Professional Documents
Culture Documents
Gestational
Age
(Case Presentation)
By:
Akemi Hoshitani
Kathleen Dimacali
Ma. Patricia Dy
Cyra Mae Cuevo
Jerwina San Pedro
Bryan Joseph Tiongson
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TABLE OF CONTENTS
Introduction…………………………………………………………………1
Objectives……………………….……………………………………………2
Overview…………………………………………………………………..3-4
Patient’s Profile………………………..………………………………….5
Patient’s Medical History……………………………………………..6
Anatomy and Physiology………………………………………………7
Pathophysiology…………………………………………………………..8
Physical Assessment……………………………………………..…9-10
Diagnostic tests…………………………………………………………..11
Medical Management…………………………………………….12-13
Nursing Management………………………………………….…14-16
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INTRODUCTION
As part of our RLE, we the 4th year students acquired the skills to be
competent enough to do the tasks given to us. There were some problems
encountered in our patient during his stay in the Neonatal Intensive Care
Unit. We identified proper nursing interventions for the client to prevent
further complications that may develop.
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OBJECTIVES
General objective
This study aims to acquire knowledge on how to improve health,
development and quality of life of infant with low birth weight.
Specific objectives
To gain understanding about the etiology of small gestational age.
To distinguish physical appearance of infant with small gestational age
to a normal infant.
To develop appropriate nursing management for small gestational age
infant.
To determine ways on how to prevent development of complications.
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OVERVIEW
An infant is Small for Gestational Age if the birth weight is below the 10th
percentile on an intrauterine growth curve for the age. Such infants may be born:
Preterm: before week of 38 of gestation
Term: between weeks 38 and 42
Postterm: past 42 weeks
SGA infants are small for their age because they have experienced intrauterine
growth restriction or failed to grow at the expected rate in the utero. This
characteristic makes them distinctly different from the infants who are born with
a less weight than the usual but their low weight is consistent for their
gestational age.
The most common cause of intrauterine growth restriction is placental issue; either the
placenta did not obtain sufficient nutrients from the uterine arteries or it was inefficient
at transporting nutrients to the fetus. Placental underdevelopment or damage, such as
partial placental separation with the bleeding is an example of a situation that would
limit placental function because the area of the placenta that separated infarcted and
fibrosed, reducing the placental surface available for nutrient exchange. Women with
systemic diseases that decrease blood flow to the placenta.
Things that can cause babies to be small for gestational age are listed below.
Problems with the mother
High blood pressure
Chronic kidney disease
Diabetes
Heart disease or respiratory disease
Malnutrition or anemia
Infection
Alcohol or drug use
Cigarette smoking
Weighing less than 100 pounds
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Problems with the uterus and placenta
Decreased blood flow in the uterus and placenta
Placenta detaches from the uterus
Placenta attaches low in the uterus
Infection in the tissues around the baby
Babies who are small for gestational age or who have IUGR may have problems at birth.
These can include:
Lower oxygen levels than normal
Low Apgar scores
Breathing in the first stools (meconium) passed in the womb. This can
cause breathing problems.
Low blood sugar
Trouble keeping a normal body temperature
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PATIENT’S PROFILE
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MEDICAL HISTORY
Present medical history
A male infant was born on march 5,2021 at 35 weeks of gestation he is small for
gestational age with a birth weight of 1.8kg. The issue encountered during his stay at
neonatal intensive care unit were respiratory distress syndrome, low birth weight,
inability to maintain a constant body temperature, difficulty in feeding and slightly
jaundice in appearance. His respiratory distress problem was given oxygen via nasal
cannula at 1-2L/min. Prophylactic aminophylline was given to decrease the risk of
apnea.
According to the hospital guidelines, premature babies are given 5 days of
prophylactic ampicillin and cefotaxime. The infant had an umbilical catheter inserted
using aseptic technique which provided good intravenous access for the first 10 days of
life.
He was kept NPO for the first 48 hours and was maintained on intravenous
fluids. On the third day of life the infant, orogastric tube was inserted to start on 1mL
expressed breast milk every 2 hours.The feeds were increased by 1mL every other feed
provided that aspirates were minimal. The neonate’s observations were monitored,
with stool and urine output recorded on a chart. On his third day infant manifested
jaundice in appearance and physician order to have photo-therapy.
Socio-economic
His mother, a 20 year old woman, lives in a semi concrete house with her
parents and other family members. His mother is a out of school youth, and usually goes
to meet her friend. She and her friends have vices and often drink alcohol without
permission of her parents.
During interview, she admitted that she has poor nutrition, often smokes and
does not have prenatal checkup.
Family History
Parent DM HPN Kidney Disease SGA
Father - - + -
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Mother + + - +
The umbilical cord is a helical and tubular blood conduit connecting the foetus to the
placenta. The umbilical cord achieves its final form by the 12th week of gestation and
normally contains two arteries and a single vein, all embedded in Wharton's jelly.
