High Risk Neonatal Nursing Care

1. High Risk Neonatal Nursing Care Developed by D. Ann Currie, RN, MSN

2. High Risk Newborn Nursing Care

3. Fetal/Neonatal Risk Factors for Resuscitation • Nonreassuring fetal heart rate pattern • Difficult birth • Fetal scalp/capillary blood sample-acidosis pH<7.20 • Meconium in amniotic fluid • Prematurity • Macrosomia or SGA • Male infant • Significant intrapartum bleeding • Structural lung abnormality or oligohydramnios • Congenital heart disease • Maternal infection • Narcotic use in labor

4. Fetal/Neonatal Risk Factors for Resuscitation (continued) • An infant of a diabetic mother • Arrhythmias • Cardiomyopathy • Fetal anemia

5. Respiratory Distress Syndrome (RDS) • Deficiency or absence of surfactant • Atelectasis • Hypoxemia, hypercarbia, academia • May be due to prematurity or surfactant deficiency

7. RDS: Nursing Care • Maintain adequate respiratory status • Maintain adequate nutritional status • Maintain adequate hydration • Education and support of family

9. 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 flaring • Subcostal retractions • Slight cyanosis

10. TTN: Nursing Care • Maintain adequate respiratory status • Maintain adequate nutritional status • Maintain adequate hydration • Support and educate family

11. Meconium Aspiration Syndrome (MAS) • Mechanical obstruction of the airways • Chemical pneumonitis • Vasoconstriction of the pulmonary vessels • Inactivation of natural surfactant

12. MAS: Nursing Care • Assess for complications related to MAS • Maintain adequate respiratory status • Maintain adequate nutritional status • Maintain adequate hydration

13. 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

14. 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

16. Cold Stress • Increase in oxygen requirements • Increase in utilization of glucose • Acids are released in the bloodstream • Surfactant production decrease

18. 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

19. Hypoglycemia Symptoms • Lethargy or jitteriness • Poor feeding and sucking • Vomiting • Hypothermia and pallor • Hypotonia, tremors • Seizure activity, high pitched cry, exaggerated moro reflex

20. Hypoglycemia: Nursing Care • Routine screening for all at risk infants • Early feedings • D10W infusion

21. Physiologic Hyperbilirubinemia • Appears after first 24 hours of life • Disappears within 14 days • Due to an increase in red cell mass

22. Pathologic Hyperbilirubinemia • Appears within first 24 hours of life • Serum bilirubin concentration rises by more than 0.2 mg/dL per hour • Bilirubin concentrations exceed the 95th percentile • Conjugated bilirubin concentrations are greater than 2 mg/dL • Clinical jaundice persists for more than 2 weeks in a term newborn

23. Causes of Pathologic Hyperbilirubinemia • Hemolytic disease of the newborn • Erythroblastosis fetalis • Hydrops fetalis • ABO incompatibility

24. Treatment of Pathologic Hyperbilirubinemia • Resolving anemia • Removing maternal antibodies and sensitized erythrocytes • Increasing serum albumin levels • Reducing serum bilirubin levels • Minimizing the consequences of hyperbilirubinemia

25. Maternal-Fetal Blood Incompatibility • Rh incompatibility • Rh-negative mother • Rh-positive fetus • ABO incompatibility • O mother • A or B fetus

26. Phototherapy: Nursing Care • Maximize exposure of the skin surface to the light • Periodic assessment of serum bilirubin levels • Protect the newborn’s 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

28. 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

29. Polycythemia • Increase in blood volume and hematocrit • Nursing management: • Assessment of hematocrit • Monitor for signs of distress • Assist with exchange transfusion

30. 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

31. Clinical Manifestations of Syphilis • Rhinitis • Red rash around the mouth and anus • Irritability • Generalized edema and hepatosplenomegaly • Congenital cataracts • SGA and failure to thrive

32. Syphilis: Nursing Management • Initiate isolation • Administer penicillin • Provide emotional support for the family

33. Gonorrhea • Clinical Manifestations • Conjunctivitis • Corneal ulcerations • Nursing management • Administration of ophthalmic antibiotic ointment • Referral for follow-up

34. Clinical Manifestationfs of Herpes • Small cluster vesicular skin lesions over the entire body • DIC • Pneumonia • Hepatitis • Hepatosplenomegaly • Neurologic abnormalities

35. 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

36. Chlamydia • Clinical Manifestations • Pneumonia • Conjunctivitis • Nursing management • Administration of ophthalmic antibiotic ointment • Referral for follow-up

37. Needs of Parents of At-risk Infants • Realistically perceiving the infant’s medical condition and needs • Adapting to the infant’s hospital environment • Assuming primary caretaking role • Assuming total responsibility for the infant upon discharge • Possibly coping with the death of the infant if it occurs

38. 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

40. Cont. to Study other conditions from the Text