HighRiskNewborn课件

High Risk Newborn,Mary L.Dunlap MSN,APRN,Preterm Infant,Infant born prior to the completion of the 37,th,week,Organs immature,Lack physical reserves,Survivability related to weight/gestational age,Preterm Infant,Respiratory last to mature,Surfactant deficiency-RDS,Unstable chest wall-atelectasis,Immature respiratory centers-apnea,Small passages-obstructions,Unable to clear fluid-TTN,Preterm Infant,Cardiovascular,Difficulty transitioning from fetal to neonatal circulatory pattern,Congenital anomalies due to continued fetal circulation,Fragile blood vessels(brain),Impaired regulation of B/P,Preterm Infant,Gastrointestinal,Lack neuromuscular coordination suck-swallow-breath,Hypoxia shunts blood from the gut-ischemia and intestinal wall damage,Risk for malnutrition-wt.loss,Small stomach-compromised metabolic function,Preterm Infant,Renal System,Slow glomerular filtration rate,Reduced ability to concentrate urine,Risk:fluid retention,electrolyte imbalance,drug toxicity,Preterm Infant,Immune system,Deficiency of IgG,Impaired ability to produce antibodies,Thin skin-limited protection barrier,Preterm Infant,Central nervous system,Long term disability due to injury,Difficulty maintaining temperature,Compounded by lack of brown fat,Preterm Infant Nursing Management,Varies with gestational Promote Oxygenation,Maintain body temperature,nutritional needs,Prevent infections,Provide stimulation,Pain management,Small for Gestational Age,SGA weight-less than 5lb 8 oz and below the 10,th,%at term,IUGR-High risk growth does not meet the norm and is pathologic,Symmetric IUGR-poor growth rate of head,abdomen and long bone,Asymmetry IUGR-head long bones spared,Small for Gestational Age Characteristics,Decreased breast tissue,Scaphoid abdomen(sunken),Wide sutures,Thin umbilical cord,Head larger than body,Wasted appearance to extremities,Reduced fat stores,Small for Gestational AgeCommon Problems,Perinatal asphyxia,Hypothermia,Hypoglycemia,Polycythemia,Meconium Aspiration,Large for Gestational Age Characteristics,LGA weight-Larger than 9 lbs and above the 90,th,%,Large body-plump full face,Body size is proportionate,Poor motor skills,Difficulty in regulating behavioral state(arouse to quiet alert state),Large for Gestational AgeCommon Problems,Birth Trauma-,Hypoglycemia,Polcythemia,Hyperbilirubinemia,Post term Infant,Gestation 42 weeks,Must determine if EDC is truly post term,After 42 weeks placenta loses ability to nourish the fetus,Post term Infant Characteristics,Newborn emaciated,Meconium stained,Hair and nails long,Dry peeling skin,Creases cover soles,Limited vernix and lanugo,Infant of Diabetic Mother,Mother can have pregestational or gestational diabetes,Increasing numbers of type 2,Related to increase in morbidity&mortality,Congenital abnormalities,Infant of Diabetic Mother,Congenital abnormalities-during first trimester due to fluctuations in BS and ketoacidosis,Macrosomia-develops last trimester due to maternal hyperglycemia-excessive fetal growth,Tight control over glucose levels needed(less than 1-0mg/dl),Infant of Diabetic MotherCommon Problems,Congenital Abnormalities,Macrosomia,Birth Trauma,Perinatal Asphyxia,RDS,Hypoglycemia,Hyperbilirubinemia,Polycythemia,Infant of Diabetic Mother,Infant Characteristics,Rosy cheeks,Short neck,Wide shoulders,Excessive subcutaneous fat,Distended abdomen,Infant of Diabetic MotherNursing Management,Monitor glucose level q.3 to 4 hrs.level no above 40 mg/dl,Until stable monitor q.3-4 hrs,Feed q.2-3 hrs,IV glucose,Monitor serum bilirubin levels,Maintain thermal environment,Respiratory Distress Syndrome,RDS caused by lack of surfactant,Poor gas exchange&ventilation,Seen in preterm newborns,Cesarean births without labor,Infants of diabetic mothers,Respiratory Distress SyndromeSymptoms,Tachypnea,Expiratory grunting,Nasal flaring,Retractions,See-saw respiration,Chest x-ray-alveolar atelectasis(ground glass pattern)&dilated bronchioles(dark streaks within granular pattern),Respiratory Distress SyndromeNursing Management,Thermoregulation,O2 administration,Mechanical ventilation if needed,Hold parenteral feedings,Monitor VS&O2 sats,Provide nutrition(gavage feedings),Transient TachypneaNewborn TTN,Mild respiratory condition,Result of delayed absorption of fluid,Last about 3 days,Transient TachypneaNewborn TTN,Symptoms,Respiratory rate as high as 100-140,Labored breathing,Grunting nasal flaring,Retractions,Chest x-ray shows lymphatic engorgement(retained lung fluid),Transient Tachypnea Newborn Nursing Care,Mainly supportive,Monitory VS&O2 Sats,Provide supplemental O2,Meconium Aspiration,Fetus inhales meconium into the lungs while in utero,Meconium blocks the airway preventing exhalation,Meconium irritates the airway making breathing difficult,Meconium aspiration related to fetal distress during labor.,Meconium Aspiration Symptoms,Cyanosis,Rapid breathing,Labored breathing,Apnea,X-ray patches or streaks of meconium&trapped air,Meconium Aspiration Nursing Management,Assess for risk factors prior t