Poor Apgar Score1st minute (9) | general condition (neuro/respi/circulatory) | 5th minute (10) | Determine if neonate can adjust to extrauterine life | 0-3 | poor: severely depressed, needs CPR | 4-6 | fair: guarded, moderately depressed | 7-10 | good: healthy |
Note: Pulse is the most important and Color is the least (acrocyanosis due to extrauterine adaptation) Respiratory Evaluations0 : Normal | 1-3 : Poor | 4-6 : Moderate | 7-10 : Severe Normal Respiratory AdaptationRR | 30-60 bpm (80 bpm in 1st min) | Breathing | Use of abdominal muscles & diaphragm. Newborns are nose breathers | Reflex | Coughing & sneezing to clear airway | Initiation of repirations: | Chemical | surfactant reduces surface tension | Thermal | sudden chilling of moist infant | Mechanical | compression of fetal chest at delivery |
Nursing InterventionsAssess | for Respiratory distress | Plan | To maintain a patent airway | Interventions | Position | Head lower | Suction | Bulb near the head, mouth first, avoid trauma to membranes | Evaluation | RR | 30-60 bpm with no signs of distress |
In order for the respiratory system to function the infant must have:
- adequate pulmonary blood flow
- adequate amount of surfactant
- strong respiratory musculature Sepsis (blood infection)Early onset | birth to 7 days after delivery | Late onset | 8-28 days after birth | Nosocomial | 1st week until discharge | Symptoms | • fever, breathing problems, lethargy | • poor feeding, bloated abdomen. vomiting (yellowish) | • Diarrhea, sleepiness, jaundiced, irregular HR | • low blood sugar and seizures | Treatment | • Sepsis is confirmed with culture test for 7-21 days | • Antibiotics to be given IV | • IV fluids to support the infant till infection clears | • Oxygen or ventilation to support breathing | Prevention | • Antibiotics to control dangerous bacteria | • Breastfeeding may help prevent sepsis | • Providing a clean place | • Delivery within 24 hrs after water breaks |
HyperbilirubinemiaPhysiologic Jaundice | • Increase in bilirubin by 2nd day of life, declines in 5th | • Onset and resolution delayed in premature (5-14days) | Pathologic Jaundice | • Persistent jaundice may indicate hepatitis, biliar atresia, down syndrome, hypothyroidism, breast milk inhibitors | • Total bilirubin increasing by >5mg/dl per day | Breastfeeding Jaundice | • appear on breastfed babies after 7 days of life | • peak during weeks 2-3 but may last for a month | Treatment | • Monitor how fast it has been rising | • Needs to be kept hydrated with breastmilk | • Feed baby often up to 12 times a day | • Phototherapy: blue light | • Blood transfusion, IV immunoglobulin |
| | Prematurity (before 37 wks)Physical Findings | <2500g (5lb 8 oz) | Sole creases, skull firmness, ear cartilage | mother's report of last menstrual period | sonographic estimation of gestational age | Risk factors | multiple gest., history of preterm, single teen mother | Physical assessment | AOG | less than 37 weeks | Respiratory | Irregular | Digestive | bowel sounds diminished | Thermoregulatory | hypothermia = hypoglycemia | Reflex | Poor suck, swallow, flexion | Nursing Care | Prevention | Prevention of acquiring infection | Promote oxygenation | maintain and monitor body temp, apical pulse, respiratory rate | Provision | tactile stimulation for apnea | | | safe and effective environment | Nutrition (readiness) | respiration is <60/m | rooting, sucking and gag reflex | Education of parents | Handle carefully when repositioning | Psychological support : sharing info, reinforce positives | Share caretaking responsibilities with parents |
Postmaturity (old man looking)Problems | Aspiration | Meconium, hypoxia | Polycythemia | Increase number of RBC | Seizure activity | severe hypoxia | Cold stress | loss of subcutaneous fat | Hypoglycemia | use of glucose stores, glycogen | Nursing Care | - may require prolonged monitoring | - support well being due to wasting effect | - Early detection of polycythemia & hyperbilirubinemia | - Focus on prevention : due date | - Attention to thermoregulation & feeding | Common complications | • 2-3 times higher morbidity than term infants | • Hypoglycemia | used depleted glycogen stores | • Aspiration | of meconium in response to hypoxia | • Polycythemia | Increase RBC response to hypoxia | • Seizure activity | from severe hypoxia | •Cold stress | start to lose weight in the utero |
