at risk, high risk, and sick newborn Cheat Sheet

by Dani (Dan_Niel) via cheatography.com/131883/cs/26598/

APGAR chart Normal Respir​atory Adaptation (cont) Sepsis (blood infection) (cont)

Reflex Coughing & sneezing to clear Trea​tment

airway • Sepsis is confirmed with culture test for 7-
Init​iation of repira​tio​ns: 21 days

Chemical surfactant reduces surface • Antibi​otics to be given IV

tension • IV fluids to support the infant till infection
Thermal sudden chilling of moist infant clears
Mechanical compre​ssion of fetal chest at • Oxygen or ventil​ation to support breathing
delivery Prev​ent​ion
• Antibi​otics to control dangerous bacteria
Nursing Interv​entions
Poor Apgar Score
• Breast​feeding may help prevent sepsis
Assess for Respir​atory distress
1st general condition (neuro​/re​‐ • Providing a clean place
minute spi​/ci​rcu​latory) Plan To maintain a patent airway
• Delivery within 24 hrs after water breaks
(9) Inte​rve​nti​ons
5th Determine if neonate can adjust Position Head lower Hyperb​ili​rub​inemia
minute to extrau​terine life
Suction Bulb near the head, mouth first, Phys​iologic Jaundice
(10)
avoid trauma to membranes
• Increase in bilirubin by 2nd day of life,
0-3 poor: severely depressed,
Eval​uat​ion declines in 5th
needs CPR
RR 30-60 bpm with no signs of • Onset and resolution delayed in
4-6 fair: guarded, moderately
distress premature (5-14days)
depressed
In order for the respir​atory system to Path​ologic Jaundice
7-10 good: healthy
function the infant must have:
• Persistent jaundice may indicate hepatitis,
Note: Pulse is the most important and - adequate pulmonary blood flow
biliar atresia, down syndrome, hypoth​yro​‐
Color is the least (acr​ocy​ano​sis due to - adequate amount of surfactant
idism, breast milk inhibitors
extrau​terine adapta​tion) - strong respir​atory muscul​ature
• Total bilirubin increasing by >5mg/dl per
day
Respir​atory Evalua​tions Sepsis (blood infection)
Brea​stf​eeding Jaundice
Early onset birth to 7 days after delivery
• appear on breastfed babies after 7 days of
Late onset 8-28 days after birth
life
Nosocomial 1st week until discharge
• peak during weeks 2-3 but may last for a
Symp​toms month
• fever, breathing problems, lethargy Trea​tment
• poor feeding, bloated abdomen. vomiting • Monitor how fast it has been rising
(yello​wish)
• Needs to be kept hydrated with breastmilk
0 : Normal | 1-3 : Poor | 4-6 : Moderate | 7- • Diarrhea, sleepi​ness, jaundiced, irregular
• Feed baby often up to 12 times a day
10 : Severe HR
• Photot​herapy: blue light
• low blood sugar and seizures
Normal Respir​atory Adaptation • Blood transf​usion, IV immuno​glo​bulin
RR 30-60 bpm (80 bpm in 1st min)
Breathing Use of abdominal muscles &
diaphragm. Newborns are nose
breathers

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 at risk, high risk, and sick newborn Cheat Sheet
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Premat​urity (before 37 wks) Postma​turity (old man looking) Large for Gestat​ional Age (cont)

Physical <2500g (5lb 8 oz) Prob​lems • Birth trauma due to cephal​opelvic dispro​‐
Findings Aspiration Meconium, hypoxia portion
Sole creases, skull firmness, ear cartilage Polycy​‐ Increase number of RBC • Increased ceasarian sections
mother's report of last menstrual period themia • Hypogl​ycemia , hyperb​ili​runemia
sonogr​aphic estimation of gestat​ional age Seizure severe hypoxia • Polycy​themia, hyperv​isc​osity
Risk factors activity • irregular HR, cyanosis
multiple gest., history of preterm, single teen Cold stress loss of subcut​aneous fat Nursing Care
mother Hypogl​‐ use of glucose stores, - Monitor for hypogl​ycemia
Physical assess​ment ycemia glycogen
- Screening for polycy​themia (cbc, h&h)
AOG less than 37 weeks Nursing Care
- Careful assessment for injuries & address
Respir​‐ Irregular - may require prolonged monitoring prenatal concerns about injuries like
atory - support well being due to wasting effect fractured clavicle
Digestive bowel sounds diminished - Early detection of polycy​themia & hyperb​‐ - Monitor temp, and minimize heat loss
Thermo​‐ hypoth​ermia = hypogl​ycemia ili​rub​inemia - Initiate early feedings, touch and cuddling
reg​ulatory - Focus on prevention : due date - Support parents and teach
Reflex Poor suck, swallow, flexion - Attention to thermo​reg​ulation & feeding
Nursing Care Common compli​cat​ions Meconium Aspiration Syndrome

