NURS356 Exam 3 Study Guide Caring for High Risk Neonates What is High Risk Risk is the chance of harm impacts pregnancy impacts nursing care impacts the family and impacts the community Infant morbidity mortality linked to the risks Everything that negatively impacts pregnancy negatively impacts fetus Risk Factors Conditions that risk the fetus maternal disease illness high BP mom babies with small gestational age diabetes in 2nd trimester increase in estrogen stores large for gestational age baby or birth defects ecclamptic or preeclampsia babies with implications d t high magnesium levels exposure to infection STI Rh mom smoke drugs alcohol moms advanced maternal age 35 any younger than 21years old polyhydraminos excessive fluid babies have genetic problems oligohydraminos mom with very little amniotic fluid lung development problems or compression injuries Factors with multiple risks maternal nutrition stress age age Lower age of mother lower birth weight baby or premature birth 2x more perinatal mortality in adolescent 21or younger don t complete pregnancy 3x more infant mortality baby dying within first year of life with these young mothers as well Nutrition effects fertility of mother embryogenesis how the egg multiplies and the fetal growth Environmental risks poverty lack of parenting NICU admissions Nursing responsibilities Be able to identify risks with mom that pregnant mom that s delivery or in baby that shows up in nursery 1 NURS356 Exam 3 Study Guide Anticipate risk conditions depending on population you are caring for Classifications Premature 37 wks gestations gestational age at birth size assessment LBW 2500 grams VLBW 1500 grams ELBW 1kg Premature babies are 20x more likely to die in the neonatal period first 28 days of life adjusted age if born four weeks early they get an additional four weeks added to their age so when they hit the 6 month mile stones they are actually 7 months 42 wks post term Term infant 37 40 weeks size assessment SGA description that baby is less than or equal to the 10 th percentile intrauterine growth retardation description that growth is below 10th percentile based on uterine growth LGA above the 90th percentile Premature babies are 20x more likely to die in the neonatal period first 28 days of life Neonatal Intensive Care Services Developed in response to significant national funding d t bill that was passed by John Kennedy 1st 3 days of life can critically impact infant morbidity mortality Tertiary care services Neonatal Intensive Care Unit NICU Transporting the high risk mom vs neonate Try transporting baby while still in the mom Better if baby is born at tertiary care hospital Collaborative family centered care Support across networks of people Neonatologists specialize in premature babies high risk babies specialists nursing advanced practice nurses social workers developmental specialists physical therapy and occupational therapy GOAL to improve outcomes for baby family 2 NURS356 Exam 3 Study Guide Assessing Neonates Review newborn assessment content REVIEW normals Systematic approach that incorporates reading monitors using technology with hands on assessment skills Nursing care must be energy sparing to the neonate we don t touch them and bother them read signs and determine when the best time to disturb infant is based on their energy needs and caloric intake Some body positions and hand gestures give us info to how baby is doing Incorporate as much good REM sleep as possible REM sleep grow faster lungs develop better Problems of Prematurity Related to lacking the final trimester 28 40 weeks Risk of infection increased due to decreased immunity function Risk of respiratory distress increased due to inadequate surfactant Surfactant production does not occur until about 34 weeks Nutritional problems related to calorie consumption vs needs and digestive problems related to prematurity babies do not make their own lactase for digestion until they are about 34 weeks the gut mucosa is not mature enough to support feedings when born before 34 weeks a lot of what we see is related to size of baby Early Signs of Problems Neonates communicate with cues most cues mean help Temperature instability can be one of the earliest cues but has multiple meanings Typically subtle vague signs not a lot of info Throwing up feeds baby that wont eat doesn t arouse easy low temperature Neonatal period babies don t have the ability to develop a fever so they don t rise their temp they DROP their temp Cues splay fingers push hands out toward you mottled apnea leave me alone or I am sick Thermoregulation Maintaining the thermal environment in care 3 way balance of heat loss heat gain heat production stabilize them and give them just enough heat for their bodies Thermal instability related to poor outcome Ill neonates require temperature every 1 3 hours 3 NURS356 Exam 3 Study Guide Provide enough heat but not overheating them Hypothermic risks due to Large surface areas limited brown fat stores fat around organs limited glycogen stores drop blood sugars high water loss skin has not yet matured so they lose a lot of water through their skin Tend to spread out in bed Typically seen in Premature SGA hypoglycemic babies of diabetic moms skin defects cardiorespiratory or CNS abnormalities use of neuromuscular blocking agents such as mag sulfate on mom Smaller the baby the lower the ability for them to produce the heat Make sure to normalize temp Hyperthermic risks due to limited ability to dissipate heat Occasionally probe is detached from baby Iatrogenic overheating hyper metabolism r t sepsis show signs of infection Spontaneous hyperthermia result of withdrawal infection dehydration CNS injury maternal temp overdressed Moms that have temperature babies develop temp Culturally diverse babies have high temp d t overdressed Every 1 degree that babies temp is off 10 increased chance of death poor outcomes in neonatal care Thermal Stress Symptoms Problems resulting from hypothermia Apnea bradycardia lethargy hypoglycemia hypoxia metabolic acidosis poor weight gain respiratory distress Nor epinephrine released triggering peripheral vasoconstriction to decrease heat loss and nonshivering thermogenisis is stimulated leading to depletion of glycogen stores increased O2 consumption and lactic acid production Problems resulting from hyperthermia Apnea dehydration poor feeding lethargy irritability tachycardia tachypnea hypernatremia because of dehydration seizures