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% Document Info
\author{vcroosevelt (vcroosevelt)}
\pdfinfo{
  /Title (nursing-care-at-risk-high-risk-sick-newborn.pdf)
  /Creator (Cheatography)
  /Author (vcroosevelt (vcroosevelt))
  /Subject (Nursing Care: At Risk/High Risk/Sick Newborn Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Nursing Care: At Risk/High Risk/Sick Newborn Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{vcroosevelt (vcroosevelt)} via \textcolor{DarkBackground}{\uline{cheatography.com/182722/cs/38029/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}vcroosevelt (vcroosevelt) \\
  \uline{cheatography.com/vcroosevelt} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 5th April, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ACUTE DISEASES OF THE NEWBORN}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- high-risk neonate regardless of Gestational Age \newline % Row Count 1 (+ 1)
- begins {\bf{23wks - 28 days post birth}}% Row Count 2 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CLASSIFICATIONS OF HIGH RISK NB}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{According to Size}}}} \newline % Row Count 1 (+ 1)
~ ~ - Low Birth Weight {\bf{LBW}} (\textless{}2.5kg) \newline % Row Count 2 (+ 1)
~ ~ - Very Low Birth Weight {\bf{VLBW}} (\textless{}1.5kg) \newline % Row Count 4 (+ 2)
~ ~ - Extremely Low Birth Weight {\bf{ELBW}} (\textless{}1kg) \newline % Row Count 6 (+ 2)
~ ~ - Appropriate for Gestational Age {\bf{AGA}} (10\%-90\%) \newline % Row Count 8 (+ 2)
~ ~ - Small for Gestational Age {\bf{SGA}} (\textless{}10\%) \newline % Row Count 10 (+ 2)
~ ~ - Large for Gestational Age {\bf{LGA}} (\textgreater{}90\%) \newline % Row Count 12 (+ 2)
~ ~ - Intrauterine Growth Restriction {\bf{IUGR}}  \newline % Row Count 14 (+ 2)
~ ~ \textgreater{}{\emph{Risk Factors:}}  \newline % Row Count 15 (+ 1)
~ ~ ~ ~- Hereditary \newline % Row Count 16 (+ 1)
~ ~ ~ ~- Placental Insufficiency \newline % Row Count 18 (+ 2)
~ ~ ~ ~- Maternal Disease \newline % Row Count 19 (+ 1)
{\bf{{\emph{According to Gestational Age}}}} ({\emph{regardless of BW}}) \newline % Row Count 21 (+ 2)
~ ~ - Late Preterm ({\bf{34-36wks AOG}}) \newline % Row Count 22 (+ 1)
~ ~ - Preterm ({\bf{\textless{}37wks AOG}}) \newline % Row Count 23 (+ 1)
~ ~ - Full term ({\bf{38-42wks AOG}}) \newline % Row Count 24 (+ 1)
~ ~ - Post term ({\bf{\textgreater{}42wks AOG}}) \newline % Row Count 25 (+ 1)
{\bf{{\emph{According to Mortality}}}} \newline % Row Count 26 (+ 1)
~ ~ - Live Birth \newline % Row Count 27 (+ 1)
~ ~- Fetal Death  \newline % Row Count 28 (+ 1)
~ ~ ~ ~ = death before 20wks \newline % Row Count 29 (+ 1)
~ ~- Neonatal Death \newline % Row Count 30 (+ 1)
} \tn 
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\vfill
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{CLASSIFICATIONS OF HIGH RISK NB (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ ~ ~ = death within first 27wks of extrauterine life \newline % Row Count 2 (+ 2)
~ ~- Perinatal Mortality \newline % Row Count 3 (+ 1)
~ ~ ~ ~ = total \# of fetal \& neonatal death/1000 live births \newline % Row Count 5 (+ 2)
~ ~- Postnatal Death \newline % Row Count 6 (+ 1)