Large for Gestational AgeAppearance | • Possible fracture of the clavicles | • Facial head bruising and palsy | • Caput succedaneum (normal: disappear 12 018 mons) | • Cephalhematoma | Complications | • Birth trauma due to cephalopelvic disproportion | • Increased ceasarian sections | • Hypoglycemia , hyperbilirunemia | • Polycythemia, hyperviscosity | • irregular HR, cyanosis | Nursing Care | - Monitor for hypoglycemia | - Screening for polycythemia (cbc, h&h) | - Careful assessment for injuries & address prenatal concerns about injuries like fractured clavicle | - Monitor temp, and minimize heat loss | - Initiate early feedings, touch and cuddling | - Support parents and teach |
Meconium Aspiration SyndromeSymptoms | • Bluish skin color of the infant | • Difficult breathing (none or rapid) | • Limpness in infant at birth | Treatment | • ET tube placement and suctioning | • Using a face mask with oxygen mixture | • Antibiotic to treat infection | • Radiant warmer to maintain body temp |
Respiratory Distress Syndrome (copy)Causes | Not enough of substance called surfactants that consists of phospholipids and protein. begins to be produced at 24-28 wks. by 35 wks most have develop adequate surfactant. | Symptoms | • Difficulty of breathing (tachypnea, grunting) | • Cyanosis (blue coloring) | • Flaring of the nostrils | • Chest retractions (pulling in ribs & sternum) | • symptoms peak at 3rd day, diuresis dec. need of O2 | Treatments | • Placing an ET tube, mechanical ventilation | • Supplemental oxygen | • Continuous positive airway pressure (CPAP) |
| | HypothermiaMethods of Heatloss | Evaporation | wet surface exposed to air | Conduction | Direct contact with cool objects | Convection | surrounding cool air. Drafts | Radiation | Transfer of heat to cooler objects | Manifestations | CC | cold skin on trunk & extremities. cyanosis | DD | decrease in temperature & activity | P | poor feeding in form of suckling | S | Shallow respirations | Nursing Care | Prevention | radiant warmer. careful not to burn | Provision | quick dry, head cap & dry warm blankets | Cold Stress | R | respiratory distress | I | increased oxygen need | D | decreased surfactant production | H | hypogylcemia (<30 mg/dl) | M | metabolic acidocis |
Small Gestation Age (<10%)Causes | - may be born preterm, term, post term | - may have experienced (IUGR) or failed to grow | - Placental anomaly, poor nutrition | - Smoking, cocaine, teratogen exposure | - Severe DM, decreased blood flow to placenta | Common complications | Perinatal asyphaxia | deficient oxygenation | Hypothermia | Inadequate surfactant | Hypoglycemia | Use of glycogen stores | Meconium aspiration | Hypoxia | RDS | Still birth | loss from death | Nursing Care | • Maintain airway and temperature | • Monitor for signs of respiratory distress | • Monitor glucose level, or signs of hypoglycemia | • Minimize heat loss to prevent hypothermia | • Provide feeding, touch, support, teaching | • Evaluate Hct level : hypoxia & polycythemia | • Monitor signs of sepsis, infection, malformations | • Fluids and frequent feedings |
Lab findings: low plasma levels and high levels of RBC makes blood thick and heart to pump harder. Increases the chance of thrombosis and prolonged cyanosis Low birth weightLBW | less than or equal to 2500g (5lbs 8 oz) | VLBW | less than or equal to 1500g (3lbs 5oz) | ELBW | less than or equal to 1000g (2lbs 3oz) | Prevention | • Early & regular prenatal care | • Seek medical check uo | • Quit smoking and other teratogenic factors | • Take multivitamin containing 400 micg of folic acid |
Failure to ThriveSymptoms | • height,weight, and head do not match growth charts | • Weight is lower than 3rd percentile (20% below ideal) | • growth may have slowed or stop | • Delayed or slow to develop physical, mental, social | Treatment | Nutritional | provide a well balanced diet | Supplements | talk to HCP first, correct deficiency |
ABO | Rh IncompatibilitySymptoms | • Back pain, blood in urine | • Chills, fever, jaundice, impending doom | Treatment | • Antihistamines to treat allergic reactions | • Steroids to treat swelling and allergies | • Fluids given intravenously | • Medicines to raise blood pressure if drops too low | • Rh immune globulins (Rhlg) for rh incompatibility | Exams and tests | • Coombs' test to llok for cell destroying antibodies | • Bilitubin test shows high. CBC: damage to RBC | • Urine test shows presence of hemoglobin |
SIDS (crib death)Factors causing SIDS | Brain Ab. | portion that controls sleep & breathing doesn't work properly | LBW | baby's brain has not matured completely | infection | contributes to breathing problems | Sleeping | on side, on soft surface, with parents | Prevention | • Sleeping on the back | • Keep the crib as bare as possible. use firm mattress | • Don't overheat baby. blanket should be lightweight. | Baby should sleep alone. baby can be rolled over by parents | • Breast feed for six months lowers risk of SIDS. |
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