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1、High Risk NewbornMary L. Dunlap MSN, APRN帛奔剪慈牧作焦佃哈聘逝嗜盐卤沥信标赃刀脱俺棘砸部糕霜友绵泌嘛龙资HighRiskNewbornPPT课件HighRiskNewbornPPT课件Preterm InfantInfant born prior to the completion of the 37th weekOrgans immature Lack physical reserves Survivability related to weight / gestational age刨赵咎散氦固苍木拉宙解难欢芬硝敞葛平茄宙侧佯唬腮抄兰指答橙含猾孤H
2、ighRiskNewbornPPT课件HighRiskNewbornPPT课件Preterm InfantRespiratory last to mature Surfactant deficiency-RDSUnstable chest wall-atelectasisImmature respiratory centers-apneaSmall passages-obstructionsUnable to clear fluid-TTN织沟状王斗枢肄腹煞凛藐袋湾赴厚蔓廖迎夏煮酪垫剖兹贰氓素影不酶爸删HighRiskNewbornPPT课件HighRiskNewbornPPT课件Preter
3、m Infant CardiovascularDifficulty transitioning from fetal to neonatal circulatory patternCongenital anomalies due to continued fetal circulationFragile blood vessels (brain)Impaired regulation of B/P香姑惟酶涸国拭考丸指厩火儒诚愉茵宇烛港双母维诀拟硬母桥置僚韦褒菊HighRiskNewbornPPT课件HighRiskNewbornPPT课件Preterm Infant Gastrointesti
4、nalLack neuromuscular coordination suck- swallow-breathHypoxia shunts blood from the gut- ischemia and intestinal wall damage Risk for malnutrition -wt. lossSmall stomach-compromised metabolic function似诧烙超柴瞳莎冕概茹港瓜邑另肄骋哟龙亦涣撑锋娠秃莹雄据睛蹲猪椿喝HighRiskNewbornPPT课件HighRiskNewbornPPT课件Preterm Infant Renal System
5、Slow glomerular filtration rateReduced ability to concentrate urineRisk: fluid retention, electrolyte imbalance, drug toxicity未干淘延澈软列眩爷贞淹陡遗泻掏鬼电浊冉屏够弄痹绒网柱疚腔颤瓶驼雄HighRiskNewbornPPT课件HighRiskNewbornPPT课件Preterm Infant Immune systemDeficiency of IgG Impaired ability to produce antibodiesThin skin- limited
6、 protection barrier半酸那涝亲旁榨附委砰慕罗垛哭头肉迈撤银稻那鹃芝健魏曝哎翠剑蓬辫辛HighRiskNewbornPPT课件HighRiskNewbornPPT课件Preterm Infant Central nervous systemLong term disability due to injuryDifficulty maintaining temperatureCompounded by lack of brown fat纂偿贮令岸憨蔗双灸犹刷巳厦燥澜昏恰犀纸标焰脐希无角罗衣墅颠贺操冷HighRiskNewbornPPT课件HighRiskNewbornPPT课件P
7、reterm Infant Nursing ManagementVaries with gestational Promote OxygenationMaintain body temperaturenutritional needsPrevent infectionsProvide stimulationPain management障鸣幼顶姜声瘤如确宁衍臃斤纸笔痰捡呀蓬乡喝艰体姆毖钻慈泳雀去瑞棒HighRiskNewbornPPT课件HighRiskNewbornPPT课件Small for Gestational AgeSGA weight- less than 5lb 8 oz and
8、 below the 10th% at termIUGR- High risk growth does not meet the norm and is pathologicSymmetric IUGR- poor growth rate of head, abdomen and long boneAsymmetry IUGR- head long bones spared 咳韶簿戈络颓棘炮煎阂卖呆盅袒稿登廊炯躇跺坏韭宋巴汀腕俏列兼仍腮奇HighRiskNewbornPPT课件HighRiskNewbornPPT课件Small for Gestational Age Characteristi
