Developed by D.

Ann Currie, RN, MSN

High Risk Newborn Nursing Care

Fetal/Neonatal Risk Factors for Resuscitation

Nonreassuring fetal heart rate pattern Difficult birth Fetal scalp/capillary blood sample-acidosis pH<7.20 Meconium in amniotic fluid Prematurity Macrosomia or SGA Male infant Significant intrapartum bleeding Structural lung abnormality or oligohydramnios Congenital heart disease Maternal infection Narcotic use in labor

Fetal/Neonatal Risk Factors for Resuscitation (continued)

An infant of a diabetic mother
Arrhythmias Cardiomyopathy Fetal anemia

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

Transient Tachypnea of the Newborn (TTN)

Failure to clear lung fluid, mucus, debris
Exhibit signs of distress shortly after birth Symptoms Expiratory grunting and nasal flaring Subcostal retractions Slight cyanosis

TTN: Nursing Care

Maintain adequate respiratory status
Maintain adequate nutritional status Maintain adequate hydration Support and educate family

Meconium Aspiration Syndrome (MAS)

Mechanical obstruction of the airways
Chemical pneumonitis Vasoconstriction of the pulmonary vessels Inactivation of natural surfactant

MAS: Nursing Care

Assess for complications related to MAS
Maintain adequate respiratory status Maintain adequate nutritional status Maintain adequate hydration

Persistent Pulmonary Hypertension (PPHN

Blood shunted away from lungs
Increased pulmonary vascular resistance (PVR) Primary Pulmonary vascular changes before birth resulting in PVR Secondary Pulmonary vascular changes after birth resulting in PVR

PPHN: Nursing Care

Minimize stimulation
Maintain adequate respiratory status Observe for signs of pneumothorax Maintain adequate nutritional status Maintain adequate hydration status Support and educate family

Cold Stress
Increase in oxygen requirements
Increase in utilization of glucose Acids are released in the bloodstream Surfactant production decrease

Cold Stress: Nursing Care

Observe for signs of cold stress
Maintain NTE Warm baby slowly Frequent monitoring of skin temperature Warming IV fluids Treat accompanying hypoglycemia

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

reflex

Hypoglycemia: Nursing Care

Routine screening for all at risk infants
Early feedings D10W infusion

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

Causes of Pathologic Hyperbilirubinemia

Hemolytic disease of the newborn
Erythroblastosis fetalis Hydrops fetalis ABO incompatibility

Treatment of Pathologic Hyperbilirubinemia

Resolving anemia
Removing maternal antibodies and sensitized

erythrocytes Increasing serum albumin levels Reducing serum bilirubin levels Minimizing the consequences of hyperbilirubinemia

Maternal-Fetal Blood Incompatibility

Rh incompatibility Rh-negative mother Rh-positive fetus ABO incompatibility O mother A or B fetus

Phototherapy: Nursing Care

Maximize exposure of the skin surface to the light
Periodic assessment of serum bilirubin levels Protect the newborns eyes with patches Measure irradiance levels with a photometer Good skin care and reposition infant at least every 2 hours Maintain an NTE and adequate hydration and nutrition

Anemia
Hemoglobin of less than 14 mg/dL (term)
Hemoglobin of less than 13 mg/dL (preterm) Nursing management Observe for symptoms Initiate interventions for shock

Polycythemia
Increase in blood volume and hematocrit
Nursing management: Assessment of hematocrit Monitor for signs of distress Assist with exchange transfusion

Clinical Manifestations of Sepsis

Increase in blood volume and hematocrit
Nursing management: Assessment of hematocrit Monitor for signs of distress Assist with exchange transfusion Temperature instability Feeding intolerance Hyperbilirubinemia Tachycardia followed by apnea/bradycardia

Clinical Manifestations of Syphilis

Rhinitis
Red rash around the mouth and anus Irritability Generalized edema and hepatosplenomegaly Congenital cataracts SGA and failure to thrive

Syphilis: Nursing Management

Initiate isolation
Administer penicillin Provide emotional support for the family

Gonorrhea
Clinical Manifestations Conjunctivitis Corneal ulcerations Nursing management Administration of ophthalmic antibiotic ointment Referral for follow-up

Clinical Manifestationfs of Herpes

Small cluster vesicular skin lesions over the entire body
DIC Pneumonia Hepatitis Hepatosplenomegaly Neurologic abnormalities

Herpes: Nursing Management

Careful hand washing and gown and glove isolation
Administration of IV vidarabine or acyclovir Initiation of follow-up referral Support and education of parents

Chlamydia
Clinical Manifestations Pneumonia Conjunctivitis Nursing management Administration of ophthalmic antibiotic ointment Referral for follow-up

Needs of Parents of At-risk Infants

Realistically perceiving the infants medical condition

and needs Adapting to the infants hospital environment Assuming primary caretaking role Assuming total responsibility for the infant upon discharge Possibly coping with the death of the infant if it occurs

Facilitating Parental Attachment

Facilitating family visits
Allowing the family to hold and touch the baby Giving the family a picture of the baby Liberal visiting hours Encouraging the family to get involved in the care

 Cont. to Study other conditions from the Text