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Nancy Pares, RN, MSN Metro Community College. Discuss pathophysiology and nursing process for high risk newborn.

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Presentation on theme: "Nancy Pares, RN, MSN Metro Community College. Discuss pathophysiology and nursing process for high risk newborn."— Presentation transcript:

1 Nancy Pares, RN, MSN Metro Community College

2 Discuss pathophysiology and nursing process for high risk newborn

3 Low socioeconomic level of the mother Limited or no prenatal care Exposure to environmental dangers Preexisting maternal conditions Maternal factors such as age or parity Medical conditions related to pregnancy Pregnancy complications



6 Inadequate surfactant production Muscular coat of pulmonary blood vessels is not completely developed Greater risk for the ductus arteriosis to remain open

7 Nonreassuring fetal heart rate pattern Difficult birth Fetal scalp/capillary blood sample-acidosis pH<7.20 Meconium in amniotic fluid Prematurity Macrosomia or SGA




11 Male infant Significant intrapartum bleeding Structural lung abnormality or oligohydramnios Congenital heart disease Maternal infection Narcotic use in labor

12 An infant of a diabetic mother Arrhythmias Cardiomyopathy Fetal anemia

13 Deficiency or absence of surfactant Atelectasis Hypoxemia, hypercarbia, academia May be due to prematurity or surfactant deficiency


15 Maintain adequate respiratory status Maintain adequate nutritional status Maintain adequate hydration Education and support of family


17 Failure to clear lung fluid, mucus, debris Exhibit signs of distress shortly after birth Symptoms Expiratory grunting and nasal flaring Subcostal retractions Slight cyanosis

18 Maintain adequate respiratory status Maintain adequate nutritional status Maintain adequate hydration Support and educate family

19 Mechanical obstruction of the airways Chemical pneumonitis Vasoconstriction of the pulmonary vessels Inactivation of natural surfactant

20 Assess for complications related to MAS Maintain adequate respiratory status Maintain adequate nutritional status Maintain adequate hydration

21 Blood shunted away from lungs Increased pulmonary vascular resistance (PVR) Primary Pulmonary vascular changes before birth resulting in PVR Secondary Pulmonary vascular changes after birth resulting in PVR

22 Minimize stimulation Maintain adequate respiratory status Observe for signs of pneumothorax Maintain adequate nutritional status Maintain adequate hydration status Support and educate family


24 Genetic disorders This information will be discussed in greater detail later in the course. For the purposes of this unit, know that certain disorders are genetic















39 Prematurity SGA Failure to thrive Enlarged spleen and liver Swollen glands

40 Recurrent respiratory infection Rhinorrhea Recurrent GI problems Persistent or recurrent candidiasis

41 Provide comfort Keep the newborn well nourished Keep the infant protected from infections Facilitate growth, development, and attachment

42 Risk factors Maternal infection (group B streptococcus most common) Long labor, prolonged rupture of the membranes Maternal fever, chorioamnionitis Fetal distress, aspiration

43 Assessment findings Unstable temperature, poor tone, poor sucking Management Antibiotics Supportive care

44 Lethargy or irritability Hypotonia Hypotension Pallor, duskiness, or cyanosis Cool and clammy skin

45 Temperature instability Feeding intolerance Hyperbilirubinemia Tachycardia followed by apnea/bradycardia

46 Rhinitis Red rash around the mouth and anus Irritability Generalized edema and hepatosplenomegaly Congenital cataracts SGA and failure to thrive

47 Initiate isolation Administer penicillin Provide emotional support for the family

48 Symptoms Conjunctivitis Corneal ulcerations Nursing management Administration of ophthalmic antibiotic ointment Referral for follow-up

49 Small cluster vesicular skin lesions over the entire body DIC Pneumonia Hepatitis Hepatosplenomegaly Neurologic abnormalities

50 Careful hand washing and gown and glove isolation Administration of IV vidarabine or acyclovir Initiation of follow-up referral Support and education of parents

51 Symptoms Pneumonia Conjunctivitis Nursing management Administration of ophthalmic antibiotic ointment Referral for follow-up




55 Neonatal abstinence scoring Monitoring VS and pulse oximetry until stable Small frequent feedings IV therapy if needed Positioning on the right side-lying or semi- Fowlers Monitoring frequency of diarrhea and vomiting

56 Weigh infant every 8 hours during withdrawal Swaddle infant Protect face and extremities from excoriation Place infant in quiet, dimly lighted area of the nursery Administration of medications






62 Hypoglycemia Meconium aspiration and oligohydramnios Polycythemia Congenital anomalies Seizures Cold stress

63 Delivery prior to 37 weeks gestation Factors Multiple gestation, PROM, incompetent cervix

64 Physical characteristics Gestational age Maternal prenatal risk factors Delivery risk factors Physical assessment Family assessment

65 Assessment Gestational age assessment Neurologic assessment Physical characteristics Thin skin, soft cartilage, absent plantar creases Abundant lanugo and vernix Genitalia characteristic of prematurity

66 Cardiovascular Patent ductus arteriosis Hypotension Central nervous system Intraventricular hemorrhage Posthemorrhagic hydrocephalus Hematologic system Anemia Polycythemia Hepatic system Hyperbilirubinemia Phototherapy

67 Gastrointestinal system Dysmotility Necrotizing enterocolitis Gastroesophageal reflux Immune system Infection Integumentary system Epidermal stripping Absorption of chemical agents Crib with head elevated for reflux

68 Ophthalmologic system Retinopathy of prematurity Renal system Oliguria Glycosuria Respiratory system Respiratory distress syndrome Bronchopulmonary dysplasia Apnea of prematurity Pneumonia Preterm infant in an oxygen hood

