The High Risk Newborn: Maternal

Most advantageous positions for facilitating an infant's open airway

1. side-lying with the head supported in alignment by a small folded blanket 2. supine, positioned to keep the neck slightly extended. With the head in the "sniffing" position, the trachea is opened at its maximum; hyperextension reduces the tracheal diameter in neonates

late preterm infant is defined as

34-36 weeks of gestation

Heel stick for baby. Blood sugar should be above?

40

We want to keep O2 sat between what percentages for newborns? What would happen if the sat was too high?

93-97% retinopathy (oxygen blindness)

Lab studies for sepsis

CBC, blood culture, CSF (spinal tap), urine collection, chest x ray to look for pneumonia

Nursing considerations for toxoplasmosis

Caution pregnant women to avoid contact with cat feces (ex. emptying cat litter boxes) and to avoid eating raw or undercooked meat Administer sulfadiazine (wiht folinic acid) and pyrimethamine (Daraprim)

The nurse is informing a diabetic pregnant patient about the dietary changes, need for exercise, and possible risks to the fetus. Which fetal risks does the nurse need to inform the patient about? Select all that apply. Galactosemia Hypoglycemia Phenylketonuria Fetal macrosomia Respiratory distress syndrome

Fetal macrosomia is seen in some infants born to diabetic women due to maternal hyperlipidemia and increased lipid transfer to the fetus. Hypoglycemia is seen in infants of diabetic women at birth because the infant's glucose supply is removed abruptly at the time of birth. Hyperinsulinemia and hyperglycemia reduce fetal surfactant synthesis and cause respiratory distress syndrome in the infant of a diabetic woman. Galactosemia is an autosomal recessive disorder that results from various gene mutations. Phenylketonuria is an inborn error of metabolism.

Which therapy is the primary health care provider likely to prescribe for a late-preterm infant with persistent pulmonary hypertension? Fluid therapy Phototherapy Inhaled nitric oxide Skin-to-skin contact

Inhaled nitric oxide is blended with oxygen and administered through the ventilator circuit for the treatment of persistent pulmonary hypertension in late-preterm infants. Fluid therapy is more effective in infants with fluid imbalances, not pulmonary hypertension. Skin-to-skin contact is used to help infants maintain thermal stability. Phototherapy is an effective treatment for infants with jaundice because it helps decrease bilirubin levels.

The clinical reports of a pregnant patient who is Rh negative indicate Rh(D) sensitization. Which nursing intervention is a priority in this case? Preparing the infant for intrauterine transfusion Preparing the pregnant patient for phototherapy Obtaining a prescription for phenobarbital (Luminal) Administering Rh immunoglobulin (RhIg), a human gamma globulin concentrate

Intrauterine transfusion in the infant helps treat hyperbilirubinemia and hydrops caused by Rh incompatibility. RhIg is administered to unsensitized Rh-negative mothers to prevent the development of maternal sensitization to the Rh factor. Phototherapy is most effective to decrease bilirubin level in the infant. Phenobarbital (Luminal) is used to decrease drug withdrawal effects in an infant exposed to a drug in the uterus.

What diseases do you assess for for respiratory in an infant

NEC PDA (patient ductuc arteriosus) IVH (intraventricular hemorrhageO

Are bacterial infections included in TORCH?

No bc they are usually identified by clinical manifestations and readily available lab tests

The nurse is assessing an infant born after 42 weeks of gestation. Which characteristics may be seen in the infant? Select all that apply. Soft cranium Weak gag reflex Green vernix caseosa Small, scrawny appearance Wasted physical appearance

Rationale An infant born after 42 weeks of gestation is a postterm infant. The infant may have a wasted physical appearance that indicates intrauterine deprivation. There is little green or deep yellow vernix caseosa in the infant's skinfolds, which indicates meconium in the amniotic fluid. Weak gag reflex, small and scrawny appearance, and a soft cranium are characteristics of a preterm infant.

The nurse observes fever, diarrhea, and vomiting in an infant 2 days after birth. On assessment the nurse finds that the mother used drugs during pregnancy. Which is the best screening method to determine the cause of the infant's condition? Coombs' test Urine toxicology Meconium sampling Kleihauer-Betke assay

Rationale An infant born to a parent who uses drugs is likely to have the withdrawal effects of the drug. Therefore meconium sampling is performed because it helps identify drug exposure. Coombs' test is used to identify antibodies in the blood. The Kleihauer-Betke assay is used to assess transplacental bleeding. Urine toxicology may be used to assess drug exposure, but it may provide less accurate results because it reflects only recent substance intake by the mother.