~ ~~ ~ = death 28 days - 1y/o% Row Count 7 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Intrauterine Growth Curve}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/vcroosevelt_1680257754_IU growth chart.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ASSESSMENT OF HIGH-RISK NB}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{1. Physical Assessment}} \newline % Row Count 1 (+ 1)
~ - General Assessment \newline % Row Count 2 (+ 1)
~ ~ ~ \textgreater{} BW \newline % Row Count 3 (+ 1)
~ ~ ~ \textgreater{} Anthropometric Measurements \newline % Row Count 5 (+ 2)
~ ~ ~ \textgreater{} Deformities \newline % Row Count 6 (+ 1)
~ ~ ~ \textgreater{} Signs of distress (poor color, mottling, hypotonia) \newline % Row Count 8 (+ 2)
{\bf{2. Respiratory Assessment}} \newline % Row Count 9 (+ 1)
~ - Chest Shape (barrel/concave) \newline % Row Count 10 (+ 1)
~ - Describe use of accessory muscles  \newline % Row Count 11 (+ 1)
~  - Determine RR; O2 Sat \newline % Row Count 12 (+ 1)
~ -  Auscultation \newline % Row Count 13 (+ 1)
{\bf{3. Cardiovascular Assessment}} \newline % Row Count 14 (+ 1)
~ - HR and rhythm \newline % Row Count 15 (+ 1)
~ - Auscultation \newline % Row Count 16 (+ 1)
~ - Determine Point of Maximal Impulse (PMI) \newline % Row Count 17 (+ 1)
~ - Color \newline % Row Count 18 (+ 1)
~ ~ ~ \textgreater{} mucous membranes, lips, BP, perfusion \newline % Row Count 20 (+ 2)
{\bf{4. Genitourinary Assessment}} \newline % Row Count 21 (+ 1)
~ - Genitalia and abnormalities \newline % Row Count 22 (+ 1)
~ - Describe urine  \newline % Row Count 23 (+ 1)
~ ~ ~ \textgreater{} amount, pH, specific gravity \newline % Row Count 25 (+ 2)
{\bf{5. Gastrointestinal Assessment}} \newline % Row Count 26 (+ 1)
~ - Presence of abdominal distention, regurgitation \newline % Row Count 28 (+ 2)
~ - Stool assessment \newline % Row Count 29 (+ 1)
~ ~ ~ \textgreater{} amount, color, consistency \newline % Row Count 30 (+ 1)
} \tn 
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\vfill
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ASSESSMENT OF HIGH-RISK NB (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{6. \seqsplit{Neurologic-Musculoskeletal} Assessment}} \newline % Row Count 1 (+ 1)
~ - Movements, Level of Activity with stimulation \newline % Row Count 3 (+ 2)
~ - Changes in Head Circumference \newline % Row Count 4 (+ 1)
{\bf{7. Temperature}} \newline % Row Count 5 (+ 1)
~ - Determine axillary temperature% Row Count 6 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{HIGH-RISK CONDITIONS RT DYSMATURITY}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{1. Preterm Infants}} \newline % Row Count 1 (+ 1)
~ - {\emph{Cause:}} \newline % Row Count 2 (+ 1)
~ ~ ~ \textgreater{} idiopathic \newline % Row Count 3 (+ 1)
~ - {\emph{Risk Factors:}} \newline % Row Count 4 (+ 1)
~ ~ ~ \textgreater{} low socio-economic status \newline % Row Count 5 (+ 1)
~ ~ ~ \textgreater{} multigravida \newline % Row Count 6 (+ 1)
~ ~ ~ \textgreater{} gestational HTN \newline % Row Count 7 (+ 1)
~ - {\emph{Characteristics:}} \newline % Row Count 8 (+ 1)
~ ~ ~ \textgreater{} very small and thin; little SQ fat \newline % Row Count 10 (+ 2)
~ ~ ~ \textgreater{} proportionally large head \newline % Row Count 11 (+ 1)
~ ~ ~ \textgreater{} bright pink, shiny, smooth skin \newline % Row Count 13 (+ 2)
