Chapter 24 Preterm Complications

How much feeding will a preterm infant be fed?

105-130 kcal/kg/day

What volume of urine output indicates oliguria in a preterm infant after 24 hours of birth?

< 0.5 ml/kg/hr indicates oliguria in a preterm infant

Which test would be performed prior to 38 weeks to determine fetal lung maturity? Biophysical profile Glucose tolerance test Amniotic fluid test Group B strep test

Amniotic fluid test

Postterm infants are at an increased risk for which of the following Asphyxia Apneic spells Respiratory Distress Syndrome Meconium aspiration Decreased amniotic fluid Compression of the umbilical cord

Asphyxia Meconium Aspiration Decreased Amniotic fluid compression of the umbilical cord

In which aspect of care would the parents of a preterm infant be encouraged to participate? Administer medications Provide all gavage feedings Assist with bathing Obtain blood glucose level

Assist with bathing

BPD Bronchopulmonary distress syndrome

BPD: chronic lung disease that requires oxygen for 28 days after birth - caused by mechanical vetilation, too much O2

Which criterion finding would be fulfilled prior to the administration of enteral feedings? Presence of bowel sounds Use of room air oxygenation Presence of suck reflex Vascular access with a central line

Before giving enteral feeds: - presence of bowel sounds - no abdominal distention - relatively stable condition

Which condition in an infant would suggest overstimulation? Increased sleep Changes in oxygenation Flexed positioning An alert, calm expression

Changes in oxygenation

Which assessment finding suggests inadequate thermoregulation one day after a preterm infant is transferred to an open crib?

Decreased weight gain - also poor feeding and oxygen requirement

Which secondary effect would cue-based feedings have on the preterm infant? Regulating blood glucose level Enhancing oxygenation Development of sleep-wake cycles Enhancing oxygenation Assisting with parental attachment

Development of sleep-wake cycles

Which measure would decrease the risk of necrotizing enterocolitis (NEC) in a newborn when the mother's milk is not available? Formula feeding Early enteral feedings Donor breast milk Nothing by mouth (NPO)

Donor breast milk

ELBW - VLBW

ELBW - < 1000 g VLBW - < 1500 g

Which benefit would "rooming-in" prior to discharge provide to parents? Enhances parental confidence Promotes parent-infant bonding Helps assess sibling interaction Aids in development of feeding routine

Enhances parental confidence

Which sign would indicate feeding complications in high-risk infants? Passage of meconium High-pitched bowel sounds Frequent regurgitation Excessive flatus

Frequent regurgitation

Which reason is associated with nutritional problems in preterm infants? Select all that apply. One, some, or all responses may be correct. Gastrointestinal tracts do not absorb nutrients well. Preterm infants have a smaller stomach capacity. Preterm infants require fewer nutrients per kilogram. Preterm infants have insufficient enzymes to digest protein. Glucose reserves are used quickly after birth.

Gastrointestinal tracts do not absorb nutrients well. Preterm infants have a smaller stomach capacity. Glucose reserves are used quickly after birth. --------------------------------------------------- preterm infants have insufficient enzymes to digest FATS, but can digest protein

Hyperbilirubinemia

Hyperbilirubinemia phototherapy treatment - risk for fluid volume deficit - risk for hyperthermia

Which action by the nurse would be expected for an overstimulated infant? Increase rest periods of the infant. Encourage parents to participate in care. Talk to the infant in a calm voice. Enhance the lightning around the infant's incubator.

Increase rest periods of the infant.

Which sign during an assessment would alert the nurse to the development of necrotizing enterocolitis (NEC)? Select all that apply. One, some, or all responses may be correct. Yellowing of the skin Increased abdominal measurement A bulging fontanel Loops of bowel seen through the abdomen Decreased bowel sounds

Increased abdominal measurement Decreased bowel sounds Loops of bowel seen through the abdomen

Which treatment would be appropriate for a preterm infant experiencing respiratory distress? Select all that apply. One, some, or all responses may be correct. Intravenous fluids Antibiotics Increased oral intake Surgery Surfactant administration

Intravenous fluids Antibiotics Surfactant administration

Which nursing intervention would be used before delivery to prepare parents for high-risk newborn care?

