Only 2 more units left in Nurs 2202 - Hang in thereWe all get tired!!

Remember in term neonateExtracellular water content is 70-75%. In reterm neonatesmaybe 90%

Factors associated with prematurity

Neonatal resuscitation suppliesAnd equipment

Narcan

Correct placement of the neonatal with oxygen maskWith incorrect placement if mask too large or too small

Silverman & Anderson Evaluation Scale

Means of administering supplemental oxygen

Note placement of head in hood

Documentation information

Clinical signs often associated with Neonatal Hypoglycemia

Any can cause further depletion in weight & metabolic stores

Detrimental effects of hypothermia in the neonate

DIC

Increase risk ofbillirubin encephalopathyAt low levels ofbillirubin

Loss of wt. orfailure to gainwt despiteadequate calorieintake

Umbilical arteryCatheter look at why doArterial vsVenous

Developmental & emotional care of infant & family

Environmental Hazards:NOISE (remember even putting something on isolate)INFECTION risks even from staff (HANDWASHING)Tape – sensitive skin, probes, leadsLight – Microwave rays & Radiation (portable x-rays, etc.

Remember increase anxiety & tension Cause increase in O2 consumption, increase RDS some other Signs & Symptoms of stress (overstimulation):

no eye contacthiccuppinggagging or increase emesispulling awayHAS TO learn to trust caregivers, but caregivers inflict painSee Pain also

NIDCAP: Neonatal Individualized Developmental Care Noise & LightPhysical Sensation: message, be careful not to over stimulateComfort measures: pain controlKangaroo care: skin to skinPositioning: make nest, gives boundaries, helps infant’s

organizational ability, remember flexed position

Pain in neonates: Assessment:

Behavioral: high pitched cry with shrill quality (remember highpitched cry seen in CNS damage), grimace, quiveringmouth, pulls away

Physiologic: increase in HR, BP(increase then decrease), increaseintercranial pressure, increase O2 consumption (tachypnea),decrease O2 sats

Document to make pain more objectiveGOALS: minimize intensity, duration & maximize the neonate's ability to cope

Clinical signs of RDS

2500gm = 5lbs. 8oz.

1000gm = 2lbs. 3oz.

1500gm = 3lbs. 4ozs.

Factors associated with prematurity

Hyaline membraneFormation

BPD = bronchiopulmonaryDysplasia caused by increasepressure used to deliver increaseO2

Increases pulmonary vascularresistance

TX ?

PreventionOxygen – lowest delivery pressure

& concentrationNutrientsFluid & acid/base balanceMedications i.e.. Diuretics corticosteriods, bronchiodilators

PDA = common in neonates weighing less than 1000 gTx = ventilation, norm blood gases, diuretics & indomethacin (prostaglandin) . If fails surgery to ligate.

PV-IVH = periventricular-intraventricular hemorrhageOne of most common & severe brain injuries 3 times in moderately 1501 – 2500 g premi ; 7 times in severe under 2 lbs. 3 oz (1000g)

Teaching considerations

NEC = necrotizing intercolitis = acute inflammatory disease of the GI mucosa commonly complicated by perforations

Etiology of Mec aspiration = Meconium aspiration

Intrauterine hypoxia

Reflex gasping relaxation of anal sphincter

Meconium aspiration

Airway obstruction

Ineffective gas exchange Inflammation & thickening of alveoli & interstitial tissues

Hypoxia

Persistent fetalCirculation (rt to lt shunting of unoxy.blood

Pulmonary hypertension increase pressure of right side of heart

Pulmonary vasocon- striction

Prenatal factors associated with IURG Which terms are used when referring to the neonate

SGA or SFD

S&S:reduced sub Q fatloose & dry skindiminished muscle mass; especially over buttocks & cheekssunken abdomenthin; yellowish; dry; and dull appearing cordsparse scalp hairwide skull sutures (inadequate bone growth)

Complications:perinaltal asphyxiameconuim aspiration - RDShypoglycemiaheat loss

Glycosylated hemoglobin values in early diabetic pregnancy are associated with a significant higher frequency of both congenital malformations & spontaneous abortions: NEW if is above 6 probablyIs a type 2 diabetic

LGA most of time related to high blood sugar in mom

Improvement noted with euglycemia of mother throughout pregnancy

Diabetes of all typesRemember hyperglycemia, hypoglycemia, ketoacidosis

Hyperbilirubinemia

Possible birth injuries in LGA

What is one of mostcommon causes of LGA ?

ERB or brachial plexus