NORTHWESTERN UNIVERSITY College of Allied Health Sciences Department of Nursing NURSING CARE MANAGEMENT 102 (NCM 102) Care

of Clients Across the Lifespan with Mother, Child and Families at Risk or with Problems 2nd SEMESTER SY 2009 2010 CARE OF THE HIGH RISK NEWBORN Problems Related to Maturity A. Premature or Preterm Infant - any infant before the completion of 37 weeks gestation Incidence: - approximately 12% of all births in the US - 18% of African-American newborns are preterm - More common in single and young mothers - 10-20% of all births born to women from low socioeconomic status Associated Factors: 1. Low Socioeconomic Status 2. Poor Nutritional Status 3. Lack of Prenatal Care 4. Multiple Pregnancy 5. Previous Early Birth 6. Cigarette Smoking 7. Age of Mother 8. Order of Birth 9. Closely Spaced Pregnancies 10. Abnormality of Mothers Reproductive System 11. Infection 12. Obstetric Complications 13. Early Induction of Labor 14. Elective Cesarean Birth 15. Race Physiologic Considerations in Preterm Infants A. Alteration in Respiratory and Cardiac Physiology Factors in the Development of Respiratory Distress 1. inability to produce adequate amounts of surfactants 2. incompletely developed muscular coat of pulmonary blood vessels 3. patent ductus arteriosus (PDA) B. Alteration in Thermoregulation Factors Limiting Heat Production 1. availability of glycogen in the liver 2. amount of brown fat available for metabolism Factors that Cause Heat Loss in a Preterm Infant 1. higher ratio of body surface to body weight 2. very little subcutaneous fat

3. thinner, more permeable skin 4. posture of preterm infant 5. decreased ability to vasoconstrict superficial blood vessels and conserve heat in the body core C. Alteration in Gastrointestinal Physiology 1. increased danger of aspiration and its complications 2. failure to meet high caloric and fluid needs 3. limited ability to convert certain essential amino acids to nonessential amino acids 4. inability to tolerate the increased osmolarity of formula protein 5. decreased ability to absorb saturated fats 6. initially unable to digest lactose 7. Rickets and Bone Demineralization 8. increased Basal Metabolic Rate (BMR) and increased oxygen requirement 9. feeding intolerance and necrotizing enterocolitis (NEC) D. Alteration in Renal Physiology 1. decreased Glomerular Filtration Rate (GFR) 2. limited ability to concentrate urine or to excrete excess amounts of fluid 3. excretes glucose at lower serum glucose level 4. decreased buffering capacity 5. decreased ability to excrete drugs E. Alteration in Reactivity Periods and Behavioral States 1. delayed periods of reactivity 2. disorganized sleep-wake cycles 3. inability to attend to human face and objects in the environment 4. weaker neurological responses Common Complications of Prematurity 1. Apnea of Prematurity Etiology: a. Neuronal Immaturity b. Blockage of Upper Airway c. Gastroesophageal Reflux

2. Patent Ductus Arteriosus (PDA) 3. Respiratory Distress Syndrome 4. Intraventricular Hemorrhage (IVH) 5. Anemia of Prematurity Nursing Responsibilities 1. Maintenance of Respiratory Function 2. Maintenance of Neutral Thermal Environment 3. Maintenance of Fluid and Electrolyte Status 4. Provision of Adequate Nutrition and Prevention of Fatigue During Feeding 5. Prevention of Infection 6. Promotion of Parent-Infant Attachment 7. Promotion of Developmentally Supportive Care 8. Preparation of Home Care B. Postmature or Postterm Infant Incidence: - 4-14% of all pregnancies - Occurs more frequently in primigravidas and women over age 35 - Common in Australian, Greek and Italian ethnic groups *Postmaturity term applicable to infants born after 42 completed weeks of gestation and also demonstrates characteristics of postmaturity syndrome - 2-3 times increased risk of morbidity and mortality than a term infant Common Complications of the Newborn with Postmaturity Syndrome 1. Hypoglycemia 2. Meconium Aspiration 3. Polycythemia 4. Congenital Anomalies 5. Seizures 6. Cold Stress Nursing Responsibilities 1. Monitor cardiopulmonary status 2. provide warmth

3. frequently monitor blood glucose 4. initiate early feeding or intravenous glucose per physicians order 5. obtain central line hematocrit