NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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RISK FACTORS THAT COULD LEAD ILLNESSES TO A
NEWBORN
Age- younger or older than ave. Maternal age
Concurrent disease- diabetes = infants is often larger than others, as a result this will
make delivery harder and increase the risk of nerve injuries or other trauma. Cesarean most
likely to happen.
Pregnancy complication Placenta previa ( the placenta partially or totally covers the mother's cervix= severe
bleeding during pregnancy or delivery)
 Olygohydramnous- below 300 ml of amniotic fluid= renal agenesis
 Polyhydramnous - excessive accumulation of amniotic fluid= esophageal atrasia
(The esophagus of the baby does not developed properly)
 Long funis- cord colapse, can coil around the neck (nuchak cord)
 Vasa previa- some blood vessels that connects the umbilical cord to the placenta lie
over near the entrance to the birth canal, when the membranes around the blood
vessles rupture the blood vessel also ruptures cause the baby to lose a lot of blood.
 Small placenta= IUGR, utero placental insuf.
 Placental infarcts= thrombosis
Lifestyle- drug abuse
Dysmature- a newborns whose birthweight is innapropriately low for gestational age
 Whether preterm, term, posterm they are at risk for complications at birth or in the
first few days of life.
NURSING PROCESS FOR INFANTS
Assessment
 Assess for obvious congenital anomaly
 Gestational age (the no. Of weeks the baby remained in the uterus)
 For assessing infants who is at high risk needs there is used of some equipment- cardiac,
oxygen, apnea saturation, blood pressure monitoring.
Nursing Diagnosis
 Ineffective airway clearance related to presence of mucus or amniotic fluid in the
airway
 Ineffective tissue oxygenation related to difficulty in breathing
 Ineffective thermoregulation related to immature status
Note: insulator doesn't allow heat to pass
conductor allow heat to pass
 Risk for deficient fluid volume related to insensible water loss
Note; Insensible fluid loss is the amount of fluid loss dai;y that is not easily
measured (from respiratory system, skin, water in the excreted stool
 Risk for imbalanced Nutrition, less that body requirements related to lack of strength in
effective sucking
 Risk for infection related to lowered immune response due to prematurity
 Risk for impaired parenting related to illness in newborn at birth
 Deficient diversional activity (lack of stimulation) related to illness at birth.
NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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Readiness for developmental care to decrease overstimulation easily caused by
necessary lifesaving procedures.
Outcome Identification and Planning.
 A goal that implies total recovery from an ilness
 Individualized care consider newborn's developmental level, physiologic strength,
weakness and needs.
Implementation
 Focus on conserving the baby's energy and provide thermoneutral environment to
prevent exhaustion and hypothermia.
 The caregiver must be consistent in caring.
Outcome evaluation
Infants maintains patent airway
Infants demonstrate an ability to suck effectively
Infant tolerates procedures without experiencing apnea, bradychardia, and oxygen
desaturation.
 Infants demonstrate growth and development appropriately for gestational age, birth
weight, and condition
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NEWBORNS PRIOTIES IN THE FIRST DAYS OF LIFE
1. Initiating and maintaining respiration.
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Infant who has difficulty in accomplishing effective breathing = residual neurologic
morbidities = cerebral hypoxia
Respiratory acidosis- when the lungs can't removed all the carbon dioxide the body
produces= body fluids, blood becomes too acidic = hypoventilation
 Respiratory Alkalosis- decreased in carbon dioxide = hyperventilation. This
can be acute or chronic.
Establishing respiration must be started immediately after birth to prevent severe
acidosis.
Asphyxia- lack of oxygen or blood flow in the brain
Asphyxia (does not received oxygen when born) in the utero could from cord
compression, maternal anesthesia, placenta previa ,premature separation of
placenta = respiratory acidosis at birth may have difficulty in the first 2 min of life.
Struggling to breath and ciculate blood the infant is forced to used serum glucosed
quickly so may become hypoglycemic.
Resuscutation is important to infants who fail to take the first breath and for those
who have difficulty in maintaning adequate respirations.
Factors predisposing infants to respiratory Difficulty in first days of life
 Low birth weight
 Maternal History of diabetes
 Cord prolapse ( unborn baby's umbilical cord slips through the cervix and
into the vagina after a mother's water breaks )
 Lowered apgar score (<7) at 1 or 5 min.
 Breech birth
 Chest, heart or respiratory anomalies
NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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RESUSCITATION
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Establish airway
Expand lungs
Initiate and maintain effective ventilation
Chest compression - id respiratory depression becomes severe that newborn's
heart begin to fail.