Plan for parents to visit the NICU

For which reason would adhesive tape be avoided when securing tubes or other equipment to a preterm infant? Adhesive ingredients may have a high risk of anaphylaxis. Removal may cause excessive bleeding. The adhesive may be absorbed through the skin. Removal may damage the skin and increase the risk of infection.

Removal may damage the skin and increase the risk of infection.

Which nursing intervention would help protect the preterm infant's skin? Avoiding the use of aqueous chlorhexidine gluconate solutions for disinfection Removing disinfectants with sterile water or saline Using warm water without soap for bathing Bathing preterm infants daily Regulating the humidity in incubators applying emollients to dry skin and fissures

Removing disinfectants with sterile water or saline Using warm water without soap for bathing Regulating the humidity in incubators Applying emollients to dry skin and fissures ----------------------- povidone-iodine should not be used on newborns that are preterm since it is toxic and can damage the thyroid. Chlorhexidine gluconate is okay.

Which complication would occur as a result of physical immaturity in late preterm infants? Hyperglycemia Alkalosis Respiratory disorders Hypobilirubinemia

Respiratory disorders

Which intervention would prevent fluid volume overload during IV medication administration to a preterm infant? Diluting medication in a moderate amount of fluid Assessing the IV site every hour Setting the infusion control device to administer fluid at 0.01 mL/hour Administering a small blood transfusion to replace blood drawn for laboratory tests

Setting the infusion control device to administer fluid at 0.01 mL/hour

Which sign suggests that the preterm infant may be overhydrated? Select all that apply. One, some, or all responses may be correct. Urine-specific gravity greater than 1.012 Edema Bulging fontanels Decreased sodium, protein, and hematocrit levels Moist breath sounds Breathing difficulty

Signs of OVERHYDRATION in a preterm infant Edema bulging fontanels decreased Na, protein, and hematocrit levels moist breath sounds breathing difficulty ----------------------- urine specific gravity at < 1.005 is overhydration

For which reason is enteral feeding advised for high-risk infants? Select all that apply. One, some, or all responses may be correct. Stimulates the gastrointestinal tract Decreases the need for parenteral nutrition Decreases feeding intolerance Enhances gut motility Reduces breast milk dependency

Stimulates the gastrointestinal tract Decreases the need for parenteral nutrition Decreases feeding intolerance Enhances gut motility

Which intervention would the nurse avoid in an infant at risk of intraventricular hemorrhage? Suctioning Swaddling Head circumference measurement Developmental care

Suctioning

Which action would the nurse perform to comfort an infant diagnosed with retinopathy of prematurity (ROP)? Swaddling the infant Increasing oxygen administration Using heat packs for comfort Avoiding eye drops

Swaddling the infant

Which criterion must be met for skin-to-skin care (SSC) to be initiated in a high-risk infant? Supplemental oxygen is not used. Weight has reached 2000 g. The infant's condition is stable. The infant has been extubated.

The infant's condition is stable.

Which sign in a gavage-fed infant would indicate readiness for nipple feeding? A respiratory rate of greater than 60 breaths per minute Sucking on gavage tube The absence of a gag reflex The presence of rooting

The presence of rooting

1. Because late preterm infants are more stable than early preterm infants, they may receive care that is much like that of a full-term baby. The mother-baby or nursery nurse knows that these infants are at increased risk for which of the following? (Select all that apply.) a. Sepsis b. Hyperglycemia c. Hyperbilirubinemia d. Cardiac distress e. Problems with thermoregulation

a. Sepsis c. Hyperbilirubinemia e. Problems with thermoregulation

Exposure to which stressor may interfere with the development of normal sleep-wake cycles in an infant? a. Assessment and treatment b. High-pitched alarms c. Bright light

a. Assessment and treatment

21. A newborn assessment finding that would support the nursing diagnosis of postmaturity would be a. loose skin. b. ruddy skin color. c. presence of vernix. d. absence of lanugo.

a. loose skin a postmature infant will have loose skin because of decreased subcutaneous fat

What are the signs of NEC?

abdominal distention, bloody stools, diarrhea, temperature instability

15. Following the vaginal birth of a macrosomic infant, the nurse should evaluate the infant for a. hyperglycemia. b. clavicle fractures. c. hyperthermia. d. an increase in red blood cells.

b. clavicle fractures.

