High risk neonate
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High Risk Neonate. Christina Hernandez RN, MSN. The High Risk Newborn. Susceptible to illness or death due to dysmaturity, immaturity, physical disorders, or complications at birth. Risk Factors: Low socioeconomic status, poor nutrition Exposure to environmental dangers

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High risk neonate

High Risk Neonate

Christina Hernandez RN, MSN


The high risk newborn

The High Risk Newborn

  • Susceptible to illness or death due to dysmaturity, immaturity, physical disorders, or complications at birth.

  • Risk Factors:

    • Low socioeconomic status, poor nutrition

    • Exposure to environmental dangers

    • Obstetric factors such as age, parity, or other premature births

    • Medical conditions related to the pregnancy such as PIH, PROM, or infection


Gestational age

Gestational Age


Classification of high risk newborns

Classification of High Risk Newborns

  • Gestational Age

    • Preterm – less than 37 weeks gestation

      (Late Preterm – 34 – 36.6 weeks gestation)

    • Term – 38-41 weeks gestation

    • Postterm – greater than 42 weeks gestation

    • LGA – large for gestational age - above the 90th percentile

    • AGA – appropriate for gestational age – between the 10th and 90th percentile

    • SGA – small for gestational age – below the 10th percentile


Assessment of gestational age

Assessment of Gestational Age

  • Ballard Scale or Dubowitz scale

    • Neuromuscular characteristics

    • Physical Characteristics


Classification of high risk newborn

Classification of High Risk Newborn

Large for Gestational Age

LGA

Appropriate for Gestational Age

AGA

Small for Gestational Age

SGA

Maturity and Intrauterine Growth Grid


The preterm infant

The Preterm Infant


Characteristics of preterm infants

Characteristics of Preterm Infants

  • Appear frail & weak

  • Underdeveloped flexor muscles & muscle tone

  • Head is larger in comparison with the rest of the body

  • Lack subcutaneous fat (white fat)

  • Skin appears red and translucent

  • Barely apparent small flat nipples

  • Plantar creases are absent in infants <32 wks

  • The pinna of the ear is soft and flat

  • Female –

  • Male –


Physiologic challenges of the premature infant respiratory

Physiologic challenges of the premature infant - Respiratory

  • Insufficient production of surfactant

  • Immaturity of alveolar system

  • Immaturity of musculature and insufficient calcification of bony thorax

  • Respirations 40-60/min., shallow, irregular, usually diaphragmatic.


Nursing interventions respiratory

Nursing interventions - Respiratory

  • Assess for signs of Respiratory Distress

    • Nasal Flaring

    • Circumoral Cyanosis

    • Expiratory Grunting

    • Retractions

    • Tachypnea

    • Apneic episodes

  • Administer O2

    • Warmed and humidified

    • Oxihood

    • Nasal Cannula

    • CPAP

    • Analyze oxygen concentration.


Nursing interventions respiratory1

Nursing interventions - Respiratory

  • Positioning

    • Position with head slightly elevated and neck slightly extended

    • Side-lying or prone

  • Suctioning

    • Only use when necessary

    • Be gently so as not to damage fragile mucus membranes


Physiologic challenges in the preterm infant thermoregulation

Physiologic Challenges in the preterm infant - Thermoregulation

  • Heat regulation unstable

    • Body temperature may be normal but it fluctuates

    • Higher ratio of body surface in proportion to body weight.

    • Lack of subcutaneous fat

    • Poor capillary response to environmental changes.

    • Decreased brown fat

    • Thinner skin


Signs of inadequate thermoregulation

Signs of Inadequate Thermoregulation

  • Axillary temperature <36.3 or >36.9 degrees C

  • Abdominal skin temperature <36 or >36.5 degrees C

  • Poor feeding or feeding intolerance

  • Irritability

  • Lethargy

  • Weak cry or suck

  • Decreased muscle tone

  • Cool skin temperature

  • Skin pale, mottled, or acrocyanotic

  • Signs of hypoglycemia

  • Signs of respiratory difficulty

  • Poor weight gain


Nursing interventions thermoregulation

Nursing Interventions - Thermoregulation

GOAL: Neutral thermal environment.