Airway
 Warming
 Drying and stimulating the baby (rubbing the back = these two is enough to
initiate breathing for a term baby
o If newborn does not initiate spontaneous breathing after gentle stimulation:
 Placed infant under radiant heat warmer in sniffing position and rub the
back
 Assess precordial pulse (heart), pulse oximetry (oxygen saturation)
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If newborn is not breathing or the heart rate is less that 100 beats/min:
 Positive pressure ventilation (respiratory therapy involves delivery of air
or mixture of oxygen combined with other gases) = respiration,
strong heart beat,color, muscle tone and reflexes will improve.
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If there is obstruction in the newborn's airway:
 Mechanical Suctioning
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Still no effort at spontaneous respirations after initial steps:
 Endotracheal tube
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PRIMARY APNEA
Infant will respond to stimulation by re-initation breathing
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SECONDARY APNEA
Asphyxia continues, regular gasping, respiratory efforts slowly decrease and
then cease.
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Used of LARYNGOSCOPE and ENDOTRACHEAL TUBE
Lung Expansion
o Well newborns expand their lungs independently with a first breath
o The sound of the baby crying is a sign that there is good lung expansion
because vocal sound are produced by free flow of air over the vocal cords
o Use of bag and mask if infants needs air or oxygen
o Air (or oxygen if needed ) = administered at rate of 40 -60 ventilations/min.
o Oxygen must be warmed (89.6 f- 93.2f or 32 -34 C)
o Oxygen must be humidified (60 - 80%)
o Pressure needed to open lung alveoli for the first time = 40 cm H20 ------->
15- 20 cm H20 (adequate to continue inflating the alveoli.
o Be certain to listen to both lungs to verify that both lungs are being aerated.
o Make sure the correct placement of the endotracheal tube in the trachea not
in the esophagus
NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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Drug Therapy
o Naloxone
o Epinephrine (IV) 1:10,000 action: stimulate the heart action
o Surfactant- preterm infants might received surfactant to replace the natural
surfactant that has not yet formed in their lungs
Ventilation Maintenance
o Placed infant in radiant warmer (removed clothes except the diaphers) in
supine position (15 degrees) because it allows the abdominal contents to
fall away from the diaphram.
2. Establishing extrauterine circulation
 Lack of cardiac function may developed if respiratory function can not be quickly
initiated.
 Audible heartbeat and heartbeat below 60 chest compression should be started
(at the lower third of the sternum, 1-2 cm depth, 100 times/min)
 Heart rate of greater that 60 but less than 100 beats/min no need for
compression but continue the ventilation process to facilitate breathing
 Pulse oximetry evaluate the cardiac efficiency of the newborn (pulse rate) and
respiration function (oxygen saturation)
 Administer epinephrine to stimulate heart action) if the newborn's heart rate is
not greater than 60 beats min. After atleast 30 sec. Of performing positive
pressure ventilation.
3. Maintaining Fluid and Electrolyte balance
 After initial resuscitation = will result in hypoglycemia because of the effort of
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newborn expended to begin breathing.
Dehydration = increased insensible water loss cause by rapid respirations.
Infant with hypoglycemia- treatment: 10 % dextrose in water to restore blood
glucose level.
Fluid such as: dillute mixute of dextrose and saline in water (used to maintain
glucose, fluid levels and electrolytes)
o Soduim, additional glucose, potasium may be added
Monitor rate of fluid administration conscientioisly in high risk newborm: fluid
overload might happen = patent ductus arteriousus or heart failure.
How to monitor fluid status? Measure the:
o Urine output- Normal level- 1.5-2 ml/kg /hr
o Urine specific gravity- Normal level= 1.005- 1.030
 Meaning: it is the concetration of all chemicals i the urine.
 *pag masyadong mataas ang USG (>1.030) ibig sabihin
dehaydrated yung patient or it suggest inaadequate fluid
intake.
Hypovolemia
o Low levels of blood or fluids in the body.
o present immediately after birth
o Cause is fetal blood loss from condition placenta previa or twin to twin
tranfusion
o Signs and symptoms
NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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Tachypnea
Pallor
Tachycardia
Decreased arterial blood pressure
Decreased central venous pressure
Decreased tissue perfusion of peripheral tissue
Metabolic acidosis
Normal hematocrit
o ISOTONIC SOLUTION (normal saline)- use to increase blood
volume.
o Vasopressor (ex. Dopamine) - used to increased blood pressure
and improve cell perfusion.
4. Regulating Temperature
 Important to keep newborn in a neutral- temperature environment = to maintain
a minimal metabolic rate essential to effective body functioning.
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Too HOT environment
= Forced to decreased metabolism to their body.
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Too COLD environment
= they must increase their metabolism to warm body cells
= INCREASED IN METABOLISM = it calls for increased oxygen.
= without oxygen because of respiratory difficulty = body cells become HYPOXIC.
HYPOXIC BODY CELLS
= When the infants body become hypoxic - vasocontriction of peripheral blood
vessles so blood can be pushed into the central torso.