The cord is sometimes called the baby's “supply line” because it carries the baby's blood
back and forth, between the baby and the placenta. It delivers nutrients and oxygen to the
baby and removes the baby's waste products.
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PATHOPHYSIOLOGY
PRECIPITATING FACTORS:
Lack of prenatal check-up
PREDISPOSING FACTORS Poor nutritional intake
Family history (SGA) Socio-economic
Smoking
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PHYSICAL ASSESSMENT
Asessment Examination Normal findings Actual findings Interpretation
Scalp Inspection Presence of Both anterior and Not fully develop
anterior and posterior fontanelles due to
posterior fontanelles are prematurity
fontanelles small
No lesion
Hair Inspection Soft, downy hair Dull and lusterless Due to lack of
nutrients
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poor skin turgor due poor
nutritional balance
Chest Inspection Presence of breast No breast edema;
Auscultation edema; unlabored
Palpation chest movement;
clear lung sounds
Abdomen Inspection Scaphoid, normal depressed Due to small liver
Palpation distended; abdomen
Cylindrical, round,
soft, bowel sound
presence 30-60
minutes after
birth, liver
plapable 1-2cm
below postal
marking;
Upper inspection Symmetrical, equal Thin extremities, Due to lack of
extremities in length, no Symmetrical, nutrients received
lesion, no equal in length, no from the mother
deformities. lesion, no during pregnancy
deformities
genital Inspection Descended testes Undescended Due to early
testes delivery
Lower Inspection sole creases over absent of sole Due to early
extremities Palpation the entire plantar creases to faint delivery
surface red markings
plantar
surface of
foot
APGAR SCORE
Indicator 1 minute after birth 5 minutes after birth 10 minutes after birth
Activity Some flexion (1) Some flexion (1) Some flexion (1)
Pulse >100bpm(2) >100bpm(2) >100bpm(2)
Grimace Good cry(2) Good cry(2) Good cry(2)
Appearance Acrocyanosis(1) Pinkish (2) Pinkish (2)
Respiration Strong and vigorous Strong and vigorous Strong and vigorous
cry(2) cry(2) cry(2)
Total 8 9 9
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DIAGNOSTIC PROCEDURE
DRUG STUDY
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Name of Drug Dosage/ Action Side Effects Nursing Consideration
Route/
Frequency
Generic Name: Dosage : Is a complex of >Increased or >Monitor & record vital
Aminophylline 4 mg theophylline and ethyl rapid heart rate signs and I&O
enediamine and is >Irregular
Brand Name: Route:
Corophyllin IV given for its heartbeat
theophylline activity to >Seizures >Monitor serum
Classification: Frequency:
relax smooth muscle theophylline levels.
Bronchodilator Every 6
hours and to relieve >Skin rash >Monitor for S&S of
bronchial spasm. toxicity
Theophylline is a >Notify physician or
smooth muscle nursing staff immediately
relaxant and it relaxes if these reactions occur.
the smooth muscle of
the bronchial airways.
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Route/
Frequency
Generic Name: Dosage : It inhibits the >Injection site >Monitor injection site for
Cefotaxime 90 mg bacterial cell wall reaction(pain) pain, swelling, and
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NURSING CARE PLAN
Assessment Background Nursing Planning Nursing Rationale Evaluation
Knowledge Diagnosis Intervention
Subjective: SGA infant had Ineffective After 8hrs of INDEPENDENT: -These measures After 8hrs of
lower body fat Thermore- nursing 1. Mummify the raise the core nursing
due to gulation r/t intervention, baby and cloth temperature and intervention,
Objective: inadequate to low infant body appropriately improve infant body
nutrient supply stored temperature circulation. Core temperature
Cold skin during fetal body fats will increase warming is increased
Pale life. Exposure as from 35°C- indicated when from 35°C-
Shivering to cold leads evidenced 36.5°C body temperature 36.5°C
to heat loss by is below 30 °C (86
Vital signs: through shivering °F) -Goals Met
HR- 180 convection, and -Decreases heat
bpm conduction temperatu loss by convection
T-35°C and re of 35°C. 2. Manipulate the
RR-68cpm evaporization environment
makes the (warm room
infant unable temperature)
to maintain -Decreases loss of
normal body heat by
temperature. 3. Warm the conduction.
objects coming in
contact with
infant’s body,
such as
stethoscopes and -Decreases
thermometer. evaporative heat
4. Change clothing losses
or bed linens
when wet. Keep
infant’s head
covered.
COLLABORATIVE: -Maintain
thermoneutral
5. Place infant in a environment and
warmer, helps prevent cold
incubator, or stress.
open bed with
radiant warmer. -Decreases heat
loss to the cooler
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6. Use heat lamps environment of
during certain the room.
procedures. -Reveals &
prevents any
7. Monitor further
lab/diagnostic complications.
studies as
appropriate.
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