OB NEONATAL HIGH RISK

BPD is a chronic lung problem associated with neonates who have been treated with mechanical ventilation. Which assessment is consistent with BPD?

-CXR shows lung hyperinflation -ABG: pH 7.30, PCO2 60, HCO3 19, PO2- 55 -Increased pressure needed for ventilation

Which RF for hyperbilirubinemia is modifiable? SATA

-Delayed cord clamping -Infrequent feedings in the first 24 hours -Bacterial infection at birth -Breast feeding only in first 24 hours

The nurse is seeing a neonate for an immediate cardiac assessment. What will the nurse be looking for? Select all that apply.

-Heart sounds -Peripheral pulses -Capillary refill

The nurse is caring for an infant born at 42 weeks gestation. What assessment findings by the nurse are consistent with post-term infants? Select all that apply.

-Meconium staining -Long fingernails

To prevent damage to the premature infant's skin, what interventions should the nurse perform? Select all that apply.

-Use the minimum amount of tape needed to secure tubes or IV lines -Use water, air, or gel mattresses -Assess skin at least once a shift for breakdown or infection

A 30-week gestation infant has been born at a small rural hospital with no neonatal intensive care unit (NICU). The health care team has decided that the infant will be transferred via ambulance to a regional care center 45 minutes away. Place the following nursing interventions in the correct order in which they will need to be performed

1. Call and report pertinent info regarding maternal and neonatal 2. dispatch the appropriate healthcare team and equipment needed 3. inform the parents of the infants status upon arrival at the regional care 4. provide development care to the infant

Neonatal gavage feedings order

1. check for residuals before starting feeding 2. assess the neonate for feeding intolerance 3. check for placement prior to feeding 4. measure the tube accurately

A nurse is caring for a 28-week gestation infant. What assessment finding would the nurse determine as being consistent with this gestational age?

Abundant lanugo

Abrupt discontinuation of intrauterine exposure to various substances, including heroin, nicotine, alcohol, cannabis, opiates, cocaine, and methamphetamines puts the neonate at risk for signs and symptoms of neonatal abstinence syndrome (NAS). The withdrawal of what substance can cause symptoms of NAS to start within 4 hours?

Alcohol

A nurse is assessing a 28-week neonate who is on 25% oxygen at 0.5 L/m via nasal cannula. The infant is pale with O2 saturation of 75%. What is the first intervention to perform?

Assess the infants airway

A mother states to the nurse, "I want to breastfeed, but my baby is too fragile to hold." What can the nurse recommend to support breastfeeding by the mother?

Begin using a breast pump and storing milk for the infant

Infants with persistent pulmonary hypertension experience increased pulmonary vascular resistance. This impedes blood flow and causes hypertension inside the heart. Select which chamber of the heart experiences increased pressure.

Blood flows from the right ventricle of the heart to the lungs. With increased pulmonary vascular resistance, pressure in the right ventricle increases.

A client calls the nurse to her room and states, "The baby is really sleepy and hasn't been feeding well." The nurse notes the infant is jittery. What additional assessment should the nurse perform?

Blood glucose

The nurse is teaching the parents of a preterm infant about necrotizing enterocolitis (NEC). What statement indicates to the nurse that teaching has been successful?

Breastfeeding will help protect my baby's gut from NEC

Despite maintaining a neutral thermal environment, a premature infant continues to have hypothermia. What intervention should the nurse perform next?

Check the infant's blood glucose

The nurse is caring for an infant born to a woman with diabetes. The nurse notes that the infant moves the left arm, but the right arm remans flaccid. What order does the nurse anticipate?

Chest x-ray

A neonate with respiratory distress syndrome is being prepared for intubation and surfactant administration. The mother refuses any animal products. What should the nurse anticipate the healthcare provider (HCP) will order?

Colfoscerial (Exosurf)

A nurse diagnosis for a very preterm neonate is ineffective thermos-regulation related to prematurity, lack of SQ fat tissue, and environmental temperature. Which interventions would be most important to perform immediately? SATA

Dry infant and discard wet linen Place on pre-heated warmer Keep head covered

To prevent heat loss from evaporation immediately after delivery, what is the most important nursing intervention?