The nurse is assessing an infant after a difficult birth. Which signs in the infant indicate Erb's palsy? Select all that apply. A grasp reflex may be present in the infant. The infant's arm hangs limp alongside the body. The elbow is extended, and the forearm is pronated. The hand muscles are paralyzed, and there is a wrist drop. The shoulder and the arm are adducted and rotated internally.

Rationale Erb's palsy is caused when the upper plexus is damaged. It results from stretching or pulling away of the shoulder from the head during a difficult birth. As a result the infant's arm hangs limp alongside the body. The shoulder and the arm are adducted and rotated internally because of the paralysis of the affected extremity. The elbow is extended, and the forearm is pronated with the wrist and fingers flexed. A grasp reflex may be present because the finger and wrist movement remain normal. The infant's hand muscles are paralyzed, and there is a wrist drop in lower-plexus palsy. This results from the stretching of the upper extremity while the trunk is less mobile.

An infant born to a diabetic patient is prescribed oral glucose for the treatment of hypoglycemia. On assessment the nurse finds that the infant's cardiorespiratory condition is stable. Which is a priority nursing intervention in this case? Initiating dextrose infusion Asking the parent to breastfeed Lowering the dosage of oral glucose Obtaining blood from the heel for testing

Rationale The administration of oral glucose may trigger a massive insulin release and cause rebound hypoglycemia in the infant. Therefore the nurse instructs the parent to breastfeed if the infant's cardiorespiratory condition is stable. The nurse does not lower the dosage of oral glucose because a lower dosage may not have therapeutic effects. Dextrose infusion is necessary for infants born to women with poorly controlled diabetes. The aim is to maintain serum blood glucose levels between 40 and 50 mg/dL. Blood is obtained from the infant's heel for testing purposes to detect hypoglycemia in the infant, not after hypoglycemia is identified. p. 657

Which nursing interventions are included in the plan of care of an infant with septicemia? Select all that apply. Encouraging the parent to breastfeed the infant Implementing isolation procedures as instructed Administering fluids and antibiotics simultaneously Performing routine suctioning to prevent complications Administering antibiotics within 1 hour after they are prepared

Rationale The nurse administers antibiotics to the infant within 1 hour after they are prepared to avoid the loss of drug stability. The nurse implements isolation procedures as instructed to prevent the risk of infection in the infant. The nurse encourages the parent to breastfeed the infant because breast milk contains protective mechanisms that provide a barrier to infection. Fluids and antibiotics are not administered simultaneously because they may interact and deactivate the drug. Suctioning is performed only when it is needed because routine suctioning may cause hypoxia and thus increase intracranial pressure.

Which interventions does the nurse incorporate in the plan of care to comfort the parents after the death of their preterm infant? Select all that apply. Notifies a member of the clergy if the parents desire Discusses the funeral arrangements with the parents Encourages the parents to take a photograph with the infant Avoids expressing grief for the infant in front of the parents Takes the infant away if the mother is unwilling to see the infant

Rationale The nurse encourages the parents to take a photograph with their infant to help them personalize the experience. The parents may not have any experience of infant death, so the nurse needs to talk to the parents about the funeral arrangements. The nurse will also notify a member of the clergy for any ritual if the parents desire. The nurse keeps the infant's body in the unit for a few hours even if the mother is unwilling to see the infant. The mother or the parents may want to see the infant after adjusting to the initial shock of loss. The nurse may experience grief and feel sorrowful. The nurse need not control the grief and should work through the grief process by attending the funeral or memorial service.

Which actions does the nurse take while counseling anxious parents who visit their preterm infant in an neonatal intensive care unit? Select all that apply. Informs the parents of visiting hours. Avoids telling the parents any unpleasant facts. Encourages the parents to express their sadness. Persuades the parents to touch and hold the infant. Explains the function of each piece of equipment used.

Rationale The nurse explains the function of each piece of equipment that is attached to the infant because this helps lessen fears and anxiety in the parents. The nurse may further alleviate their anxiety by informing them that they can visit the infant anytime. The nurse encourages the parents to express feelings of sadness so that they are better able to focus on their infant. The nurse needs to inform the parents honestly about all of the infant's conditions. The parents may not be ready to touch or hold the infant because of fear. Therefore the nurse should not persuade the parents to do so and should let the parents adjust to the infant's condition.