20. Following a traumatic birth of a 10lb infant, the nurse should evaluate a. gestational age status. b. flexion of both upper extremities. c. infant's percentile on growth chart. d. blood sugar to detect hyperglycemia.

b. flexion of both upper extremities. - large for gestational age infant is at increased risk for shoulder dystocia and clavicle fractures

18. Which nursing diagnosis would be considered a priority for a newborn infant who is receiving phototherapy in an isolette? a. Hypothermia because of phototherapy treatment b. Impaired skin integrity related to diarrhea as a result of phototherapy c. Fluid volume deficit related to phototherapy treatment d. Knowledge deficit (parents) related to initiation of medical therapy

c. Fluid volume deficit related to phototherapy treatment

7. A characteristic of a post-term infant who weighs 7lb, 12oz, and who lost weight in utero, is a. soft and supple skin. b. a hematocrit level of 55%. c. lack of subcutaneous fat. d. an abundance of vernix caseosa.

c. lack of subcutaneous fat.

Which nursing intervention is appropriate when caring for a late preterm infant with thermal instability? a. Check the infant's temperature every six hours. b. Suggest parents hold their infant while swaddling. c. Place the infant in an incubator d. Bathe the infant in warm water

c. Place the infant in an incubator -------------------------- parents must hold their infant skin-to-skin to maintain thermal stability

6. Overstimulation may cause increased oxygen use in a preterm infant. Which nursing intervention helps to avoid this problem? a. Group all care activities together to provide long periods of rest. b. Keep charts on top of the incubator so the nurses can write on them there. c. While giving a report to the next nurse, stand in front of the incubator and talk softly about how the infant responds to stimulation. d. Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.

d. Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.

13. Which data should alert the nurse caring for an SGA infant that additional calories may be needed? a. The latest hematocrit was 53%. b. The infant's weight gain is 40 g/day. c. The infant is taking 120 mL/kg every 24 hours. d. Three successive temperature measurements were 36.1°C, 35.5°C, and 36.1°C (97, 96, and 97°F).

d. Three successive temperature measurements were 36.1°C, 35.5°C, and 36.1°C (97, 96, and 97°F). Low body temperature indicates that additional calories are needed to maintain body temperature. The hematocrit is within the expected range for a newborn. A weight gain of about 20 g/day is expected. Preterm SGA infants need about 120 kcal/kg/day

9. In caring for the post-term infant, thermoregulation can be a concern, especially in an infant who also has a(n) a. hematocrit level of 58%. b. RBC count of 5 million/mcL. c. WBC count of 15,000 cells/mm3. d. blood glucose level of 25 mg/dL.

d. blood glucose level of 25 mg/dL.

What would help prevent necrotizing enterocolitis?

feeding with breast milk will help prevent NEC

What is a primary nursing intervention for a preterm infant? - touching them often - breastfeeding - helping them to conserve energy

helping them to conserve energy

periodic breathing is more common in ______ what is periodic breathing

periodic breathing is common in preterm infants Periodic breathing - 5-10 seconds of apnea followed by 10-15 seconds of rapid respirations - requires continuous monitoring - not associated with heart rate or color changes

Which intervention would help prevent heat loss by convection in a preterm infant who is kept in a radiant warmer?

placing a transparent cover over the infant

Which remedial step would the nurse begin after a preterm infant is diagnosed with necrotizing enterocolitis? encourage oral intake position the infant on the side intermittent or continuous gastric suction restrict intake and output abdominal girth measurement

position infant on the side intermittent or continuous gastric suction restrict intake and output abdominal girth measurement -------------------------------- want to restrict intake parenteral nutrition is given

For which reason would a high-risk preterm infant be placed in the flexed position? reduces energy loss Promotes lung expansion Prevents flattening of the head Enhances sleep-wake cycles

reduces energy loss

Which positions are premature infants placed in the NICU?

side-lying or prone

Which physical manifestation would alert the nurse to a possible intraventricular hemorrhage?

tense fontanel

Which nursing intervention would help to reduce noise around an infant?

using an incubator cover

Which criterion needs to be met for discharge of a high-risk infant?

weight-gain is sustained