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

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

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

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

7. 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

8. 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

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

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

11. 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

12. NAS testing Neonatal abstinence scoring system Bowel movement testing
Urinalysis

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