A patient who used cocaine during pregnancy asks the nurse about feeding the infant. The infant is being treated for cocaine withdrawal symptoms. After further discussion, the nurse finds that the patient is not willing to participate in the drug rehabilitation program and still uses cocaine frequently. What does the nurse instruct the patient related to infant nutrition? "Avoid breastfeeding the child." "The child needs parenteral nutrition." "Avoid using infant formulas for the child." "Breastfeeding may be good for the child."

Rationale The nurse instructs the parent to avoid breastfeeding the infant because significant amounts of cocaine are found in breast milk. Breastfeeding may expose the child to further complications. The nurse encourages the parent to use infant formulas because they are safe for the infant. Parenteral nutrition is not needed unless the infant is unable to feed orally.

Which nursing interventions does the nurse include in the plan of care for an infant who is receiving an exchange transfusion because of hemolytic disease? Select all that apply. Electronically monitors vital signs frequently Assesses for cardiac or respiratory problems Provides peripheral infusion of dextrose and electrolytes Prepares the infant for the procedure and orients the family Administers Rh immunoglobulin (RhIg) to the infant before the procedure

Rationale The nurse prepares the infant and the family for the procedure so that they understand what is being done. A peripheral infusion of dextrose and electrolytes is necessary because the infant needs to receive nothing by mouth (NPO) during the procedure. The nurse needs to monitor the vital signs frequently because there is a risk for cardiac and respiratory problems. The nurse needs to assess the infant for cardiac or respiratory problems so that the procedure can be stopped immediately if needed to prevent further complications. RhIg is administered to unsensitized Rh-negative mothers to prevent the development of maternal sensitization to the Rh factor. RhIg is not administered to the infant.

Which actions does the nurse take after an infant is delivered? Select all that apply. Instills antibiotics in the infant's eyes Uses cool water to clean the infant's body Cleans the cord with a neutral pH cleanser Uses nonmedicated soap to clean the infant Rubs vernix caseosa vigorously to remove it

Rationale The nurse puts antibiotics in the infant's eyes 1 to 2 hours after the birth to prevent infection. A nonmedicated soap is used to clean the infant to avoid stinging the skin. The nurse cleans the cord with a neutral pH cleanser to prevent infection. The vernix caseosa is not rubbed vigorously to remove it because this may disrupt the properties of the skin. Cool water is not used to clean the infant because it may disturb the infant's thermal stability. Instead, warm water is used to clean the blood and meconium from the infant's face, head, and body.

Which condition may be seen in a newborn infant affected by hemolytic disease? Select all that apply. Anemia Jaundice Macrosomia Anencephaly Hypoglycemia

Rationale The serum levels of unconjugated bilirubin rise rapidly in an infant with hemolytic disease after birth. The inability of the liver to conjugate and excrete the excess bilirubin results in jaundice in the infant. Anemia results from the hemolysis of large numbers of erythrocytes. Hypoglycemia may occur as a result of pancreatic cell hyperplasia. Macrosomia refers to excessive weight gain in the child after birth, most often seen in infants born to diabetic women. Anencephaly is a central nervous system anomaly seen in infants of diabetic mothers. pp. 654-655

What precautions does the nurse take while providing skin care to a preterm infant? Select all that apply. Avoids solvents to remove tape Uses hydrocolloid adhesives on the skin Uses small scissors to remove dressings Uses alkaline-based soap to clean the skin Rinses with water after using alcohol on the skin

Rationale The use of alcohol may cause severe irritation and chemical burns on the infant's skin. Therefore the nurse rinses the skin with water. Hydrocolloid adhesives are safe because they mold well to skin contours and adhere in moist conditions. Solvents are not used to remove tape, because they dry and burn the skin. Alkaline-based soap is not used because it can destroy the acid mantle of the infant's skin. The use of scissors is unsafe because they may snip off tiny extremities.

A newborn infant of a mother who has human immunodeficiency virus (HIV) infection is tested for the presence of HIV antibodies. An enzyme-linked immunosorbent assay (ELISA) is performed, and the results are positive. Which is the correct interpretation of these results? Positive for HIV Indicates the presence of maternal infection Indicates that the newborn will develop acquired immunodeficiency syndrome (AIDS) later in life Positive for AIDS

Rationale: A positive antibody test in a child younger than 18 months of age indicates only that the mother is infected because maternal immunoglobulin G antibodies persist in infants for 6 to 9 months and, in some cases, for as long as 18 months. A positive ELISA does not indicate true HIV infection or the development of AIDS, nor does it indicate that the newborn will develop AIDS later in life.

