Only 2 more units left in Nurs 2202 - Hang in thereWe all get tired!!
Remember in term neonateExtracellular water content is 70-75%. In reterm neonatesmaybe 90%
Factors associated with prematurity
Neonatal resuscitation suppliesAnd equipment
Narcan
Correct placement of the neonatal with oxygen maskWith incorrect placement if mask too large or too small
Silverman & Anderson Evaluation Scale
Means of administering supplemental oxygen
Note placement of head in hood
Documentation information
Clinical signs often associated with Neonatal Hypoglycemia
Any can cause further depletion in weight & metabolic stores
Detrimental effects of hypothermia in the neonate
DIC
Increase risk ofbillirubin encephalopathyAt low levels ofbillirubin
Loss of wt. orfailure to gainwt despiteadequate calorieintake
Umbilical arteryCatheter look at why doArterial vsVenous
Developmental & emotional care of infant & family
Environmental Hazards:NOISE (remember even putting something on isolate)INFECTION risks even from staff (HANDWASHING)Tape – sensitive skin, probes, leadsLight – Microwave rays & Radiation (portable x-rays, etc.
Remember increase anxiety & tension Cause increase in O2 consumption, increase RDS some other Signs & Symptoms of stress (overstimulation):
no eye contacthiccuppinggagging or increase emesispulling awayHAS TO learn to trust caregivers, but caregivers inflict painSee Pain also
NIDCAP: Neonatal Individualized Developmental Care Noise & LightPhysical Sensation: message, be careful not to over stimulateComfort measures: pain controlKangaroo care: skin to skinPositioning: make nest, gives boundaries, helps infant’s
organizational ability, remember flexed position
Pain in neonates: Assessment:
Behavioral: high pitched cry with shrill quality (remember highpitched cry seen in CNS damage), grimace, quiveringmouth, pulls away
Physiologic: increase in HR, BP(increase then decrease), increaseintercranial pressure, increase O2 consumption (tachypnea),decrease O2 sats
Document to make pain more objectiveGOALS: minimize intensity, duration & maximize the neonate's ability to cope
Clinical signs of RDS
2500gm = 5lbs. 8oz.
1000gm = 2lbs. 3oz.
1500gm = 3lbs. 4ozs.
Factors associated with prematurity
Hyaline membraneFormation
BPD = bronchiopulmonaryDysplasia caused by increasepressure used to deliver increaseO2
Increases pulmonary vascularresistance
TX ?
PreventionOxygen – lowest delivery pressure
& concentrationNutrientsFluid & acid/base balanceMedications i.e.. Diuretics corticosteriods, bronchiodilators
PDA = common in neonates weighing less than 1000 gTx = ventilation, norm blood gases, diuretics & indomethacin (prostaglandin) . If fails surgery to ligate.
PV-IVH = periventricular-intraventricular hemorrhageOne of most common & severe brain injuries 3 times in moderately 1501 – 2500 g premi ; 7 times in severe under 2 lbs. 3 oz (1000g)
Teaching considerations
NEC = necrotizing intercolitis = acute inflammatory disease of the GI mucosa commonly complicated by perforations
Etiology of Mec aspiration = Meconium aspiration
Intrauterine hypoxia
Reflex gasping relaxation of anal sphincter
Meconium aspiration
Airway obstruction
Ineffective gas exchange Inflammation & thickening of alveoli & interstitial tissues
Hypoxia
Persistent fetalCirculation (rt to lt shunting of unoxy.blood
Pulmonary hypertension increase pressure of right side of heart
Pulmonary vasocon- striction
Prenatal factors associated with IURG Which terms are used when referring to the neonate
SGA or SFD
S&S:reduced sub Q fatloose & dry skindiminished muscle mass; especially over buttocks & cheekssunken abdomenthin; yellowish; dry; and dull appearing cordsparse scalp hairwide skull sutures (inadequate bone growth)
Complications:perinaltal asphyxiameconuim aspiration - RDShypoglycemiaheat loss
Glycosylated hemoglobin values in early diabetic pregnancy are associated with a significant higher frequency of both congenital malformations & spontaneous abortions: NEW if is above 6 probablyIs a type 2 diabetic
LGA most of time related to high blood sugar in mom
Improvement noted with euglycemia of mother throughout pregnancy
Diabetes of all typesRemember hyperglycemia, hypoglycemia, ketoacidosis
Hyperbilirubinemia
Possible birth injuries in LGA
What is one of mostcommon causes of LGA ?
ERB or brachial plexus
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