Dry the neonate gently and replace the wet linen

The nurse receives an order to begin trophic feeding at 2 ml/hour via nasogastric tube. The nurse recognizes what about trophic feedings?

Enhances gastrointestinal functioning

A premature neonate with severe hyperbilirubinemia is starting phototherapy. What nursing interventions is the most important?

Eye patches in place while under lights

The nurse is assessing a preterm neonate immediately after delivery. Which assessment finding indicates respiratory distress?

Grunting on exhalation Intercostal retractions

During the cardiac assessment of a preterm neonate, the nurse is likely to identify what abnormality?

Heart murmur

The nurse is admitting a 28 week neonate to the NICU. Which assessment would indicate an intraventricular hemorrhage (IVH)

Hypotonia

The nurse is planning to assess a neonate born at 25 weeks. Which would be an expected assessment finding?

Hypotonic muscles Fused eyelids

The nurse is teaching parents about home use of the fiberoptic bili blanket. Which statement by the mother indicates effective teaching?

I should keep the bili blanket on 24 hours a day

The registered nurse (RN) is educating a mother whose infant is receiving phototherapy for hyperbilirubinemia. What statement by the mother does the RN identify as correct?

I will feed my baby frequently while on phototherapy

After birth, an infant received surfactant replacement therapy. The father questioned the nurse regarding the purpose of this therapy. What is the correct response by the nurse?

It allows the infant to expand his lungs more easily

The nurse knows that maternal alcohol, tobacco, cannabis, and cocaine abuse can all cause many long-term adverse effects. Which assessment findings can be attributed to all of these substances?

Low birth weight and attention deficit disorder

The nurse is caring for a neonate with a grade II IVH. Routine nursing care can cause fluctuations in cerebral blood flow. What nursing strategies will decrease the worsening of this condition?

Minimize crying Minimize stimulation Keep temperature normal

The nurse is teaching parents of a preterm neonate about feedings in the NICU. What statement about nutrition indicates an understanding of the teaching?

My baby will need fortified breastmilk

The nurse is teaching a father how to bottle feed his premature infant. What instructions should the nurse include in the teaching?

Pace the feeding to allow for breathing breaks

The nurse is assessing a client during a prenatal visit. The client is at 30 weeks gestation. What assessment identifies a non-modifiable risk for PTL?

Placenta Previa

During labor, the nurse notes the presence of meconium-stained fluid. What does the nurse prepare for at the time of delivery?

Suctioning of the infant's mouth and trachea

The student nurse asks about the use of surfactant. Which statement indicates to the nurse that the student understands the teaching?

Surfactant decreases the risk of bronchopulmonary dysplasia

The parents of an infant diagnosed with PDA met with the cardiologist. Which statement by the mother indicates to the nurse that she understands the teaching?

The open shunt can be closed with a clip or suture

Zika is an arbovirus that can infect the neonate in utero. What would the nurse explain as the method of transmission to the parents?

Trans-placental transfer

A mother asks the nurse when her infant's nasogastric tube may be removed. What is the correct response by the nurse?

When he demonstrates a coordinated suck, swallow, breathe pattern

Alcohol related birth defects (ARBD) affect the heart, skeleton, kidneys, and ears. The nurse is the most concerned about what assessment?

cardiac anomalies

The nurse is concerned that a newborn may be suffering from neonatal methamphetamine withdrawal. Which assessment finding is indicative of neonatal methamphetamine withdrawal?

poor weight gain and excoriated skin

The nurse is administering oxygen to a 29-week gestation infant. To decrease the risk of retinopathy of prematurity (ROP), what safety measure does the nurse utilize?

use an oxygen blender to administer oxygen

The nurse is teaching parents to administer gavage feedings. Which statement made by the parents indicates to the nurse that further teaching is required?

we should lay the infant flat