~ ~ ~ \textgreater{} abundant fine lanugo \newline % Row Count 14 (+ 1)
~ ~ ~ \textgreater{} ear cartilage soft and pliable \newline % Row Count 16 (+ 2)
~ ~ ~ \textgreater{} male NB = few scrotal rugae; cryptochordism \newline % Row Count 18 (+ 2)
~ ~ ~ \textgreater{} female NB = labia minora \& clitoris prominent \newline % Row Count 20 (+ 2)
{\bf{2. Post-term Infants}} \newline % Row Count 21 (+ 1)
~ - {\emph{Cause:}} \newline % Row Count 22 (+ 1)
~ ~ ~ \textgreater{} idiopathic \newline % Row Count 23 (+ 1)
~ - {\emph{Characteristics:}} \newline % Row Count 24 (+ 1)
~ ~ ~ \textgreater{} absent lanugo \newline % Row Count 25 (+ 1)
~ ~ ~ \textgreater{} abundant scalp hair; long fingernails \newline % Row Count 27 (+ 2)
~ ~ ~ \textgreater{} cracked \seqsplit{skin/parchment-like/desquamation} \newline % Row Count 29 (+ 2)
~ ~ ~ \textgreater{} depleted SQ fat \newline % Row Count 30 (+ 1)
} \tn 
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\vfill
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{HIGH-RISK CONDITIONS RT DYSMATURITY (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ ~ \textgreater{} little vernix caseosa% Row Count 1 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PROBLEMS RT GESTATIONAL WEIGHT}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{SGA RT Intrauterine Growth Restriction (IUGR)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{Cause:}} \newline % Row Count 1 (+ 1)
~ ~ \textgreater{} poor nutrition \newline % Row Count 2 (+ 1)
~ ~ \textgreater{} adolescent pregnancy \newline % Row Count 3 (+ 1)
~ ~ \textgreater{} placental anomaly \newline % Row Count 4 (+ 1)
~ ~ \textgreater{} maternal systemic disease (HTN, DM) \newline % Row Count 6 (+ 2)
- {\bf{Diagnostic Evaluation}} \newline % Row Count 7 (+ 1)
~ ~ \textgreater{} fundal height \textless{} expected \newline % Row Count 8 (+ 1)
~ ~ \textgreater{} UTZ = \{\{fa-arrow-down\}\} size; placental grading; amniotic fluid \newline % Row Count 10 (+ 2)
~ ~ \textgreater{} biophysical profile \newline % Row Count 11 (+ 1)
~ ~ \textgreater{} non-stress test (NST) \newline % Row Count 12 (+ 1)
-{\bf{Fetal Implications}} \newline % Row Count 13 (+ 1)
~ ~ \textgreater{} poor skin turgor \newline % Row Count 14 (+ 1)
~ ~ \textgreater{} large head, small body \newline % Row Count 15 (+ 1)
~ ~ \textgreater{} small liver \newline % Row Count 16 (+ 1)
~ ~ \textgreater{} skull sutures widely separated \newline % Row Count 17 (+ 1)
~ ~ \textgreater{} \{\{fa-arrow-up\}\} Hct level \newline % Row Count 18 (+ 1)
~ ~ \textgreater{} polycythemia (\{\{fa-arrow-up\}\} RBC) \newline % Row Count 20 (+ 2)
~ ~ \textgreater{} hypoglycemia (\textless{}45mg/dL)% Row Count 21 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{LGA (Macrosomia)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- appears healthy, but will soon reveal underdevelopment \newline % Row Count 2 (+ 2)
- {\emph{Causes:}} \newline % Row Count 3 (+ 1)
~ ~ \textgreater{} gestational DM (GDM) \newline % Row Count 4 (+ 1)
~ ~ \textgreater{} multiparity \newline % Row Count 5 (+ 1)
~ ~ \textgreater{} {\bf{Beckwith Syndrome}} \seqsplit{(overgrowth+macroglossia)} \newline % Row Count 7 (+ 2)
