High Risk neonatal nursing Alicia Stone PHD, RN, FNP High Risk neonatal nursing

Respiratory Distress Syndrome (RDS) Deficiency or absence of surfactant Atelectasis Hypoxemia, hypercarbia, academia May be due to prematurity or surfactant deficiency

RDS: Nursing Care Maintain adequate respiratory status Maintain adequate nutritional status Maintain adequate hydration Education and support of family

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

Pathologic Hyperbilirubinemia 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

Phototherapy: Nursing Care Maximize exposure of the skin surface to the light Periodic assessment of serum bilirubin levels Protect the newborn’s eyes with patches Measure irradiance levels with a photometer Good skin care and reposition infant at least every 2 hours Maintain adequate hydration and nutrition

Neonatal Abstinence Syndrome Caused by opioids Codeine and hydrocodone Morphine Oxycodone Heroin Antidepressants Benzodiazepines

What problems can arise? Low birthweight Respiratory distress Feeding problems Seizure activity Congenital birth defects

Signs and Symptoms Body shakes (tremors) Seizures Overactive reflexes Tight muscle tone Fussiness Excessive crying (Crie du chat) Poor feeding, poor sucking or slow weight gain Tachypnea Fever, sweating or blotchy skin Trouble sleeping and lots of yawning Diarrhea or throwing up Stuffy nose or sneezing

NAS testing Neonatal abstinence scoring system Bowel movement testing Urinalysis

Treatment IV fluids Medications Higher calorie formula Swaddle in blanket Skin to skin care Keep in a quiet dimly lit room. Breastfeed