Nursing Management of NEWBORN INFANT AT RISK: ACQUIRED & CONGENITAL CONDITIONS

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Nursing Management of NEWBORN INFANT AT RISK:  ACQUIRED & CONGENITAL CONDITIONS Powered By Docstoc
					MATERNAL NEONATAL
      Nursing
 NEWBORN INFANT AT RISK:
 ACQUIRED & CONGENITAL
      CONDITIONS
              GENETIC DISORDERS
   ABNORMAL GENES:                     Environmental factors –
   Body structure – clubfoot            infections, drug or alcohol
   Body function - fragile X            abuse, chemical exposure
    syndrome, a form of mental
    retardation                         Birth defects can be a
   Metabolism – Tay-Sachs               combination of abnormal
    disease, a lipid storage disease     genes or heredity &
                                         environment
  CHROMOSOMAL DISORDERS
 Normal  – 23 paired chromosomes; 1 pair from
  mother & 1 pair from father
 Abnormal – number or arrangement of DNA, extra
  or missing chromosomes; broken chromosomes
  can also cause a genetic defect
           DOWN’S SYNDROME OR
            TRISOMY 21 fig 17-1
   Most common chromosomal syndrome-1 in 600 to 800 live births. Have an extra
    chromosome, usually in #21.
   Mostly affects mothers older than 35.
   Characteristics:
   craniofacial features : eyes with upward slant, speckles in the iris of the eye,
    small nose with wide bridge, low set ears. Large tongue that protrudes from
    mouth
    wide space between the 1st 2 toes, single palmar crease
   mental retardation that varies in severity
    heart defects
    duodenal atresia
   At birth are hypotonic, feeding difficulties, susceptible to resp infections
              INBORN ERRORS OF
                 METABOLISM
   NOT ALWAYS                         GALACTOSEMIA – cannot
    SYMPTOMATIC AT BIRTH                metabolize galactose – if not
    – states have screening tests       treated with milk substitute
    mandated- ONE NEONATAL              will have failure to thrive,
    SCREENING TESTS FOR                 cataracts, jaundice, cirrhosis of
    ALL 3 OF THE                        the liver and mental retardation
    FOLLOWING:                         HYPOTHYROIDISM –
   PHENYLKETONURIA –                   caused by a maternal iodine
    PKU – unable to metabolize          deficiency or the use of
    the amino acid phenylalanine.       antithyroid drugs by the
    If not treated with diet can        mother. If not treated with
    result in irreversible brain        thyroid replacement can result
    damage.                             in hypothermia, poor feeding,
                                        lethargy, jaundice & cretinism
        COMMON CONGENITAL
            ANOMALIES
 SEE  TABLE 17-1 pgs 272 - 274
 Cleft Lip & Palate
 Esophageal atresia
 Spina bifida
 Hydrocephalus
 Patent ductus arteriosus
 Tetralogy of Fallot
           HYPERBILIRUBINEMIA
   An abnormally high level of          Pathologic Jaundice- caused
    bilirubin in the blood                by hemolytic disease such as
o     total bili in term newborns >       RH incompatibilities or ABO
    12mg/dl or in preterm > 15            incompatibility – clinical
    mg/dl                                 jaundice is evident within the
   Causes: hemorrhage,                   lst 24 hrs of life, persists for
    infections, hypoxia, acidosis         more than 14 days.
   Physiologic jaundice –               S/S: temperature instablility,
    usually shows up at day 3 of          poor feeding, decreased muscle
    life or after. Treated with           tone, lethargy, high-pitched cry
    phototherapy. Usually lasts a        Treated with phototherapy –
    short period of time < 2 weeks.       fig 17-3, 17-4, 17-5
                                         Precautions for phototherapy
                  Prevention
 Administration of RhoGAM to Rh-negative
  mother within 72 hours of delivery of Rh-positive
  baby.
 RhoGAM usually given to Rh-negative woman at
  28 weeks gestation
 Also given to Rh-negative woman after abortion,
  amniocentesis or with bleeding during pregnancy.
 See Box 17-1
     HYPOGLYCEMIA – box 17-2
 NORMAL – levels fall to about 50 during the 1st 2 hrs
  after birth then start to rise & stabilize
 Hypoglycemia is defined as glucose levels below 40mg/dl
  based on 2 consecutive low values 30 minutes apart.
 S/S – lethargy, hypotonia, jitteriness, poor feeding,
  tachypnea, apnea, sweating, shrill cry, low temp &
  seizures
 Treatment – keep warm, early feedings, aggressive blood
  screening.
        RESPIRATORY DISORDERS
   RESPIRATORY DISTRESS                   MECONIUM ASPIRATION
    SYNDROME (RDS) – seen in                SYNDROME (MAS) – usually
    premature infants – s/s –               affects postterm infants or due
    tachypnea, nasal flaring, sub &         to prolonged, difficult labor.
    intercostal retractions, cyanosis      Prevention, amnioinfusion,
    & exp grunting; fig 17-6                immediate upper airway
                                            suctioning as soon as the head
   Treatment – avoid premature             is delivered if the meconium is
    birth, administer                       thick particulate (pea souplike)
    corticosterioids to mother             S/S: skin, nails & umbilical
    prior to delivery if possible or        cord stained yellowish-green;
    administer surfactants to infant        tachypnea, retractions
    via trachea after delivery             Treatment: ventilation, ECMO
    Transient Tachypnea of the Newborn
                  (TTN)
  Seen more in infants born via C-section
 Occurs usually within 1st hour of birth
 Respirations as high as 100-140/minute
 On room air will have expiratory grunting, nasal
  flaring, & mild cyanosis
 Treatment: 02, respiratory support & parenteral
  nutrition
 Usually improve within 48 hours
          Infants of Diabetic Mothers
   Outcome of infant depends on      Increased risk for
    mother’s pregnancy glucose         hypoglycemia
    control                           Polycythemia
   Large fetus, macrosomia, fig      SGA, IUGR
    17-8                              Birth trauma if very large
   Congenital heart defects
   Tracheoesophageal fistulae
   CNS anomalies
   RDS
   Neonatal Sepsis                             Maternal Substance Abuse
    caused by variable pathogens,
    usually more than 1 kind.                   See box 17-3
    S/S – poor feeding, vomiting,              Infants may have neonatal
    diarrhea, lethargy, cyanosis, jaundice       abstinence syndrome
    & hypothermic
   Treatment – prevention by screening          Nursing care: minimize
    for STDs & treating mom during               stimulation & handling,
    pregnancy; antibiotics after cultures        swaddle, nonnutritive sucking,
    done or prophylactically if no culture
    available; use of aseptic technique          sedatives
    during labor & delivery                     Refer mother to social
   Nursing care plan 17-1                       services/CPS usually involved
    DC PLANNING & HOME CARE
 Should begin as soon as the infant is diagnosed with a
  problem
 Assess home environment
 Multidisciplinary approach
 Parental education & competence with infant care
 Follow up home care very important
 Make sure parents have appropriate telephone numbers in
  case they have questions once they get home

				
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