~ ~ \textgreater{} congenital anomalies (omphalocele)  \newline % Row Count 9 (+ 2)
- {\emph{Diagnostic Evaluation}} \newline % Row Count 10 (+ 1)
~ ~ \textgreater{} UTZ \newline % Row Count 11 (+ 1)
~ ~ \textgreater{} NST \newline % Row Count 12 (+ 1)
~ ~ \textgreater{} amniocentesis \newline % Row Count 13 (+ 1)
- {\emph{Fetal Implications}} \newline % Row Count 14 (+ 1)
~ ~ \textgreater{} immature reflexes \newline % Row Count 15 (+ 1)
~ ~ \textgreater{} extensive bruising/birth injury/{\bf{Erb-Duchenne}} \newline % Row Count 17 (+ 2)
~ ~ \textgreater{} caput succedaneum; cephalhematoma \newline % Row Count 18 (+ 1)
~ ~ \textgreater{} hyperbilirubinemia \newline % Row Count 19 (+ 1)
~ ~ \textgreater{} polycythemia vera \newline % Row Count 20 (+ 1)
~ ~ \textgreater{} cyanosis \newline % Row Count 21 (+ 1)
~ ~ \textgreater{} \{\{fa-arrow-up\}\} insulin (up to 24hrs post birth=hypoglycemia)% Row Count 23 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{MANAGEMENT OF HIGH-RISK NEWBORN}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{NEWBORN PRIORITIES}} \newline % Row Count 1 (+ 1)
1. {\bf{{\emph{Initiating/Maintaining Respiration}}}} \newline % Row Count 2 (+ 1)
~ ~ - most deaths occur within 48hrs \newline % Row Count 3 (+ 1)
~ ~ - ineffective respiration = cerebral hypoxia \newline % Row Count 5 (+ 2)
~ ~ \textgreater{} Management: \newline % Row Count 6 (+ 1)
~ ~ ~ ~ - O2 administartion \newline % Row Count 7 (+ 1)
~ ~ ~ ~ - appropriate positioning to open airway \newline % Row Count 9 (+ 2)
~ ~ ~ ~ - \seqsplit{resuscitation+ventilation} \newline % Row Count 11 (+ 2)
2. {\bf{{\emph{Establish Extrauterine Circulation}}}} \newline % Row Count 12 (+ 1)
~ ~ \textgreater{} Management: \newline % Row Count 13 (+ 1)
~ ~ ~ ~ - closed-chest massage ({\bf{1-2cm, 100x/min}}) \newline % Row Count 15 (+ 2)
~ ~ ~ ~ - lung ventilation ({\bf{30x/min}}) \newline % Row Count 17 (+ 2)
~ ~ ~ ~ - monitor pulse oximeter \newline % Row Count 19 (+ 2)
~ ~ ~ ~ - {\bf{0.1-0.3mL/kg Ephinephrine}} may be sprayed on ET tube \newline % Row Count 21 (+ 2)
~ ~ ~ ~ - transfer to NICU \newline % Row Count 22 (+ 1)
3. {\bf{{\emph{Maintain Fluid Balance}}}} \newline % Row Count 23 (+ 1)
~ ~ \textgreater{} Management: (after initial resuscitation) \newline % Row Count 25 (+ 2)
~ ~ ~ ~ - Hypoglycemia ({\bf{D10W IVF}}) \newline % Row Count 27 (+ 2)
~ ~ ~ ~ - Hypotension (vasopressor {\bf{Dopamine}}) \newline % Row Count 29 (+ 2)
~ ~ ~ ~ - Hypovolemia ({\bf{NSS/RL IVF}}) \newline % Row Count 31 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{MANAGEMENT OF HIGH-RISK NEWBORN (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ ~ ~ - Dehydration ({\bf{RL/D5W IVF}}) \newline % Row Count 2 (+ 2)
4. {\bf{{\emph{Maintaining Thermoneutrality}}}} \newline % Row Count 3 (+ 1)
~ ~ \textgreater{} Management: \newline % Row Count 4 (+ 1)
~ ~ ~ ~ - thorough drying \newline % Row Count 5 (+ 1)
~ ~ ~ ~ - skin-skin contact \newline % Row Count 6 (+ 1)
~ ~ ~ ~ - neutral thermal environment \newline % Row Count 8 (+ 2)
5. {\bf{{\emph{Establishing Adequate Nutritional Intake}}}} \newline % Row Count 9 (+ 1)
~ ~ \textgreater{} Management: \newline % Row Count 10 (+ 1)
~ ~ ~ ~ - parenteral/enteral nutrition \newline % Row Count 12 (+ 2)