If this process continues for a long time = pulmonary vessles constrict and
pulmonary perfusion decreases
= Infant's PO2 Level will fall and PCO2 level will increase.
Note: lowered PO2 level causes fetal shunts such as Ductus arteriosus to
remain open
= Surfactant production can halt as well
= The infant's body will undergo ANAEROBIC GLYCOLYSIS when the environment is
too cold = increased metabolism = this process pours acid into the bloodstream
= Infant's will be more acidic = risk of acute bilirubin encephalophaty or
kernicterus .
= Kernicterus : accumulation of unconjugated bilirubin into the brain cells.
In short, COLD ENVIRONMENT will result in compromasing:
= heart action
= breathing
= electrolyte balnce
= brain function (possibly)
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Intervention to regulate temp.
o Covering cap
o Wiping the body and head with dried towel
NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
o Using Radiant warmer or prewarmed incubator
o Skin to skin contact.
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Normal Infant Temp. = 36. 5 degree C - 37. 5 degree C ( 97.8 - 99.5 degree F)
NOTE!
over weight people sweat more profusely than normal-weight individuals because fat
acts as an insulator that raises core temperature. Sweating is a natural process to
maintain your body temperature, due to the excess layer of fat, your body temperature is
higher than that of a thin individual. Hence, to maintain the temperature, your body
produce more sweat.
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RADIANT HEAT WARMER
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Open beds that have an attached overhead source of radiant heat.
There's a probe that register the baby's temperature.
The probe is place in the abdomen bet. Infant umbilicus and xyphoid process.
Note: do not place on the underside, not over the liver , not overt the rib
cage = false readings
INCUBATORS
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Provide warmth and visual observation of the baby.
The temp. Of the incubators varies with the amount of time the partholes remain
open.
The acrylic shield inside the incubator helps to prevent radiation or convection
heat loss
NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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Has probe also.
Portholes must remain closed to keep the servo control operating efficiently.
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If infants become medically stabile and old enough to maintain steady
body temp.
o Infant can be weaned from the incubator
o Dress the infant
o Then set the incubator about 1.2 degree C (2 degree F) below the infant
temperature.
o After half an hour infant still able to maintain steady temp. Lower again the
incubator temp. Another 1.2 degree C (2 degree F) continue until the room
temp is reach.
Skin to skin contact
 Kangaroo care
 To maintain body heat
5. Establishing adequate Nutritional Intake.
 Infants who experienced ASPHYXIA at birth received INTRAVENOUS FLUID
o To prevent exhaustion due to sucking
o To prevent NECROTIZING ENTEROCOLITS (temporary reduction of
oxygen to the bowel)
 Gavage Feeding (nose to stomach- nasogastirc):
o This is introduce to infant's who's respiratory rate remains so rapid and
result in ineffective sucking.
o Can be use to deliver breast milk from the mother to her baby.
 Gastrostomy: use for long term nutrition.
 Benefits of Breast milk:
o Immune Protection
 Use of Pacifier - helps to developed sucking reflex.
 Infants who can't use pacifier because they must no swallow air, such as those
with TRACHEOESOPHAGEAL FISTULA awaiting surgery
 Gastronomy and gavage feeding needs oral stimulation
6. Establishing waste elimination
 Immature infant void later than term infants because of the result in all
procedures for resuscitation
 Document any voidings that occur during resuscitation because this is a proof that
hypotension is improving and kidneys are being perfused.
 Immature infants may pass stool later than the term infant because the
meconium does not yet reached the end of the intestine at birth.
7. Preventing Infections
 Contracting an infection = drastically complicate high risk newborn's ability to
adjust in extrauterine life
increasing metabolic oxygen demand
= stressing immature immune system = lowering defense
mechanism protection
CYTOMEGALOVIRUS - common virus that affects infants during intrauterine life.
 Infection =
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NCM 109- Care of the Mother, Child at
Risk or with Problems (Acute or Chronic)
NCM 109- Care of the Mother, Child at
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- CMV can cause mononucleosis or hepatitis (liver problem)
- Babies born with CMV can have brain, liver, spleen, lung, and
growth problems.
TOXOPLASMOSIS VIRUS - common virus that affects infants during intrauterine
life.
- Most babies born with toxoplasmosis have no symptoms.
Symptoms can include eye infections, swollen glands, liver or
spleen, or jaundice.
Staphylococcus Aureus, Enterobacteria, Candiad - hospital acquired infections
PREVENTIONS:
 Hand washing technique and standard precautions
8. Establishing Parent infant Bonding
 Informed the parents about what is happening during resuscitation at birth
 Urge the parents to spend as much as time with infants
 Be certain parent have continuing access to healthcare personnel after
discharge.