Prevention Prevention of acquiring • 2-3 times higher morbidity than term Symp​toms
infection infants • Bluish skin color of the infant
Promote maintain and monitor body • Hypogl​‐ used depleted glycogen • Difficult breathing (none or rapid)
oxygen​‐ temp, apical pulse, respir​atory ycemia stores
• Limpness in infant at birth
ation rate • Aspiration of meconium in response to
Trea​tment
Provision tactile stimul​ation for apnea hypoxia
• ET tube placement and suctioning
safe and effective enviro​‐ • Polycy​‐ Increase RBC response to
• Using a face mask with oxygen mixture
nment themia hypoxia
• Antibiotic to treat infection
Nutrition respir​ation is <60/m | rooting, • Seizure from severe hypoxia
(readi​‐ sucking and gag reflex activity • Radiant warmer to maintain body temp
ness) •Cold stress start to lose weight in the
Respir​atory Distress Syndrome (copy)
Educ​ation of parents utero
Causes
Handle carefully when reposi​tioning
Large for Gestat​ional Age Not enough of substance called surfac​tants
Psycho​logical support : sharing info,
Appe​ara​nce that consists of phosph​olipids and protein.
reinforce positives
begins to be produced at 24-28 wks. by 35
Share caretaking respon​sib​ilities with • Possible fracture of the clavicles
wks most have develop adequate surfac​‐
parents • Facial head bruising and palsy
tant.
• Caput succed​aneum (normal: disappear
Symp​toms
12 018 mons)
• Difficulty of breathing (tachy​pnea,
• Cephal​hem​atoma
grunting)
Comp​lic​ati​ons
• Cyanosis (blue coloring)
• Flaring of the nostrils

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 at risk, high risk, and sick newborn Cheat Sheet
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Respir​atory Distress Syndrome (copy) Hypoth​ermia (cont) Low birth weight

(cont)
M metabolic acidocis LBW less than or equal to 2500g (5lbs 8
• Chest retrac​tions (pulling in ribs & oz)
sternum) Small Gestation Age (<10%) VLBW less than or equal to 1500g (3lbs
• symptoms peak at 3rd day, diuresis dec. Causes 5oz)
need of O2 ELBW less than or equal to 1000g (2lbs
- may be born preterm, term, post term
Trea​tme​nts 3oz)
- may have experi​enced (IUGR) or failed to
• Placing an ET tube, mechanical ventil​ation grow Prev​ent​ion
• Supple​mental oxygen - Placental anomaly, poor nutrition • Early & regular prenatal care
• Continuous positive airway pressure - Smoking, cocaine, teratogen exposure • Seek medical check uo
(CPAP) • Quit smoking and other terato​genic factors
- Severe DM, decreased blood flow to
placenta • Take multiv​itamin containing 400 micg of
Hypoth​ermia
Common compli​cat​ions folic acid
Methods of Heatloss
Perinatal asyphaxia deficient oxygen​ation
Evapor​‐ wet surface exposed to air Failure to Thrive
Hypoth​ermia Inadequate
ation Symp​toms
surfactant
Conduction Direct contact with cool • height​,we​ight, and head do not match
Hypogl​ycemia Use of glycogen
objects growth charts
stores
Convection surrou​nding cool air. Drafts • Weight is lower than 3rd percentile (20%
Meconium Hypoxia | RDS
Radiation Transfer of heat to cooler aspiration below ideal)
objects • growth may have slowed or stop
Still birth loss from death
Mani​fes​tat​ions • Delayed or slow to develop physical,
Nursing Care
CC cold skin on trunk & extrem​‐ mental, social
• Maintain airway and temper​ature
ities. cyanosis Trea​tment
• Monitor for signs of respir​atory distress
DD decrease in temper​ature & Nutrit​ional provide a well balanced diet
• Monitor glucose level, or signs of hypogl​‐
activity
ycemia Supple​‐ talk to HCP first, correct
P poor feeding in form of ments deficiency
• Minimize heat loss to prevent hypoth​ermia
suckling
• Provide feeding, touch, support, teaching
S Shallow respir​ations ABO | Rh Incomp​ati​bility
• Evaluate Hct level : hypoxia & polycy​‐
Nursing Care Symp​toms
themia
Prevention radiant warmer. careful not to • Back pain, blood in urine
• Monitor signs of sepsis, infection, malfor​‐
burn
• Chills, fever, jaundice, impending doom
mations
Provision quick dry, head cap & dry
Trea​tment
• Fluids and frequent feedings
warm blankets
• Antihi​sta​mines to treat allergic reactions
Cold Stress Lab findin​gs: low plasma levels and high
levels of RBC makes blood thick and heart • Steroids to treat swelling and allergies
R respir​atory distress
to pump harder. Increases the chance of • Fluids given intrav​enously
I increased oxygen need
thrombosis and prolonged cyanosis
D decreased surfactant
production
H hypogy​lcemia (<30 mg/dl)

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 at risk, high risk, and sick newborn Cheat Sheet
by Dani (Dan_Niel) via cheatography.com/131883/cs/26598/

ABO | Rh Incomp​ati​bility (cont)

• Medicines to raise blood pressure if drops too low

• Rh immune globulins (Rhlg) for rh incomp​ati​bility
Exams and tests
• Coombs' test to llok for cell destroying antibodies
• Bilitubin test shows high. CBC: damage to RBC
• Urine test shows presence of hemoglobin

SIDS (crib death)

Factors causing SIDS

Brain portion that controls sleep & breathing doesn't work
Ab. properly
LBW baby's brain has not matured completely
infection contri​butes to breathing problems
Sleeping on side, on soft surface, with parents
Prev​ent​ion
• Sleeping on the back
• Keep the crib as bare as possible. use firm mattress
• Don't overheat baby. blanket should be lightw​eight.
Baby should sleep alone. baby can be rolled over by parents
• Breast feed for six months lowers risk of SIDS.

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