High Risk Newborn
Chapter 22, 29, and 30
Assessment of Gestational Age: (ch. 22, p. 524-531)
1. What is gestational age?
2. What assessment tools are used in determining gestational age? What are the
neuromuscular and physical characteristics used in determining gestational age?
What is the difference in SGA, AGA, and LGA? What is the relationship between
gestational age and infant size?
Chapter 29
3. What is the relationship between the pretermaturity, SGA, and IUGR?
Premature Infant: (p. 716-736)
4. What are the characteristics of the preterm infant?
5. What are the physiologic challenges of the premature infant in regard to the
following systems and related treatment and nursing care
a. Respiratory and Cardiac
 Why does the preterm infant have difficulty with breathing?
 What are the signs of respiratory distress? What is the difference between
periodic breathing and apnea?
 What are the nursing interventions used to maintain respiratory function
in the preterm infant including:
o Respiratory equipment
o Positioning
o Suctioning secretions
b. Thermoregulation
 Why are preterm infants at a greater risk for heat loss? What are
complications of heat loss?
 What are the nursing interventions used to maintain a neutral thermal
environment?
c. Fluid and Electrolyte Balance
 What are signs of fluid imbalance – dehydration and overhydration - in the
preterm infant?
 How is intake and output measured?
 What are specific nursing interventions are used to maintain hydration?
d. Renal
 What are the consequences of an immature renal system?
e. Skin
 What nursing interventions are used to protect the skin?
f. Infection
 What are the nursing interventions used to prevent infection / sepsis?
 What are the signs and symptoms of infection / sepsis in the preterm
infant?
g. Pain
 What are signs of pain in infants?
 What are nursing interventions to alleviate pain in the preterm infant?
6. What are signs of overstimulation in the preterm infant? What are measures used
in reducing stimuli?
7. Why is maintenance of nutrition a problem with the preterm infant? What are
methods of feeding? What assessments are important prior to nipple feeding?
What are measures to assist the mother of the preterm infant with lactation and
breastfeeding?
8. What are specific nursing interventions to facilitate and promote parent-infant
attachment with the high risk/preterm neonate?
Common Complications of Preterm Infants:
Respiratory Distress Syndrome:
9. Discuss the pathophysiology involved with RDS.
10.What are the clinical manifestations of RDS?
11.What are treatment options and related nursing interventions including:
 Oxygenation, ventilation
 Surfactant replacement therapy
 Heat stabilization
Periventricular-intraventricular Hemorrhage (PIVH)
12. What is the cause of hemorrhage?
13. What are the clinical manifestations of PIVH?
14. What is the treatment options and related nursing interventions?
Retinopathy of Prematurity:
14. What is ROP?
15. What nursing interventions assist with preventing ROP?
Necrotizing Enterocolitis:
16. Explain the cause of NEC.
17. What assessment findings does the nurse monitor to assure early detection of
NEC?
18. What is the treatment and nursing care for the newborn with NEC?
Postterm Newborn:
19. Define the term "post term infant".
20. What are the physical manifestations of postmaturity?
21. What complications does this condition cause in the neonate?
Small-for-Gestational Age and Large-for-Gestational Age Infants:
22. Compare the SGA infant with the LGA infant.
Chapter 30
Asphyxia in the Newborn:
23. What are risk factors predisposing to asphyxia?
24. What are methods used in resuscitation?
25. What medication is used in resuscitation?
Meconium Aspiration Syndrome:
26. Explain the cause of meconium aspiration.
27. What precautions do healthcare providers take to prevent the occurrence of
Hyperbilirubinemia:
28. Discuss the Pathophysiology of hyperbilirubinemia.
29. Explain the cause of hemolytic disease.
a. What additional assessments are necessary for an infant at risk for RH
incompatibility?
b. What does a positive Coombs test indicate?
c. What are the nursing interventions used for an infant receiving phototherapy?
d. Why is an exchange transfusion performed?
e. What is the indication for, and action of Rh immune globulin (RhoGam or
Rhophylac)? (361-364)
f. Explain ABO incompatability.
g. What complications occur as a result of hemolytic disease?
Infectious diseases- TORCHA:
Toxoplasmosis
30. What is the cause of toxoplasmosis?
31. What are the possible results of the infections on the newborn?
Other:
32. What are the signs and symptoms of congenital syphilis?
33. What is the treatment for congenital syphilis?
34. How does an infant become infected with Hepatitis B?
35. What is the treatment of an infant whose mother tests positive for Hepatitis B?
Rubella:
36. 39.What are the anomalies associated with congenital rubella?
37. 40.At what point is a woman offered MMR immunization if she is rubella nonimmune?
Cytomegalovirus:
38. How does a neonate become infected with cytomegalovirus?
39. What are the effects of a cytomegalovirus infection on the newborn?
Herpes Simplex Type 2:
40. How is herpes simplex type 2 transmitted to a neonate?
41. What are the effects of a neonatal herpes infection on the newborn?
HIV- AIDS:
42. How is AIDS transmitted to an infant?
43. Explain the laboratory tests used in determining the severity of the disease
including:
 Viral load
 CD4 count
 ELISA
44. When is the infant tested?
45. Discuss the nursing interventions for an infant born to an HIV positive mother
including:
 Isolation
 Medications – protocol for administration
Infant of Diabetic Mother/ Hypoglycemia:
46. Infant of a Diabetic Mother:
a. What causes the excessive fetal growth?
b. What are the complications associated with the IDM?
c. Why are infants of diabetic mothers at risk for hypoglycemia?
d. What are the clinical manifestations and nursing interventions for an infant
with hypoglycemia?
Newborn of Substance Abuse Mother:
47. What are the clinical manifestations of an infant suffering from Fetal Alcohol
Syndrome?
48. What are the clinical manifestations by systems of an infant undergoing
Withdrawal?
49. What nursing interventions would the nurse initiate for the drug-dependent
newborn?
50. What are the risks and complications of the infant of a mother who smokes
including responses to nicotine and carbon monoxide.