~ ~ ~ ~ - breastfeeding \newline % Row Count 13 (+ 1)
6. {\bf{{\emph{Establishing Waste Elimination}}}} \newline % Row Count 14 (+ 1)
~ ~ - Immature infants void within 24hrs \newline % Row Count 16 (+ 2)
~ ~ - stool passage may be later than term infants \newline % Row Count 18 (+ 2)
7. {\bf{{\emph{Protection from Infection}}}} \newline % Row Count 19 (+ 1)
~ ~ \textgreater{} Prevention: \newline % Row Count 20 (+ 1)
~ ~ ~ ~ - handwashing and PPE use \newline % Row Count 22 (+ 2)
~ ~ ~ ~ - standard precautions \newline % Row Count 24 (+ 2)
~ ~ ~ ~ - physical isolation \newline % Row Count 25 (+ 1)
8. {\bf{{\emph{Skin Care}}}} \newline % Row Count 26 (+ 1)
~ ~ - \{\{fa-arrow-up\}\} skin sensitivity \& fragility \newline % Row Count 28 (+ 2)
~ ~ \textgreater{} Management: \newline % Row Count 29 (+ 1)
~ ~ ~ ~ - Zinc Oxide-based tape is used \newline % Row Count 31 (+ 2)
} \tn 
\end{tabularx}
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\vfill
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{MANAGEMENT OF HIGH-RISK NEWBORN (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ ~ ~ - avoid use of solvents \newline % Row Count 2 (+ 2)
9. {\bf{{\emph{Establishing Mother-Infant Bonding}}}} \newline % Row Count 3 (+ 1)
~ ~ - parents kept informed \newline % Row Count 4 (+ 1)
~ ~ - spend time with NB% Row Count 5 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{2. (1:3 = Lung ventilation:Cardiac massage) \newline }}3. Monitor UO (if UO=\textless{}2mL/kg/hr = inadequate fluid intake) \newline {\emph{4. 3 Main Methods for Neutral Thermal Environment: Incubator, Radiant panel, Bassinet \newline }}5.  If gavage fed, provide oral stimulation to develop effective sucking reflex}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{ACUTE CONDITIONS OF NEONATES}}  \tn
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\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Distress Syndrome  (RDS)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Hyaline Membrane Disease \newline % Row Count 1 (+ 1)
- surfactant deficiency \newline % Row Count 2 (+ 1)
- {\bf{Types:}} \newline % Row Count 3 (+ 1)
~ ~ \textgreater{} {\emph{Structural}} \newline % Row Count 4 (+ 1)
~ ~ ~ ~ - lungs are underdeveloped \newline % Row Count 6 (+ 2)
~ ~ ~ ~ - respiratory muscle prone to fatigue \newline % Row Count 8 (+ 2)
~ ~ \textgreater{} {\emph{Functional}}  \newline % Row Count 9 (+ 1)
~ ~ ~ ~ - deficient surfactant \newline % Row Count 11 (+ 2)
- {\bf{Risk Factors:}} \newline % Row Count 12 (+ 1)
~ ~ \textgreater{} Multifetal pregnancy \newline % Row Count 13 (+ 1)
~ ~ \textgreater{} GDM \newline % Row Count 14 (+ 1)
~ ~ \textgreater{} CS Delivery \newline % Row Count 15 (+ 1)
~ ~ \textgreater{} Cold stress \newline % Row Count 16 (+ 1)
~ ~ \textgreater{} Asphyxia  \newline % Row Count 17 (+ 1)
~ ~ \textgreater{} Hx of RDS \newline % Row Count 18 (+ 1)
- RDS of Non-Pulmonary Origin Risk Factors: \newline % Row Count 19 (+ 1)
~ ~ \textgreater{} Sepsis \newline % Row Count 20 (+ 1)
~ ~ \textgreater{} Cardiac Defect \newline % Row Count 21 (+ 1)
~ ~ \textgreater{} Hypoglycemia \newline % Row Count 22 (+ 1)
~ ~ \textgreater{} Metabolic Acidosis \newline % Row Count 23 (+ 1)
~ ~ \textgreater{} Drugs \newline % Row Count 24 (+ 1)