  • Thermal Neutrality – Nursing Interventions

    • Incubator or radiant warmer

    • Warm surfaces

    • Warm humidified oxygen

    • Warm ambient humidity

    • Warm feedings

    • Keep skin dry and head covered


High risk neonate

Radiant Warmer/

Open Warmer

Isolette / Incubator


Physiologic challenges fluid electrolyte balance

Physiologic Challenges-Fluid & Electrolyte Balance

  • Preterm infants lose fluid very easily

  • Rapid respiratory rate and use of oxygen increase fluid lose from the lungs

  • Lack of keratin, which helps maintain water in the skin

  • Large surface area & lack of flexion increases insensible water losses

  • Radiant warmers heighten insensible water loss


Physiologic challenges fluid electrolyte balance1

Physiologic Challenges-Fluid & Electrolyte Balance

  • Development of kidneys is not complete until approximately 35 weeks.

  • In ability of preterm kidneys to concentrate or dilute urine.

  • Kidneys unable to regulate electrolytes.


Physiologic challenges fluid electrolyte balance2

Physiologic Challenges-Fluid & Electrolyte Balance

Dehydration

Overhydration

Urine output >5 ml/kg/hour

Urine specific gravity <1.001

Edema

Weight gain greater than expected

Bulging fontanels

Blood: Decreased sodium, protein, and hematocrit levels

Moist breath sounds

Difficulty breathing

  • Urine output >2 ml/kg/hour

  • Urine specific gravity >1.020

  • Weight loss greater than expected

  • Dry skin and mucous membranes

  • Sunken anterior fontanel

  • Poor tissue turgor

  • Blood: Elevated sodium, protein, and hematocritlevels


Nursing interventions fluid and electrolyte balance

Nursing Interventions- Fluid and Electrolyte Balance

  • Weigh diapers (1gm = 1ml of urine)

  • Obtain specific gravity

  • Carefully regulate IV fluids

  • Dilute IV medications in as little fluid that is recommended (include medications on intake measurements)

  • Assess IV sites frequently


Physiologic challenges skin

Physiologic Challenges-Skin

  • The Preterm infants skin is:

    • Fragile

    • Transparent

    • Permeable


Nursing interventions skin

Nursing Interventions-Skin

  • Nursing Care

    • No use of alcohol or betadine on skin

    • All skin products should be rinsed off with water

    • No use of adhesives, use pectin barriers and back tape with cotton

    • Use semi-permeable adhesives such as tegaderm

    • Reposition frequently, as tolerated


Physiologic challenges infection

Physiologic Challenges-Infection

  • Exposure to maternal infections

  • Lack of transfer of immunoglobulin G (IgG) from mother during third trimester

  • Immature immune response to infection

  • Subject to invasive procedures (IV’s, lab’s)

  • Prolonged hospital stays


Signs and symptoms of infection in the preterm infant

Signs and Symptoms of Infection in the preterm infant

  • Behavioral changes

  • Color changes

  • Temperature instability

  • Cool, clammy skin

  • Feeding intolerance

  • Hyperbilirubinemia

  • Tachycardia followed by apnea and bradycardia


Nursing interventions infection

Nursing Interventions-Infection

  • Maintain skin integrity

  • Maintain sterile technique with procedures

  • ‘Scrub’ before entering – EVERYONE

  • Hand sanitizer at every bedside and used in between care

  • No entry if sick – EVERYONE

  • No artificial nails / short nails

  • Single infant incubators, clean weekly

  • Report early signs of infection immediately

  • Assess infants response to treatment (possible resistance)

  • Position change, use sheepskin


Physiologic challenges hepatic system

Physiologic Challenges –Hepatic System

  • Poor glycogen stores -increased susceptibility to hypoglycemia.

  • Inability to conjugate bilirubin - increase hyperbilirubinemia.

  • Decrease ability to produce clotting factors, low plasma prothrombin levels.


Physiologic challenges renal system

Physiologic Challenges – Renal System

  • Decreased glomerular filtration rate

  • Inability to concentrate urine

  • Decreased ability of kidneys to buffer

  • Decreased drug excretion time


Pain in preterm infants

Pain in preterm infants

  • High-pitched, intense, harsh cry

  • Whimpering, moaning

  • “Cry face”