69 Poorly developed gag reflex Incompetent esophageal cardiac sphincter Poor sucking and swallowing reflexes Difficulty meeting caloric needs for growth Inability to handle the increased osmolarity of formula protein Difficulty with absorbing saturated fats

70 Difficulty with lactose digestion Deficiency of calcium and phosphorous Increased basal metabolic rate and increased oxygen requirements Feeding intolerance Potential for the development of necrotizing enterocolitis (NEC)

71 Unavailability of glycogen and brown fat Inability to increase oxygen consumption High ratio of body surface area to body weight Extended position increases body surface area Decreased ability to vasoconstrict superficial blood vessels

72 Lower glomerular filtration rate (GFR) Limited ability to concentrate urine or excrete large amounts of fluid Excrete glucose at a lower serum glucose level Buffering capacity is reduced Excretion time of drugs is longer

73 Glycogen stores are used rapidly Glycogen stores are affected by asphyxia and cold stress Low iron stores Conjugation is impaired

74 Immunologic Lack of passive IgG antibodies Skin is easily excoriated Neurologic Increased risk for IVH & ICH Delayed or absent reactivity

75 Occipital-frontal baseline measurements Daily head circumferences Skin integrity Signs and symptoms of infection Signs of widening of suture lines

76 Assist with head ultrasounds and transillumination Change position frequently Clean skin creases Keeping a sheepskin under the head Postoperatively position head off the operative site

77 Intrauterine growth restriction Small for gestational age Large for gestational age Post term infant

78 Infants <10th percentile for weight at birth May be symmetric or asymmetric Factors may be fetal, maternal, or placental Complications Hypoxia, hypothermia, hypoglycemia, polycythemia, hyperbilirubinemia, meconium aspiration

79 Nursing implications Prevent heat loss Monitor blood glucose, feed early Monitor for respiratory complications Management of hyperbilirubinemia

80 Maternal factors Maternal disease Environmental factors Placental factors Fetal factors


82 Infants >90th percentile for weight at birth Factors Maternal diabetes, parental obesity Complications Difficult delivery, birth trauma, hypoglycemia Nursing implications Assess for birth injury Monitor for hypoglycemia

83 LGA SGA Hypoglycemia Hypocalcemia Hyperbilirubinemia

84 Birth trauma Polycythemia RDS Congenital malformations

85 Risk factors Congenital anomalies Macrosomia (>4,000 gm) Hypoglycemia Respiratory distress syndrome

86 Prevention of complications Normoglycemia during gestation and labor Deliver when lungs are mature Prepare for delivery of large infant Monitor for hypoglycemia

87 Lethargy or jitteriness Poor feeding and sucking Vomiting Hypothermia and pallor Hypotonia, tremors Seizure activity, high pitched cry, exaggerated moro reflex

88 Routine screening for all at risk infants Early feedings D10W infusion




92 Excess bilirubin in the blood resulting in jaundice Can be caused by physiologic or pathologic processes Normal RBC breakdown Rh or ABO incompatibility

93 Complications Kernicterus Erythroblastosis fetalis Hydrops fetalis Assessment findings Jaundice, elevated bilirubin levels

94 Encourage frequent feedings Exposure to sunlight Phototherapy Shield infants eyes Monitor body temperature Monitor weight Monitor fluid intake Weigh diapers Note frequency of stools

95 Appears after first 24 hours of life Disappears within 14 days Due to an increase in red cell mass

96 Appears within first 24 hours of life Serum bilirubin concentration rises by more than 0.2 mg/dL per hour Bilirubin concentrations exceed the 95th percentile Conjugated bilirubin concentrations are greater than 2 mg/dL Clinical jaundice persists for more than 2 weeks in a term newborn

97 Hemolytic disease of the newborn Erythroblastosis fetalis Hydrops fetalis ABO incompatibility

98 Resolving anemia Removing maternal antibodies and sensitized erythrocytes Increasing serum albumin levels Reducing serum bilirubin levels Minimizing the consequences of hyperbilirubinemia

99 Maximize exposure of the skin surface to the light Periodic assessment of serum bilirubin levels Protect the newborns eyes with patches Measure irradiance levels with a photometer Good skin care and reposition infant at least every 2 hours Maintain an NTE and adequate hydration and nutrition


101 Fluids Strict I&O, weigh diapers Electrolyte management Management of sodium and potassium levels Glucose homeostasis Feeding Gavage or nipple method Types: formula or breast milk Gavage feeding tube

102 Light Sound Temperature Positioning and containment strategies Handling and touching Nonnutritive sucking

103 Increase in oxygen requirements Increase in utilization of glucose Acids are released in the bloodstream Surfactant production decreases


105 Observe for signs of cold stress Maintain NTE Warm baby slowly Frequent monitoring of skin temperature Warming IV fluids Treat accompanying hypoglycemia

106 Explain the assessment and nursing interventions associated with birth injuries

107 Fractures Clavicle, long bones, skull most common Risks Large infant, breech, difficult labor Assessment Impaired mobility Management Immobilization, traction, casting

108 Facial Palsy Usually related to use of forceps Brachial Palsy Usually related to difficult delivery such as shoulder dystocia Assessment Impaired mobility of arm Paralysis may be temporary or permanent

109 Realistically perceiving the infants medical condition and needs Adapting to the infants hospital environment Assuming primary caretaking role Assuming total responsibility for the infant upon discharge Possibly coping with the death of the infant if it occurs

110 Facilitating family visits Allowing the family to hold and touch the baby Giving the family a picture of the baby Liberal visiting hours Encouraging the family to get involved in the care


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