ATI Maternal Newborn Nursing Chapter 27

What congenital physical defects/long-term complications are newborns with fetal alcohol syndrome at risk for?
Feeding problems, CNS dysfunction (mental retardation and cerebral palsy), behavioral difficulties such as hyperactivity, language abnormalities, future substance use, delated growth and development, and poor maternal-newborn bonding

Abstinence withdrawal CNS findings?
Increased wakefulness, high-pitched cry, irritability, tremors, increased Moro reflex, increased muscle tone, hyperactivity, increase deep tendon reflexes, and convulsions

Abstinence withdrawal respiratory findings?
Nasal congestion with flaring, frequent yawning, tachypnea > 60/min, sweating, and temp greater than 37.2 (99)

Abstinence withdrawal GI findings?
Poor feeding, regurgitation, diarrhea, and excessive and uncoordinated sucking

Opiate withdrawal
Lasts 2-3 weeks, rapid changes in mood, hypersensitivity to noise and external stimuli, dehydration, and poor weight gain

Heroin withdrawal
Low birth weight (SGA), decreased Moro reflex, hypothermia or hyperthermia

Methadone withdrawal
Increased incidence of seizures, sleep pattern disturbances, high birth weight, and high risk of SIDS (not contraindicated during breast feeding)

Marijuana withdrawal
Preterm birth and meconium staining

Amphetamine withdrawal
Preterm or SGA, drowsy, jitteriness, sleep pattern disturbances, respiratory distress, frequent infections, poor weight gain, emotional disturbances, and delayed growth

Fetal alcohol syndrome findings?
Eyes have folds, strabismus (lazy eye), ptosis (drooping of eyelid), mouth with poor suck, small teeth, cleft lip, deafness, abnormal palmar crease, irregular hair, heart defect, neuro abnormalities, pre and postnatal growth retardation, and sleep disturbances

Tobacco effects on newborn
Premature, low birth weight, increased risk for SIDS, increased risk for bronchitis, pneumonia, and developmental delays

Why is phenobarbital (Solfoton) given?
To decrease CNS irritability and control seizures for newborns who have alcohol or opioid addiction

Hypoglycemia
Blood glucose less than 40 mg/dL (two consecutive levels)

Preterm hypoglycemia?
Blood glucose less than 25 mg/dL (two consecutive levels)

Risk factors of neonatal hypoglycemia?
Maternal diabetes, preterm infant, LGA or SGA, stress at birth, and maternal epidural anesthesia

Findings of hypoglycemia?
Poor feeding, jittery, hypothermia, diaphoresis, weak/shrill cry, lethargy, flaccid muscle tone, seizures/coma, irregular respirations, cyanosis, and apnea

Respiratory distress syndrome
Result of surfactant deficiency in the lungs and is characterized by poor gas exchange and ventilator failure.
Surfactant (phospholipid that assists in alveoli expansion) It helps alveoli from collapsing and allows gas exchange to occur.

Risks of respiratory distress syndrome?
Preterm, perinatal asphyxia, maternal diabetes, maternal use of barbiturates or narcotics, maternal hypotension, hydrous fetalis (massive edema of the fetus caused by hyperbilirubinemia), and maternal bleeding during 3rd trimester

Objective findings of respiratory distress syndrome?
RR > 60/min, nasal flaring, retractions, labored breathing, crackles in lungs, cyanosis, expiratory grunting, and unresponsiveness, apnea with decreased breath sounds, flaccidity (worsening RDS)

Respiratory distress syndrome care?
Administer sodium bicarb to treat metabolic acidosis, mouth/skin care, suction, thermoregulation, treat respiratory acidosis with ventilatory support, decrease stimuli, Beractant (Survanta) is a surfactant

Nursing care when administering Beractant (Survanta)?
-Perform respiratory assessment
-provide suction to the newborn prior to administration
-assess endotracheal tube placement
-avoid suctioning of the endotracheal tube for 1 hour after administraction

Preterm birth?
After 20 weeks and before 37 weeks (cervix dilates to 4 cm)

Bronchopulmonary dysplasia?
Lungs become stuff and noncompliant, requiring a newborn to receive mechanical ventilation and 02

Retinopathy of prematurity?
Diseased caused by abnormal growth of retinal blood vessels and is a complication associated with 02 administration to the neonate

Necrotizing entereocolitis?
Inflammatory disease of the GI mucosa due to ischemia resulting in necrosis and perforation of the bowel

Risk factors for premature birth?
Maternal hypertension, adolescent pregnancy, multiple, closely spaced pregnancies, substance use, abnormalities of uterus, placenta previa

Assessment for premature birth?
Ballard assessment (physical and neurological) less than 37 weeks of gestation, 5-10 second reparatory pauses followed by compensatory breathing, low birth weight, minimal fat deposits, skull/rib cage is soft, dehydration, evidence of infection

Dehydration signs
Output less than 1 mL/kg/hr, specific gravity more than 1.015, weight loss, dry mucous membranes, absent skin turgor, depressed fontanel

Over-hydration signs
Output greater than 3 mL/kg/hr, specific gravity less than 1.001, edema, increased weight gain, crackles, intake greater than output

What is the best body position to promote heat regulation?
Prone and side-lying

Why is Betamethasone (Celestone) given?
Administered for a 24 hr period prior to delivery to promote fetal lung development and increase surfactant in an attempt to prevent respiratory distress syndrome

SGA?
Birth weight is at or below the 10th percentile and who has intrauterine growth restriction

SGA risk factors?
Chromosomal abnormalities, maternal infections/disease/malnutrition, smoking, drugs, alcohol use, multiple gestations

SGA findings
Sparse hair, dry/loose skin, decreased fat, decreased muscle, thin, dry, yellow umbilical cord, meconium aspiration, hypoglycemia

LGA?
Above 90th percentile for weight or more than 8 lbs 12 oz.

McRoberts position?
Legs flexed to chest to maximize pelvic outlet

What is given for neonatal infection?
Ampicillin and gentamicin sulfate

Physiologic jaundice?
No manifestations and shows evidence of jaundice after 24 hours of age

Pathologic jaundice?
Result of underlying disease, appear before 24 hours of age or is persistent after day 7. Levels increase more than 0.5 mg/dL/hr, peaks at greater than 13 mg/dL.

What can result from untreated bilirubinemia?
Kernicterus (bilirubin encephalopathy)

Signs of kernicterus?
Yellow/orange skin, lethargy, hypotonic, poor suck reflex, increased sleepiness, high pitched cry, backward arching of neck and trunk, and fever.

What does direct Coombs’ test reveal?
Presence of antibody-coated (sensitized) Rh-positive RBCs in the newborn

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