  • Eyes squeezed shut

  • Mouth open

  • Grimacing

  • Bulging or furrowing of brow

  • Tense, rigid muscles or flaccid muscle tone

  • Rigidity or flailing of extremities

  • Color changes: Red, dusky, pale

  • Increased or decreased heart rate and respirations, apnea

  • Decreased oxygen saturation

  • Increased blood pressure

  • Sleep-wake pattern changes


Nursing interventions

Nursing Interventions

  • Swaddle, wake slowly

  • Pacifier, may use Sucrose

  • Medications


Signs of overstimulation in preterm infants

Signs of Overstimulationin Preterm Infants

Oxygenation changes

Behavior changes

Posture

Facial expression

Gaze

Regurgitation

Yawning

Fatigue

  • Respirations

  • Pulse

  • Blood pressure

  • Oxygen saturation levels

  • Color

  • Sneezing, coughing, hiccupping


Physiologic challenges digestive system

Physiologic Challenges –Digestive System

  • Decreased gag and suck reflexes

  • Hypotonic cardiac sphincter

  • Suck and swallow reflexes may be uncoordinated

  • Small stomach capacity

  • Vomiting

  • Intolerance of fats

  • Immature absorption of nutrients


Maintaining nutrition

Maintaining Nutrition

  • Nursing Care

    • Assess Daily weights

    • Monitor I&O

    • Accurate IV rates to prevent circulatory overload

    • Provide feedings via nasogastric if unable to feed orally

    • Initiate oral feedings and assess for tiring

      with feedings

    • Monitor urine pH and specific gravity

    • Involve parents in feedings


Nursing interventions1

Nursing Interventions

  • Pre-feeding assessment

    • Respirations

    • Measure abdominal girth

    • Bowel sounds

    • Gastric residual

    • Sucking , swallowing , and gag reflexes


Readiness for nipple feeding

Readiness for Nipple Feeding

  • Rooting

  • Sucking on gavage tube, finger, or pacifier

  • Able to tolerate holding

  • Respiratory rate <60 breaths per minute

  • Presence of gag reflex


Signs of nonreadiness for nipple feedings

Signs of Nonreadiness for Nipple Feedings

  • Respiratory rate >60 breaths per minute

  • No rooting or sucking

  • Absence of gag reflex

  • Excessive gastric residuals


Parenting

Parenting

  • Facilitating Parent-Infant Attachment

    • Prepare parents for first visit

      • Equipment, tubes etc.

    • Establish safe/trusting environment

      • Provide support, reassurance, encouragement

    • Encourage visitation

    • Involved in care taking

    • Repeat explanations

    • Promote touching, talking, rocking, cuddling

    • Refer to infant by name

    • Allow parents to phone as desired


Common complications of preterm infants

Common Complications ofPreterm Infants


Respiratory distress syndrome

Respiratory Distress Syndrome


Respiratory distress syndrome1

Respiratory Distress Syndrome

  • Pathophysiology

    • Primary absence, deficiency or alteration in the production of surfactant

    • Decrease in Surfactant = increase in atelectasis= lack of gas exchange

    • Leads to hypoxia and acidosis which further inhibit surfactant production and causes pulmonary vasoconstriction.

    • Common Clinical manifestations:

      • Nasal Flaring

      • Circumoral cyanosis

      • Expiratory grunting

      • Retracting

      • Tachypnea


Respiratory distress syndrome nursing interventions

Respiratory Distress Syndrome-Nursing Interventions

  • Maintain airway, oxygenation, ventilation

    • Supplemental oxygen:

      • Nasal prongs

      • Oxyhood

    • Continuous positive airway pressure (CPAP)

    • Intubation with endotracheal tube


Surfactant replacement therapy

Surfactant Replacement Therapy

  • Surfactant preparation can be lifesaving and reduces complications, such as pneumothorax.

    • Administered through an endotracheal tube

    • Surfactant treatments may be repeated several times during the first days until respiratory distress syndrome resolves.


Respiratory distress syndrome nursing interventions1

Respiratory Distress Syndrome-Nursing Interventions

Nutrition Support

  • Newborns with RDS may be given food and water by the following means:

    • Tube feeding—a tube is inserted through the baby's mouth and into the stomach

    • Parenteral feeding—nutrients are delivered directly into a vein

      Support to Parents

    • Allow parents to hold and feed

      when possible.

