Developed by D. Ann Currie, RN, MSN High Risk Newborn Nursing Care Fetal/Neonatal Risk Factors for Resuscitation 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 Respiratory Distress Syndrome (RDS) Deficiency or absence of surfactant Atelectasis Hypoxemia, hypercarbia, academia May be due to prematurity or surfactant deficiency RDS: Nursing Care Maintain adequate respiratory status Maintain adequate nutritional status Maintain adequate hydration Education and support of family Transient Tachypnea of the Newborn (TTN) Failure to clear lung fluid, mucus, debris Exhibit signs of distress shortly after birth Symptoms Expiratory grunting and nasal flaring Subcostal retractions Slight cyanosis 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 Cold Stress Increase in oxygen requirements Increase in utilization of glucose Acids are released in the bloodstream Surfactant production decrease 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 Hypoglycemia Symptoms Lethargy or jitteriness Poor feeding and sucking Vomiting Hypothermia and pallor Hypotonia, tremors Seizure activity, high pitched cry, 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 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 Cont. to Study other conditions from the Text