The nurse administers erythromycin ointment (0.5%) to the eyes of a newborn and the mother asks the nurse why this is performed. Which explanation is best for the nurse to provide about neonatal eye prophylaxis?Protects the newborn's eyes from possible infections acquired while hospitalized. Prevents cataracts in the newborn born to a woman who is susceptible to rubella. Minimizes the spread of microorganisms to the newborn from invasive procedures during labor. Prevents an infection called ophthalmia neonatorum from occurring after birth in a newborn born to a woman with an untreated gonococcal infection.

Rationale: Erythromycin ophthalmic ointment 0.5% is used as a prophylactic treatment for ophthalmia neonatorum, which is caused by the bacterium Neisseria gonorrhoeae. Preventive treatment of gonorrhea is required by law. Options 1, 2, and 3 are not the purposes for administering this medication to a newborn infant.

The nurse is creating a plan of care for a newborn diagnosed with fetal alcohol syndrome. The nurse should include which priority intervention in the plan of care? Allow the newborn to establish own sleep-rest pattern. Maintain the newborn in a brightly lighted area of the nursery. Encourage frequent handling of the newborn by staff and parents. Monitor the newborn's response to feedings and weight gain pattern.

Rationale: Fetal alcohol syndrome, a diagnostic category delineated under fetal alcohol spectrum disorders (FASDs), is caused by maternal alcohol use during pregnancy. A primary nursing goal for the newborn diagnosed with fetal alcohol syndrome is to establish nutritional balance after birth. These newborns may exhibit hyperirritability, vomiting, diarrhea, or an uncoordinated sucking and swallowing ability. A quiet environment with minimal stimuli and handling would help to establish appropriate sleep-rest cycles in the newborn as well. Options 1, 2, and 3 are inappropriate interventions.

The nurse has provided instructions about measures to clean the penis to a mother of a male newborn who is not circumcised. Which statement, if made by the mother, indicates an understanding of how to clean the newborn's penis? "I should retract the foreskin and clean the penis every time I change the diaper." "I need to retract the foreskin and clean the penis every time I give my infant a bath." "I need to avoid pulling back the foreskin to clean the penis because this may cause adhesions." "I should gently retract the foreskin as far as it will go on the penis and then pull the skin back over the penis after cleaning."

Rationale: In male newborn infants, the prepuce is continuous with the epidermis of the glans and is not retractable. If retraction is forced, this may cause adhesions to develop. The mother should be told to allow separation to occur naturally, which usually occurs between 3 years and puberty. Most foreskins are retractable by 3 years of age and should be pushed back gently at this time for cleaning. Options that identify actions that retract the foreskin are therefore incorrect

The nurse employed in a neonatal intensive care nursery receives a telephone call from the delivery room and is told that a newborn with spina bifida (myelomeningocele type) will be transported to the nursery. The maternity nurse prepares for the arrival of the newborn and places which priority item at the newborn's bedside? A rectal thermometer A blood pressure cuff A specific gravity urinometer A bottle of sterile normal saline

Rationale: Spina bifida is a central nervous system defect that results from failure of the neural tube to close during embryonic development. The newborn with spina bifida is at risk for infection before the closure of the sac, which is done soon after birth. A sterile normal saline dressing is placed over the sac to maintain moisture of the sac and its contents. This prevents tearing or breakdown of the skin integrity at the site. A thermometer will be needed to assess temperature, but in this newborn the priority is to maintain sterile normal saline dressings over the sac. Blood pressure may be difficult to assess during the newborn period and is not the best indicator of infection. Urine concentration is not well developed in the newborn stage of development.

The nurse is assessing the reflexes of a newborn infant. In eliciting the Moro reflex, the nurse should perform which action?Rationale: The Moro reflex is elicited by placing the newborn on a flat surface and striking the surface or making a loud, abrupt noise to startle the newborn. The newborn assumes sharp extension and abduction of the arms with the thumbs and forefingers in a C position; this is followed by flexion and adduction to an "embrace" position (legs follow a similar pattern). The Moro reflex is present at birth and is absent by 6 months of age if neurological maturation is not delayed. A persistent response lasting more than 6 months may indicate a neurological abnormality. The plantar grasp reflex is elicited by stimulating the ball of the foot by firm pressure, and the palmar grasp reflex is elicited by stimulating the palm of the hand by firm pressure. The rooting reflex is elicited by stimulating the perioral area with the finger. 1. Make a loud, abrupt noise to startle the newborn. 2. Stimulate the ball of the foot of the newborn by firm pressure. 3. Stimulate the perioral cavity of the newborn infant with a finger. 4. Stimulate the pads of the newborn infant's hands by firm pressure

