased activity level Weak cry > 24 hours Inability to coordinate suck & swallow Assess for signs and document. Will need to include in discharge teaching. |
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What is intraventricular hemorrhage (IVH) and why does it happen?
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Most common intracranial hemorrhage
The germinal matrix lining of the ventricles are highly susceptible to hypoxic events, birth trauma, & birth asphyxia (These blood vessels become weak and can rupture with hypoxia) Grades 1-4 (unilateral or bilateral): Grade 1: bleeding in the germinal matrix Grade 2: bleeding spills into the ventricles Grade 3: more severe bleeding into the ventricles causing the ventricles to enlarge (Approx. 1/3 will develop mental retardation) Grade 4: bleeding in the brain tissue outside the ventricles (profound damage) (50% won't survive) (70%-90% will have neurological complications) |
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What are the symptoms of IVH?
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Most don't have symptoms
Some will have a sudden drop in B/P or a seizure Bedside ultrasound is performed 3-10 days after birth |
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What is the treatment of IVH?
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General medical care including blood transfusions, treatment for seizures
Surgery is not an option due to the fragile preemie brain Some will need a ventriculo-peritoneal shunt due to developing hydrocephalus Betamethasone or indomethacin can reduce the risk of IVH |
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What preventative interventions can be done for IVH?
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Position head midline and HOB elevated
NTE maintained Maintain oxygenation Avoid rapid infusions of fluids |
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What is the hematologic status of the preterm infant?
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Problems such as anemia arise from:
Increased capillary friability Increased tendency to bleed Slowed RBC production from decreased erythropoiesis after birth Shorter RBC life span Decreased iron stores, deficient Vitamin E Loss of blood from frequent blood sampling |
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What nursing assessments should be done for the hematologic system of the preterm infant?
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Assess:
For bleeding from puncture sites, GI tract Observe for anemia (Decreased hemoglobin and hematocrit, pale skin, increased apnea, lethargy, tachycardia, poor weight gain) |
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What nursing assessments are done for risk for infection of the premature infant?
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Temperature instability
(Hypothermic or hyperthermic) CNS changes (Lethargic, irritable) Changes in color (Cyanosis, pallor, jaundice) Respiratory distress (Apnea) Cadiovascular instability (Poor perfusion, hypotension) GI problems (Feeding intolerance, glucose instability, N&V) Metabolic acidosis |
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What nursing interventions are done for risk for infection of the premature infant?
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Strict handwashing #1
Persons with infectious disorders not permitted Standard precautions Handle skin carefully Use caution with skin products that can dry out skin Avoid skin breakdown, change positions, ROM Reverse isolation Equipment for each baby Strict aseptic practices |
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What parental bonding can be expected for the preterm infant?
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Parents go through the grief process over potential loss, failure to give birth to healthy infant
Attempts to bond could be influenced by transportation, fear, work, degree of illness Once the baby's condition is stable, encourage parental caretaking to begin |
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What kind of developmental care is done for the preterm infant?
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Positioning
(Blanket rolls, swaddling, cross infant arms, provide boundaries, prone position encourages flexion) Reducing inappropriate stimuli (Quiet, schedule procedures when active, cover incubator, keep doors to incubators closed) Infant communication (Cues to overstimulation include gaze aversion, hiccupping, gagging, and regurgitation, irregular respiratory rate, increased heart rate) |
