high risk neonatal nursing care

7/30/2019 High Risk Neonatal Nursing Care

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Developed by D. Ann Currie, RN, MSN


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High Risk Newborn Nursing

Care


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Fetal/Neonatal Risk

Factors for Resuscitation Nonreassuring fetal heart rate pattern Difficult birth Fetal scalp/capillary blood sample-acidosis pH


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Fetal/Neonatal Risk Factors

for Resuscitation (continued)An infant of a diabetic mother

Arrhythmias

Cardiomyopathy Fetal anemia


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Respiratory Distress

Syndrome (RDS) Deficiency or absence of surfactant

Atelectasis

Hypoxemia, hypercarbia, academia May be due to prematurity or surfactant deficiency


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RDS: Nursing Care Maintain adequate respiratory status

Maintain adequate nutritional status

Maintain adequate hydration Education and support of family


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Transient Tachypnea of

the Newborn (TTN) Failure to clear lung fluid, mucus, debris

Exhibit signs of distress shortly after birth

Symptoms Expiratory grunting and nasal f laring

Subcostal retractions

Slight cyanosis


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TTN: Nursing Care Maintain adequate respiratory status

Maintain adequate nutritional status

Maintain adequate hydration Support and educate family


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MAS: Nursing CareAssess for complications related to MAS

Maintain adequate respiratory status

Maintain adequate nutritional status Maintain adequate hydration


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Persistent Pulmonary

Hypertension (PPHN Blood shunted away from lungs

Increased pulmonary vascular resistance (PVR)

Primary Pulmonary vascular changes before birth resulting in

PVR

Secondary

Pulmonary vascular changes after birth resulting in PVR


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PPHN: Nursing Care Minimize stimulation

Maintain adequate respiratory status

Observe for signs of pneumothorax Maintain adequate nutritional status

Maintain adequate hydration status

Support and educate family


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Cold Stress Increase in oxygen requirements

Increase in utilization of glucose

Acids are released in the bloodstream Surfactant production decrease


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Cold Stress: Nursing Care Observe for signs of cold stress

Maintain NTE

Warm baby slowly Frequent monitoring of skin temperature

Warming IV fluids

Treat accompanying hypoglycemia


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Hypoglycemia Symptoms Lethargy or jitteriness

Poor feeding and sucking

Vomiting Hypothermia and pallor

Hypotonia, tremors

Seizure activity, high pitched cry, exaggerated moro

reflex


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Hypoglycemia:

Nursing Care Routine screening for all at risk infants

Early feedings

D10W infusion


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Physiologic

HyperbilirubinemiaAppears after first 24 hours of life

Disappears within 14 days

Due to an increase in red cell mass


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Pathologic

HyperbilirubinemiaAppears within first 24 hours of life

Serum bilirubin concentration rises by more than 0.2mg/dL per hour

Bilirubin concentrations exceed the 95th percentile

Conjugated bilirubin concentrations are greater than 2mg/dL

Clinical jaundice persists for more than 2 weeks in aterm newborn


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Causes of Pathologic

Hyperbilirubinemia Hemolytic disease of the newborn

Erythroblastosis fetalis

Hydrops fetalisABO incompatibility


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Treatment of Pathologic

Hyperbilirubinemia Resolving anemia

Removing maternal antibodies and sensitizederythrocytes

Increasing serum albumin levels

Reducing serum bilirubin levels

Minimizing the consequences of hyperbilirubinemia


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Maternal-Fetal

Blood Incompatibility Rh incompatibility

Rh-negative mother

Rh-positive fetus

ABO incompatibility

O mother

A or B fetus


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Phototherapy: Nursing Care Maximize exposure of the skin surface to the light

Periodic assessment of serum bilirubin levels

Protect the newborns eyes with patches

Measure irradiance levels with a photometer

Good skin care and reposition infant at least every 2 hours

Maintain an NTE and adequate hydration and nutrition


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Anemia Hemoglobin of less than 14 mg/dL (term)

Hemoglobin of less than 13 mg/dL (preterm)

Nursing management Observe for symptoms

Initiate interventions for shock


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Polycythemia Increase in blood volume and hematocrit

Nursing management:

Assessment of hematocrit Monitor for signs of distress

Assist with exchange transfusion


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Clinical Manifestations of Sepsis Increase in blood volume and hematocrit

Nursing management:

Assessment of hematocrit Monitor for signs of distress

Assist with exchange transfusion

Temperature instability

Feeding intolerance Hyperbilirubinemia

Tachycardia followed by apnea/bradycardia


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Clinical Manifestations of Syphilis Rhinitis

Red rash around the mouth and anus

Irritability Generalized edema and hepatosplenomegaly

Congenital cataracts

SGA and failure to thrive


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Syphilis: Nursing

Management Initiate isolation

Administer penicillin

Provide emotional support for the family


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Gonorrhea Clinical Manifestations

Conjunctivitis

Corneal ulcerations

Nursing management

Administration of ophthalmic antibiotic ointment

Referral for follow-up


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Clinical Manifestationfs of Herpes Small cluster vesicular skin lesions over the entire body

DIC

Pneumonia Hepatitis

Hepatosplenomegaly

Neurologic abnormalities


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Herpes: Nursing

Management Careful hand washing and gown and glove isolation

Administration of IV vidarabine or acyclovir

Initiation of follow-up referral Support and education of parents


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Chlamydia Clinical Manifestations

Pneumonia

Conjunctivitis

Nursing management

Administration of ophthalmic antibiotic ointment

Referral for follow-up


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Needs of Parents of

At-risk Infants Realistically perceiving the infants medical condition

and needs

Adapting to the infants hospital environment

Assuming primary caretaking role

Assuming total responsibility for the infant upondischarge

Possibly coping with the death of the infant if it occurs


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Facilitating Parental

Attachment Facilitating family visits

Allowing the family to hold and touch the baby

Giving the family a picture of the baby Liberal visiting hours

Encouraging the family to get involved in the care


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Cont. to Study other conditions from the Text

high risk neonatal nursing care

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