- {\bf{Clinical Manifestations:}} \newline % Row Count 25 (+ 1)
~ ~ \textgreater{} tachypnea (\textgreater{}60cpm) \newline % Row Count 26 (+ 1)
~ ~ \textgreater{} retractions; nasal flaring \newline % Row Count 27 (+ 1)
~ ~ \textgreater{} inspiratory crackles \newline % Row Count 28 (+ 1)
~ ~ \textgreater{} circumoral and central cyanosis \newline % Row Count 29 (+ 1)
- {\bf{ Laboratory Diagnoses:}} \newline % Row Count 30 (+ 1)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Distress Syndrome  (RDS) (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ \textgreater{} Glucometry (tests hypoglycemia) \newline % Row Count 1 (+ 1)
~ ~ \textgreater{} ABG (tests acidosis, hypoxia, hypercapnia) \newline % Row Count 3 (+ 2)
~ ~ \textgreater{} CXR  \newline % Row Count 4 (+ 1)
~ ~ ~ ~ - diffuse granular pattern = alveolar atelectasis \newline % Row Count 6 (+ 2)
~ ~ ~ ~ - dark streaks = dilated, air-filled bronchioles \newline % Row Count 8 (+ 2)
-{\bf{Treatment:}} \newline % Row Count 9 (+ 1)
~ ~ \textgreater{} ventilation and oxygenation with Continuous Positive Airway Pressure (CPAP) \newline % Row Count 11 (+ 2)
~ ~ \textgreater{} maintain acid-base balance \newline % Row Count 12 (+ 1)
~ ~ \textgreater{} neutral thermal environment \newline % Row Count 13 (+ 1)
~ ~ \textgreater{} maintain hydration and electrolytes \newline % Row Count 15 (+ 2)
~ ~ \textgreater{} avoid nipple and gavage feedings \newline % Row Count 16 (+ 1)
~ ~ \textgreater{} administer exogenous surfactants \newline % Row Count 17 (+ 1)
- {\bf{Nursing Responsibilities:}} \newline % Row Count 18 (+ 1)
~ ~ \textgreater{} collect and monitor ABG \newline % Row Count 19 (+ 1)
~ ~ \textgreater{} O2 monitoring \newline % Row Count 20 (+ 1)
~ ~ \textgreater{} assess tolerance on procedure/drug% Row Count 21 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{ Surfactants produced at 24wks AOG, matures at 36wks  \newline }} Surfactant Complications: pulmonary hemorrhage; mucus plugging}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Meconium Aspiration Syndrome}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{Meconium}}}} \newline % Row Count 1 (+ 1)
- sticky and tarlike; present at bowel 10wks AOG \newline % Row Count 2 (+ 1)
- accumulates at 16wks AOG \newline % Row Count 3 (+ 1)
{\bf{{\emph{Meconium Aspiration}}}} \newline % Row Count 4 (+ 1)
- occurs inside utero/at first breath at birth \newline % Row Count 5 (+ 1)
- occurs when the vagus reflex is stimulated due to hypoxia \{\{fa-arrow-right\}\} releasing meconium to amniotic fluid \newline % Row Count 8 (+ 3)
- NB born at breech position \newline % Row Count 9 (+ 1)
- {\bf{Pathophysiology:}} \newline % Row Count 10 (+ 1)
~ ~ \textgreater{} hypoxia\{\{fa-arrow-right\}\}meconium passing\{\{fa-arrow-right\}\}aspiration\{\{fa-arrow-right\}\}obstruction\{\{fa-arrow-right\}\}atelectasis\{\{fa-arrow-right\}\}respiratory failure \newline % Row Count 14 (+ 4)
- {\bf{Clinical Manifestations:}} \newline % Row Count 15 (+ 1)
~ ~ \textgreater{} tachypnea; retractions; expiratory grunting; nasal flaring \newline % Row Count 17 (+ 2)
~ ~ \textgreater{} cyanosis/pallor \newline % Row Count 18 (+ 1)
~ ~ \textgreater{} barrel chest (from hyperinflation) \newline % Row Count 20 (+ 2)