    • Assist to decrease their fears


Periventricular intraventricular hemorrhage

Periventricular-IntraventricularHemorrhage


Periventricular intraventricular hemorrhage1

Periventricular-IntraventricularHemorrhage

  • Rupture of fragile blood vessels around the ventricles of the brain

  • Usually associated with hypoxia

  • Diagnosed via cranial ultrasound

  • Signs – lethargy, poor muscle tone, decreased reflexes, seizures, apnea or cyanosis, full or bulging fontanels

  • Nursing Care – daily measure FOC, observe for changes in LOC


Retinopathy of prematurity

Retinopathy of Prematurity


Retinopathy of prematurity1

Retinopathy of Prematurity

  • Formation of immature blood vessels in the retina constrict and become necrotic

  • Most common in infants < 28 weeks gestation

  • Also associated with O2 therapy


Retinopathy of prematurity2

Retinopathy of Prematurity

  • Nursing Interventions to Prevent ROP

    • Administer O2 in concentration ordered

    • Ensure proper ventilatory settings


Necrotizing enterocolitis

Necrotizing Enterocolitis


Necrotizing enterocolitis1

Necrotizing Enterocolitis

  • An inflammatory disease of the intestinal tract frequently complicated with perforation of the gut.

    • NEC develops when there is asphyxia or hypoxia in which cardiac output tends to be directed more toward the heart and brain and away from the abdominal organs.

    • The intestinal cells become ischemic and damaged and stop secreting protective mucus infection occurs.

    • Perforation may occur with overwhelming sepsis.


Necrotizing enterocolitis signs and symptoms

Necrotizing EnterocolitisSigns and Symptoms

  • Early:

    • Increase in gastric aspirate - >5-25 ml.

    • Increase in abdominal girth

    • Decrease bowel sounds, abdominal tenderness or rigidity of abdominal wall.

  • Subtle:

    • Lethargy, sudden listlessness, temperature instability, decrease urine output, occult blood in stools, poor color, and apneic periods.

  • Dramatic:

    • Massive abdominal distention, vasomotor collapse.


Necrotizing enterocolitis treatment and nursing care

Necrotizing EnterocolitisTreatment and Nursing Care

  • Surgery:Resection of necrotic sections and possible temporary colostomy. This allows bowel to recover.

  • Medical:

    • NPO with NG tube.

    • Peripheral or central hyperalimentation

    • Antibiotic therapy.

    • Continue to monitor for changes in condition.

    • Gradually introduce oral feedings


Post term newborn greater than 42 weeks gestation

Post-Term NewbornGreater than 42 weeks gestation


Post mature infant

Post Mature Infant

  • Physical manifestations:

    • Dry, cracking,

      parchment-like skin

    • Reduced subcutaneous

      tissue -Loose appearing

      skin

    • No vernix or lanugo

    • Long fingernails

    • Profuse scalp hair

    • Long, thin body appearance

    • Often meconium stained skin, cord, nails


Post mature infant1

Post Mature Infant

  • Complications of post term:

    • Hypoglycemia

    • Meconium aspiration

    • Congenital anomalies

    • Seizure activity

    • Cold stress


Small for gestational age below the 10 th percentile

Small for Gestational AgeBelow the 10th percentile


Risk factors

Risk Factors

  • Maternal factors:

    • High blood pressure.

    • Chronic kidney disease.

    • Advanced diabetes.

    • Heart or respiratory disease.

    • Malnutrition, anemia.

    • Infection.

    • Substance use (alcohol, drugs); Cigarette smoking.

  • Factors involving the uterus and placenta:

    • Decreased blood flow in the uterus and placenta.

    • Placental abruption (placenta detaches from the uterus).

    • Placenta previa (placenta attaches low in the uterus).

    • Infection in the tissues around the fetus.

  • Factors related to the developing baby (fetus):

    • Multiple gestation (twins, triplets, etc.).

    • Infection.

    • Birth defects.

    • Chromosomal abnormality.


Complications of the sga newborn

Complications of the SGA Newborn

  • Asphyxia

  • Aspiration syndrome

  • Hypothermia

  • Hypoglycemia

  • Polycythemia


Large for gestational age greater than 90 th percentile

Large for Gestational AgeGreater than 90th percentile


High risk neonate

What condition is associated with the newborn being LGA?


