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NURS 2410 Unit 4

NURS 2410 Unit 4. Nancy Pares, RN, MSN Metro Community College. Identification of At-risk Newborn. Low socioeconomic level of the mother Limited or no prenatal care Exposure to environmental dangers Preexisting maternal conditions. Identification of At-risk Newborn (continued).

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NURS 2410 Unit 4

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  1. NURS 2410 Unit 4 Nancy Pares, RN, MSN Metro Community College

  2. Identification of At-risk Newborn • Low socioeconomic level of the mother • Limited or no prenatal care • Exposure to environmental dangers • Preexisting maternal conditions

  3. Identification of At-risk Newborn (continued) • Maternal factors such as age or parity • Medical conditions related to pregnancy • Pregnancy complications

  4. Feeding Guidelines

  5. Early Feeding Skills (EFS)

  6. Congenital Anomalies

  7. Congenital Anomalies

  8. Congenital Anomalies

  9. Congenital Anomalies

  10. Congenital Anomalies

  11. Congenital Anomalies

  12. Congenital Anomalies

  13. Congenital Anomalies

  14. Nursing Care of the Drug-Exposed Newborn • 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-Fowler’s • Monitoring frequency of diarrhea and vomiting

  15. Nursing Care of the Drug-Exposed Newborn • 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

  16. Infants Born to HIV/AIDS Infected Mothers: Consequences • Prematurity • SGA • Failure to thrive • Enlarged spleen and liver • Swollen glands

  17. Infants Born to HIV/AIDS Infected Mothers: Consequences • Recurrent respiratory infection • Rhinorrhea • Recurrent GI problems • Persistent or recurrent candidiasis

  18. Nursing Care of the Infant Born to HIV/AIDS Infected Mothers • Provide comfort • Keep the newborn well nourished • Keep the infant protected from infections • Facilitate growth, development, and attachment

  19. Newborn Withdrawal

  20. Neonatal Abstinence

  21. Neonatal Abstinence

  22. Infants at Risk for HIV/AIDS

  23. Cardiac Defects

  24. Cardiac Defects

  25. Cardiac Defects

  26. Cardiac Defects

  27. Cardiac Defects

  28. Small-for-gestational-age • Maternal factors • Maternal disease • Environmental factors • Placental factors • Fetal factors

  29. Triplets Manifesting Different Rates of Growth

  30. Intrauterine Growth Restriction • 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

  31. Intrauterine Growth Restriction (continued) • Nursing implications • Prevent heat loss • Monitor blood glucose, feed early • Monitor for respiratory complications • Management of hyperbilirubinemia

  32. Large for Gestational Age Infant • 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

  33. Impact of Maternal Diabetes Mellitus (DM) on the Newborn • LGA • SGA • Hypoglycemia • Hypocalcemia • Hyperbilirubinemia

  34. Impact of Maternal Diabetes Mellitus (DM) on the Newborn • Birth trauma • Polycythemia • RDS • Congenital malformations

  35. Infants of Diabetic Mothers • Risk factors • Congenital anomalies • Macrosomia (>4,000 gm) • Hypoglycemia • Respiratory distress syndrome

  36. Infants of Diabetic Mothers (continued) • Prevention of complications • Normoglycemia during gestation and labor • Deliver when lungs are mature • Prepare for delivery of large infant • Monitor for hypoglycemia

  37. Hypoglycemia Symptoms • Lethargy or jitteriness • Poor feeding and sucking • Vomiting • Hypothermia and pallor • Hypotonia, tremors • Seizure activity, high pitched cry, exaggerated moro reflex

  38. Hypoglycemia: Nursing Care • Routine screening for all at risk infants • Early feedings • D10W infusion

  39. Figure 33–14 Potential sites for heel sticks. Avoid shaded areas to prevent injury to arteries and nerves in the foot and the important longitudinally oriented fat pad of the heel, which in later years could impede walking.

  40. Figure 33–15 Heel stick. With a quick, piercing motion, puncture the lateral heel with a microlance. Be careful not to puncture too deeply.

  41. Postmaturity Syndrome • Hypoglycemia • Meconium aspiration and oligohydramnios • Polycythemia • Congenital anomalies • Seizures • Cold stress

  42. The Premature Infant • Delivery prior to 37 weeks’ gestation • Factors • Multiple gestation, PROM, incompetent cervix

  43. Assessment of the Preterm Newborn • Physical characteristics • Gestational age • Maternal prenatal risk factors • Delivery risk factors • Physical assessment • Family assessment

  44. The Premature Infant (continued) • Assessment • Gestational age assessment • Neurologic assessment • Physical characteristics • Thin skin, soft cartilage, absent plantar creases • Abundant lanugo and vernix • Genitalia characteristic of prematurity

  45. Review of Systems and Potential Complications • Cardiovascular • Patent ductus arteriosis • Hypotension • Central nervous system • Intraventricular hemorrhage • Posthemorrhagic hydrocephalus • Hematologic system • Anemia • Polycythemia • Hepatic system • Hyperbilirubinemia Phototherapy

  46. Risk Factors for Hyperbilirubinemia

  47. Lab Evaluation of Jaundice

  48. Checklist for in-room Phototherapy

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

  50. Hyperbilirubinemia (continued) • Complications • Kernicterus • Erythroblastosis fetalis • Hydrops fetalis • Assessment findings • Jaundice, elevated bilirubin levels

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