Developed by D.

Ann Currie, RN, MSN

High Risk Newborn Nursing Care

Fetal/Neonatal Risk Factors for Resuscitation
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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

academia  May be due to prematurity or surfactant deficiency . hypercarbia.Respiratory Distress Syndrome (RDS)  Deficiency or absence of surfactant  Atelectasis  Hypoxemia.

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RDS: Nursing Care  Maintain adequate respiratory status  Maintain adequate nutritional status  Maintain adequate hydration  Education and support of family .

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mucus. debris  Exhibit signs of distress shortly after birth  Symptoms  Expiratory grunting and nasal flaring  Subcostal retractions  Slight cyanosis .Transient Tachypnea of the Newborn (TTN)  Failure to clear lung fluid.

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 .

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

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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 .

high pitched cry. tremors  Seizure activity.Hypoglycemia Symptoms  Lethargy or jitteriness  Poor feeding and sucking  Vomiting  Hypothermia and pallor  Hypotonia. 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 newborn’s 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 .

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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 infant’s medical condition and needs  Adapting to the infant’s 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 .

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 Cont. to Study other conditions from the Text .