Complications of the lga newborn

Complications of the LGA newborn

  • Birth Trauma

  • Increase of Cesarean births

  • Hypoglycemia

  • Polycythemia

  • Hyperviscosity


Asphyxia of the newborn

Asphyxia of the Newborn


Asphyxia

Asphyxia

  • Lack of oxygen and increase of carbon dioxide in the blood

    • Occurs in utero or after birth

  • S/S asphyxia after birth:

    • Cessation of respirations and rapid fall in heart rate

  • Interventions:

    • Primary apnea: stimulation and O2

    • Secondary apnea: positive pressure ventilation &/or chest compressions

    • Naloxone 0.1mg/kg IM (if narcotics given to expectant mother shortly before birth)


Meconium aspiration syndrome

Meconium Aspiration Syndrome


Meconium aspiration syndrome1

Meconium Aspiration Syndrome

  • Meconium stained amniotic fluid

    • Aspirated into the trachobronchial tree

    • Occurs either in utero or after birth with the first breaths.

  • Meconium in the lungs causes air to become trapped and results in alveoli over-distension and rupture.


Meconium aspiration syndrome2

Meconium Aspiration Syndrome

  • Measures for Prevention of Meconium Aspiration

    • After delivery of the infant’s head while shoulders and chest are still in the birth canal,

      • Suction oropharynx and nasopharynx

    • After delivery of the infant’s body

      Crying Not crying

      - Stimulate - Do not stimulate

      - Suction with - Direct tracheal suction

      bulb syringe with endotracheal tube


Meconium aspiration syndrome3

Suction

Meconium Aspiration Syndrome

Intubation


Meconium aspiration syndrome4

Meconium Aspiration Syndrome

  • Nursing Interventions:

    • Maintain adequate oxygenation and ventilation

    • Regulate temperature

    • Accurate IV fluid administration

    • Assess for hypoglycemia

    • Administer antibiotics

    • Prevent caloric requirements

    • Provide support care if on ECMO


Hyperbilirubinemia

Hyperbilirubinemia


Hyperbilirubinemia1

Hyperbilirubinemia

  • Pathophysiology

    • Unconjugated bilirubin is a break-down product of destroyed RBC’s.

    • Unconjugated bilirubin is normally transferred in the plasma firmly bound to albumin to the liver where conjugation occurs.

    • Conjugated bilirubin is water soluble and can then be excreted into the bile and eliminated with the feces.

    • Unconjugated bilirubin is not in excretable form and remains in the circulation causing problems.

    • Hyperbilirubinemia occurs when the body cannot conjugate the bilirubin released into the serum.


Causes of hyperbilirubinemia

Causes of Hyperbilirubinemia

  • Hemolytic disease (Rh and ABO incompatibility)

  • Extravascular bleed (cephalhematoma)

  • Bilirubin conjugation defects (breastmilk jaundice, asphyxia)

  • Hypoalbumin

  • Physiologic jaundice (occurs after the first 24 hours of birth. Mainly due to immature liver and lack of glucoronyl transferase).


Hyperbilirubinemia2

Hyperbilirubinemia

  • Clinical Manifestations:

    • Sclerae appearing yellow before skin appears yellow – usually in the first 24 hours after delivery

    • Skin appearing light to bright yellow – advances from head to toe

    • Lethargy

    • Dark, amber concentrated urine

    • Poor feeding

    • Dark stools


Hyperbilirubinemia3

Hyperbilirubinemia

  • Diagnosis:

    • Bilirubin levels on Cord Blood

      • Average level of Unconjugatedbilirubin is 2 mg/dl at birth

      • Bilirubin levels should NOT exceed 5 mg/dl

    • Coombs Test

      • may be done on the fetal cord blood (direct Coombs test) or on the maternal blood (indirect Coombs test).

      • Tests for the presence of maternal antibodies attached on the infant’s red blood cells.

      • The test is positive if there are maternal antibodies.


Hyperbilirubinemia nursing care

Hyperbilirubinemia Nursing Care

  • Careful observation of infant for signs of increased jaundice

  • Careful observation for and prevention of acidosis/hypoxia and hypoglycemia, which decrease binding of bilirubin to albumin and contribute to jaundice.

  • Maintain adequate hydration

  • Avoid cold stress

  • Phototherapy – use of “bili” lights, special fluorescent

  • Exchange Transfusion


Hyperbilirubinemia nursing care1

HyperbilirubinemiaNursing Care

  • Nursing Interventions for Phototherapy

    • Exposure of skin

    • Cover eyes (remove for feeding/parent visit)

    • Monitor temperature – prone to hyperthermia or hypothermia

    • Reposition newborn every 2 hours

    • Increase fluids

    • Assess for dehydration

    • Perform T-Bili q 12 – 24 hr as ordered

    • Explain need to keep under phototherapy except during feedings and diaper changes.

