high risk newborn2
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HIGH RISK NEWBORNCATHERINE V. STA. MONICA, RN
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Preterm Newborn Description
Primary concern is immaturity of allbody systems
Assessment Respirations irregular, with periods of
apnea Body temperature below normal
Poor suck and swallow reflexes
Diminished bowel sounds
Thin extremities, with minimalcreasing on soles and palms
No maintenance of flexion inextremities
Lanugo present
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Preterm Newborn (continued)
Assessment
Thin skin, with visible blood vessels and minimal subcutaneous fatpads; skin may appear jaundiced
Undescended testes in boys, narrow labia in girls
Interventions
Monitor vital signs every 2 to 4 hours
Maintain cardiopulmonary function; administer oxygen as prescribed Monitor intake, output, electrolyte balance, daily weight
Maintain neutral thermal environment
Handle newborn carefully, changing position every 1 to 2 hours
Avoid exposure to infections
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Post-term Newborn Description
Neonate born after 42 weeks gestation
Assessment
Hypoglycemia; parchment-like skin without lanugo; long
fingernails, extended over fingers; profuse scalp hair;long, thin body; wasting of fat and muscle in extremities;meconium staining on nails and umbilical cord
Interventions
Provide normal newborn care Monitor for meconium aspiration
Monitor for hypoglycemia
Maintain newborns temperature
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Small for Gestational Age Description
Neonate plotted at or below tenthpercentile on intrauterine growthcurve
Assessment Fetal distress; irregular temperature;
hypoglycemia; signs ofpolycythemia, including ruddyappearance, cyanosis, jaundice;signs of infection; signs of aspirationof meconium; physical abnormalities
Interventions Monitor for signs of respiratorydistress
Initiate early feedings, monitor forsigns of aspiration
Provide stimulation
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Large for Gestational Age Description
Neonate plotted at or above the ninetiethpercentile on intrauterine growth curve
Assessment
Birth trauma or injury, respiratorydistress, hypoglycemia
Interventions
Monitor for signs of hypoglycemia
Initiate early feedings
Monitor for infection; initiate measures toprevent sepsis
Provide stimulation, such as touch andcuddling
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Respiratory Distress Syndrome(RDS)
Description Serious lung disorder caused by immaturity and inability
to produce surfactant, resulting in hypoxia and acidosis
Assessment
Tachypnea Flaring nares Expiratory grunting Retractions
Decreased breath sounds Apnea Pallor and cyanosis Hypothermia Poor muscle tone
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Respiratory Distress Syndrome (RDS)(continued)
Interventions Monitor color, respiratory rate, degree of effort in
breathing, arterial blood gases, oxygen saturation Support respirations as prescribed; suction every 2 hours
and PRN
Position newborn on side or back, with neck slightlyextended
Administer surfactant replacement therapy intoendotracheal tube
Administer respiratory therapy as prescribed
Provide nutrition as prescribed Encourage mother to pump breasts for future nutrition Encourage bonding of parents and newborn
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Meconium Aspiration Syndrome Description
Aspiration can occur in uteroor with first breath
Assessment
Signs of respiratory distress
Yellow-stained nails, skin,umbilical cord
Interventions
Suctioning immediately afterhead is delivered
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Sepsis
Description
Generalized infection resulting from presence ofbacteria in blood
Assessment Pallor
Tachypnea
Tachycardia
Poor feeding
Abdominal distention
Temperature instability
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Sepsis (continued)
Interventions
Assess for periods of apnea or irregularrespirations
Administer oxygen as prescribed Monitor vital signs
Maintain neutral thermal environment
Monitor intake and output, daily weights
Monitor for diarrhea
Assess feeding and suck reflex
Assess for jaundice
Administer antibiotics as prescribed
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Hyperbilirubinemia
Description
At any serum bilirubin level, appearance ofjaundice during first day of life indicatespathological process
Assessment
Jaundice; elevated serum bilirubin levels;hepatomegaly; poor muscle tone; lethargy; poorsuck reflex
Interventions
Monitor for presence of jaundice
Maintain well-hydrated status
Administer early, frequent feedings as prescribed
Report any signs of jaundice in first 24 hours tophysician
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Hyperbilirubinemia (continued) Phototherapy
Expose as much of newborns skin as
possible, except for shielding eyesand genital area
Remove shields, patches at leastonce per shift and assess eyes forinfection or irritation
Monitor skin temperature frequently
Increase fluid intake as prescribed
Educate parents that stools and urine
may be green Reposition newborn every 2 hours
Provide stimulation to newborn
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SIDS Sudden Infant Death Syndrome
Known as CRIB death Causes: Hypoxemia theory and Apnea
theoryAssessment:
Autopsy: mottled complexion and extremelycyanotic lips and fingertipsDiagnostic: (autopsy) petechiae over the
visceral surfaces of the pleura,edematous pulmonary artery , congestedlungs fully expanded , stomach curdinside the stomach
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SIDS Nursing mgt.: provide emotional support
Other measures to prevent SIDS : infant on his back when sleeping No smoking anywhere near the infant Remove pillows, stuffed toys in crib
Use a firm mattress with a snug-fitting sheet Make sure the infants head remains uncovered