~ ~ \textgreater{} hypoglycemia; hypocalcemia \newline % Row Count 21 (+ 1)
- {\bf{Diagnostic Evaluation:}} \newline % Row Count 22 (+ 1)
~ ~ \textgreater{} laryngoscopy \newline % Row Count 23 (+ 1)
~ ~ \textgreater{} CXR \newline % Row Count 24 (+ 1)
- {\bf{Management:}} \newline % Row Count 25 (+ 1)
~ ~ \textgreater{} tracheal suctioning \newline % Row Count 26 (+ 1)
~ ~ \textgreater{} intubation (in severe cases) \newline % Row Count 27 (+ 1)
~ ~ \textgreater{} surfactant administration \newline % Row Count 28 (+ 1)
~ ~ \textgreater{} Echocardiography (diagnose shunting) \newline % Row Count 30 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Meconium Aspiration Syndrome (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ \textgreater{} chest physiotherapy% Row Count 1 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Apnea of Prematurity (AOP)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{{\emph{Apnea}}}} \newline % Row Count 1 (+ 1)
- cessation of respiration that lasts {\bf{\textgreater{}20secs}}, accompanied by bradypnea and cyanosis \newline % Row Count 3 (+ 2)
{\bf{Types:}} \newline % Row Count 4 (+ 1)
~ {\emph{1. Central Apnea}} \newline % Row Count 5 (+ 1)
~ ~ ~ - absent function of diaphragmatic and other respiratory muscles \newline % Row Count 7 (+ 2)
~ ~ ~ - CNS does not transmit signals to respiratory muscles \newline % Row Count 9 (+ 2)
~ {\emph{2. Obstructive Apnea}} \newline % Row Count 10 (+ 1)
~ ~ ~ - airflow stops due to obstruction \newline % Row Count 12 (+ 2)
~ {\emph{3. Mixed Apnea}} \newline % Row Count 13 (+ 1)
~ ~ ~ - central + obstructive \newline % Row Count 14 (+ 1)
~ ~ ~ - most common on premature infants \newline % Row Count 16 (+ 2)
- {\bf{Causes:}} \newline % Row Count 17 (+ 1)
~ ~ \textgreater{} prematurity (weak thorax muscles) \newline % Row Count 18 (+ 1)
~ ~ \textgreater{} airway obstruction \newline % Row Count 19 (+ 1)
~ ~ \textgreater{} anemia; polycythemia vera \newline % Row Count 20 (+ 1)
~ ~ \textgreater{} hypoglycemia; hypocalcemia  \newline % Row Count 21 (+ 1)
~ ~ \textgreater{} sepsis; meningitis; seizures \newline % Row Count 22 (+ 1)
- {\bf{Management:}} \newline % Row Count 23 (+ 1)
~ ~ \textgreater{} gentle tactile stimulation \newline % Row Count 24 (+ 1)
~ ~ \textgreater{} Caffeine Citrate PO/Parenteral (CNS Stimulant) \newline % Row Count 26 (+ 2)
~ ~ \textgreater{} monitor weight and UO (Caffeine citrate = diuretic) \newline % Row Count 28 (+ 2)
~ ~ \textgreater{} nasal CPAP \& nasal intermittent positive pressure ventilation \newline % Row Count 30 (+ 2)
} \tn 
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Apnea of Prematurity (AOP) (cont)}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{~ ~ \textgreater{} neutral thermal environment \newline % Row Count 1 (+ 1)
- {\bf{Nursing Responsibilities:}} \newline % Row Count 2 (+ 1)
~ ~ \textgreater{} routine observation (RR \& HR) \newline % Row Count 3 (+ 1)
~ ~ \textgreater{} gentle tactile stimulation, if it fails, raise chin to open airway \newline % Row Count 5 (+ 2)
~ ~ \textgreater{} careful burping = reduces apnea \newline % Row Count 6 (+ 1)
~ ~ \textgreater{} never take rectal temperature% Row Count 7 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}