    • Explain to parents and allow them to hold during feedings


Hyperbilirubinemia phototherapy

HyperbilirubinemiaPhototherapy

  • Side Effects to Phototherapy

    • Frequent loose, green stools

    • Skin rash

    • Increased basal body metabolism

    • Dehydration

    • Hyperthermia


Hyperbilirubinemia exchange transfusion

HyperbilirubinemiaExchange Transfusion

  • Exchange Transfusion

    • Treat anemia

    • Remove sensitized RBCs that will soon lyse

    • Remove serum bilirubin

    • Provides albumin to increase bilirubin binding sites


Hyperbilirubinemia4

Hyperbilirubinemia

  • Rhogam

    • Provides temporary passive immunity which prevents permanent active immunity (antibody formation)

    • Given within 72 hours of delivery

    • Prevents production of maternal antibodies


Hyperbilirubinemia5

Hyperbilirubinemia

  • ABO incompatibility

    • Occurs when type O pregnant woman with A, B or AB blood type fetus

    • If woman has anti A or anti B antibodies, these antibodies cross the placental barrier

    • Results in hemolysis of fetal RBCs


Hyperbilirubinemia6

Hyperbilirubinemia

  • Complications of Hemolytic Disease

    • Kernicterus – Deposits of conjugated and unconjugated bilirubin in the basal ganglia of the brain

      • Neurologic damage

    • Hydrops fetalis – severe anemia

      • Marked edema

      • Cardiac decompensation

      • Multiple organ failure

      • Possible death


Infections

Infections

TORCHA


Infectious diseases torch

Infectious Diseases: TORCH

  • Toxoplasmosis

  • Other

    • Syphillis

    • Hepititis B

  • Rubella

  • Cytomegalovirus

  • Herpes Simplex II

  • HIV - AIDs


Toxoplasmosis

Toxoplasmosis

  • Protozoan infection in the pregnant woman

    • Raw or under cooked meats

    • Infected Cat feces

  • Transmission:transplacental

  • Affects on the fetus

    • Retinochoroiditis (inflammation of the retina and choroid of the eye. Blindness

    • Deafness

    • Convulsions

    • Microcephaly

    • Hydrocephaly

    • Severe mental impairment


Other syphil lis

Other - Syphillis

  • Transmission:Transplacental

  • Clinical Manifestations:

    • Rhinitis (Snuffles)

    • Excoriated upper lip

    • Red rash around mouth and anus

    • Copper colored rash of face, palms and soles

    • Irritability

    • Edema

    • Cataracts.

  • Treatment:

    • Culture orifices

    • Isolation

    • Penicillin


  • Other hepatitis b

    Other – Hepatitis B

    Transmission

    Placental

    Birth

    Breast milk

    Treatment

    If mother + HbSAG - administer to newborn:

    Hepitisis B vaccine

    HBIG

    (administer within 12 hours of birth)


    Rubella

    Rubella

    • Transmission:transplacental

    • S/S of Newborn

      • Congenital cataracts

      • Deafness

      • Congenital heart defects

      • Sometimes fatal

      • Intellectual disability

        (Affects are greatest if infected in 1st trimester)

    • MMR Immunization of mother

      • Give when not pregnant – usually in immediate postpartum period.

      • Newborns are infectious:

        • CONTACT ISOLATION


    Cytomegalovirus

    Cytomegalovirus

    • Herpatic virus

    • Transmission:

      • Crosses placental barrier

      • Direct contact at birth

      • Breast milk

    • S/S of Newborn

      • Severe neurological problems

      • Eye abnormalities

      • Hearing loss

      • Microcephaly

      • Hydrocephaly

      • Enlarged liver

      • Cerebral palsy


    Herpes simplex ii

    Herpes Simplex II

    • Transmission:Direct contact at birth

    • S/S of Newborn

      • Custer of vesicles

      • Lethargy

      • Encephalitis

      • Mental delays

      • Seizures

      • Retinal dysplasia

      • Apnea

      • Coma

    • CONTACT ISOLATION - culture vesicles

    • Treatment:Antivial drugs


    Hiv aids

    HIV/AIDS

    • Transmission:

      • Transplacentally

      • Exposure at birth

      • Breast milk

    • Diagnosis:

      • Serology tests are performed within 48 hours of birth;

        repeated at 3 and 6 months

      • HIV antibody

      • ELISA

      • CD4 + T-cell


    Hiv aids diagnosis

    HIV/ AIDSDiagnosis

    • HIV infected (two or more positive tests for HIV)

    • Perinatally exposed (born to a mother know to be infected with HIV)

    • Seroconverter (born to a mother known to be infected with HIV but has had two negative HIV tests


    Hiv a ids

    HIV / AIDS

    • Nursing Interventions

      • HIV infected mothers should be identified and begin treatment with AZT during pregnancy and in labor

      • All infants born to an infected mother should be treated prophylactically

        • 6 weeks of AZT orally after birth

        • Bactrim and Septra

      • Provide care like that of any other newborn


    Infant of diabetic mother

    Infant of Diabetic Mother

    IDM


    High risk neonate

    What causes

    the

    Excessive fetal growth?


    Complications of infants of diabetic mothers

    Complications of Infants of Diabetic Mothers

    • Hypoglycemia

    • Hypocalcemia

    • Hyperbilirubinemia

    • Polycythemia

    • Respiratory Distress Syndrome


    Infants of diabetic mothers

    Infants of Diabetic Mothers

    • Why are they prone to HYPOGLYCEMIA?

      • High levels of glucose cross the placenta

      • In response, fetus produces high levels of insulin

      • High levels of insulin production continues after cord cut

      • Depletes the infant’s blood glucose


    Infants of diabetic mothers1

    Infants of Diabetic Mothers

    • Clinical Manifestations:

      • Large size – Macrosomia; enlarged spleen, heart, liver

      • Tremors

      • Cyanosis

      • Apnea

      • Temperature instability

      • Poor sucking and feeding

      • Hypotonic muscle tone / Lethargy

  • Nursing Interventions

    • Assess blood glucose

      • Intervene if < 45mg/dl:

        • Feed infant

      • Revaluate blood sugar 30-45 minutes pc

    • If no improvement:

      • IV of D10W


  • Newborn of substance abuse mother

    Newborn of Substance Abuse Mother


    Infant of addicted mother

    Infant of Addicted Mother

    • The newborn of an alcoholic or drug-dependent mother will also be alcohol or drug dependent.

    • After birth, when an infant’s connection with the maternal blood supply is severed, the neonate suffers withdrawal.

    • In addition, the drugs ingested by the mother may be teratogenic, resulting in congenital anomalies.


    Fetal alcohol syndrome fas clinical manifestations

    Fetal Alcohol Syndrome – FASClinical Manifestations


    Fetal alcohol syndrome fas

    Fetal Alcohol Syndrome - FAS

    • Clinical Manifestations:

      • Jitteriness

      • Abdominal distention

      • Exaggerated rooting and sucking reflexes

    • Affected body systems:

      • CNSGI system

    • Long-term psychosocial implications:

      • Feeding difficulties

      • Mental retardation


    Infants of addicted mothers clinical manifestations of infant withdrawal

    Infants of Addicted MothersClinical Manifestations of Infant Withdrawal

    • Central Nervous System

      • IRRITABILITY

        • Hyperactivity

        • Shrill cry

        • Exaggerated reflexes

        • Facial scratches

        • Short non-quiet sleep

      • Sneezing, coughing, yawning

    • Gastroinestional System

      • Poor feeding

      • Disorganized vigorous suck

      • Vomiting and/or Diarrhea

    • Vasomotor and Cutaneous Signs

      • Tachypnea

      • Sweating

      • Excoriated skin


    Infants of addicted mothers nursing care

    Infants of Addicted Mothers Nursing Care

    • Soothing:

      • Swaddle with hands near mouth

      • Offer pacifier

      • Place in quiet dimly lit area of the nursery

    • Protect skin from excoriation

    • Monitor V/S

    • Feeding

      • Provide small frequent feedings

      • Position with HOB elevated

      • Weigh every 8 hours (if vomiting & diarrhea)

    • Assess with Finnegan Abstinence Scale

    • Administer morphine, phenobarbitol, methadone


    Affects of smoking on the fetus during pregnancy

    Affects of Smoking on the Fetus during pregnancy

    Nicotine

    Causes vasoconstriction

    Reduces placental blood circulation

    Carbon Monoxide

    Inactivates fetal and maternal hemaglobin

    Reduced amount of oxygen to fetus results in prematurity or low birth weight


    Thank you

    Thank you!

    Christina Hernandez RN, MSN

    [email protected]


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