Rationale: The Moro reflex is elicited by placing the newborn on a flat surface and striking the surface or making a loud, abrupt noise to startle the newborn. The newborn assumes sharp extension and abduction of the arms with the thumbs and forefingers in a C position; this is followed by flexion and adduction to an "embrace" position (legs follow a similar pattern). The Moro reflex is present at birth and is absent by 6 months of age if neurological maturation is not delayed. A persistent response lasting more than 6 months may indicate a neurological abnormality. The plantar grasp reflex is elicited by stimulating the ball of the foot by firm pressure, and the palmar grasp reflex is elicited by stimulating the palm of the hand by firm pressure. The rooting reflex is elicited by stimulating the perioral area with the finger.

Name of the shot given to mother at 28 weeks for rH factor

RhoGAM

Which action does the nurse implement in the plan of care of a breastfeeding infant if the mother is taking selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression? Administers antibiotics to the infant Asks the parent to avoid breastfeeding Assesses the infant's skin for side effects Monitors the infant for sleep disturbances

SSRIs are prescribed for depression. However, the drugs pass into the breast milk after the infant's birth and cause sleep disturbances, irritability, and poor feeding. Hence, the nurse needs to monitor the infant for these conditions. The nurse administers antibiotics to infants who have infections. SSRIs do not have any side effects on the infant's skin. The nurse does not ask the parent to avoid breastfeeding because breast milk is beneficial for the infant's health.

Why might sepsis occur?

STD's or late onset of a nosocomial infection

SSx of NEC (necrotizing enterocolitis)

Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall.

What is an exchange transfusion?

Used for babies with hemolytic disorder. Exchange transfusions, in which the infant's blood is removed ini small amounts and replaced with compatible blood, is a standard mode of therapy for treatment of sever hyperbilirubinemia and is the treatment of choice for hyperbilirubinemia and hydrops caused by Rh incompatibility. Indications for exchange transfusion in full-term infants may include a rapidly increasing serum bilirubin level and hemolysis despite intensive phototherapy.

What is hydrocephalus?

a condition in which fluid accumulates in the brain, typically in young children, enlarging the head and sometimes causing brain damage.

What is macrosomia?

a newborn who weighs significantly more than an average newborn

Cytomegalovirus infection is

a rash on the infant's body caused by fetal exposure to drugs

Congenital malformations are more likely to be seen in infants exposed to _______, not as a result of _________.

alcohol, diabetes

a preterm infant is defined as

an infant born before 37 weeks of gestation

congenital vs. health associated

congenital is an earlier onset than health associated

Nursing care for substance abuse baby

decrease stimuli swaddle baby give them a pacifier bc they have frantic sucking

postterm infant is defined as

gestation that extends beyond 42 weeks

Primary therapeutic management of hemolytic disorders

immunization To be effective RhIg (RhoGAM) must be administered to unsensitized mothers during first pregnancies and within 72 hours after the first birth or spontaneous/therapeutic abortion. It is also administered during subsequent pregnancies at 26-28 weeks of gestation and aafter pregnancy losses.

If the baby has a hemolytic disorder, they are most likely going to show signs of

jaundice

A birth trauma baby is at risk for?

jaundice *make sure baby eats frequently*

excessive bilirubin that causes neurological damage to the brain

kernicterus

Silverman-Anderson index: We want the number to be high or low

low

What would a baby with fetal alcohol syndrome look like?

microcephaly short palpebral fissures (almond shaped eyes) Flat midface poor feeding learning disabilities NCLEX: Abnormal palmar creases

the term used to describe the set of behaviors exhibited by infants exposed to opioids in utero

neonatal abstinence syndrome

Risks for a newborn with a diabetic mother

newborns are macrosomic so risk for birth injuries, risk for hypoglycemia short after birth (initiate early feeding). Infants born to mothers with poorly ontrolled diabetes may require IV dextrose (D10). Goal is to have glucose levels ranging from 40-50

Effects of Substance abuse in a neonate

shrill or high-pitched cry inconsolable frantic sucking poor feeding nasal stuffiness precipitous delivery (from onset to delivery is 3 hours)

SSx of neonatal sepsis

temp instability lethargy poor feeding respiratory distress Pale/dusky appearance

Which TORCH infection could be contracted by the infant because the mother owned a cat?

toxoplasmosis

What does TORCH complex stand for?

toxoplasmosis Other (hep b, HIV, Parvovirus, west nile) Rubella Cytomegalovirus Herpes Simplex Virus

What should you do to keep an infant from having apnea?

warm them slowly