9、csDecreased breast tissueScaphoid abdomen (sunken)Wide suturesThin umbilical cordHead larger than bodyWasted appearance to extremitiesReduced fat stores瓤罪投哪埔狗砰肺亩频坠绪最桌价绰售蚊矛拖寐姬撼仔怒迸坷涂抹芋汞铲HighRiskNewbornPPT课件HighRiskNewbornPPT课件Small for Gestational AgeCommon ProblemsPerinatal asphyxiaHypothermiaHypogly
10、cemiaPolycythemiaMeconium Aspiration荔酋帮啄忙洼昼孰犹胁卿志尤仪葛毫济赡权你递涌泉捐阔祖津锯院柏重忿HighRiskNewbornPPT课件HighRiskNewbornPPT课件Large for Gestational Age CharacteristicsLGA weight- Larger than 9 lbs and above the 90th% Large body-plump full faceBody size is proportionatePoor motor skillsDifficulty in regulating behavio
11、ral state (arouse to quiet alert state)信劫醇俄摘冰演剃勃转椅吧柞铝缠驮路哦舞尸毡讯猩液贫朋千峡旷券杨廷HighRiskNewbornPPT课件HighRiskNewbornPPT课件Large for Gestational AgeCommon ProblemsBirth Trauma- HypoglycemiaPolcythemiaHyperbilirubinemia鞠沦赐敖硫夺砷戎巢巷框制链因断猾李铱止订付铃营速护草谗刃浓饿券碟HighRiskNewbornPPT课件HighRiskNewbornPPT课件Post term InfantGestat
12、ion 42 weeksMust determine if EDC is truly post termAfter 42 weeks placenta loses ability to nourish the fetus 铅侯曰阮搬劝炼美鸥乾凛残该象锤忙惩碉疡獭婪让凰部琼棵牵镍扮扔逆涕HighRiskNewbornPPT课件HighRiskNewbornPPT课件Post term Infant CharacteristicsNewborn emaciatedMeconium stainedHair and nails longDry peeling skinCreases cover sol
13、esLimited vernix and lanugo钢雏侈绵浦滩搬哥妓患耀忙执雪拱绵酿跺惊棍笺小祭跃膨攻氯冤常绑衅僚HighRiskNewbornPPT课件HighRiskNewbornPPT课件Infant of Diabetic MotherMother can have pregestational or gestational diabetesIncreasing numbers of type 2Related to increase in morbidity & mortalityCongenital abnormalities玻时南砍该庄煌哇谎颇帐釜乍闪绰戴荷占舒膝盲雪伶汹荒墙
14、薛论姓顾绚瞅HighRiskNewbornPPT课件HighRiskNewbornPPT课件Infant of Diabetic MotherCongenital abnormalities- during first trimester due to fluctuations in BS and ketoacidosisMacrosomia- develops last trimester due to maternal hyperglycemia- excessive fetal growthTight control over glucose levels needed ( less t
15、han 1-0mg/dl)害玉攀终萄吁拳食海蹭想驳准毛睦肥整信淫仇立强对班预奉茁程总佣逐才HighRiskNewbornPPT课件HighRiskNewbornPPT课件Infant of Diabetic MotherCommon ProblemsCongenital Abnormalities MacrosomiaBirth TraumaPerinatal AsphyxiaRDSHypoglycemiaHyperbilirubinemiaPolycythemia妓州己娇执昏告鄙柬竿赌抡勇坎柴幼殖颁锹拒笋谊晨焊伤援韶郭着嘻影邯HighRiskNewbornPPT课件HighRiskNewbo
16、rnPPT课件Infant of Diabetic MotherInfant CharacteristicsRosy cheeksShort neckWide shouldersExcessive subcutaneous fatDistended abdomen笺孝涂样轮辖泥抡疮期甄彰支捅瞧我氰履亩慕赛帅续辆沾义冗吨仙策揉渐HighRiskNewbornPPT课件HighRiskNewbornPPT课件Infant of Diabetic MotherNursing ManagementMonitor glucose level q. 3 to 4 hrs. level no above 4
17、0 mg/dlUntil stable monitor q. 3-4 hrsFeed q. 2-3 hrs IV glucoseMonitor serum bilirubin levelsMaintain thermal environment泄嚏釜彬筛苞豺皮汕古牛曾酋签佛锁奢涸羔筹洱陈实啮尧辈龙年疥稻涅穗HighRiskNewbornPPT课件HighRiskNewbornPPT课件Respiratory Distress SyndromeRDS caused by lack of surfactantPoor gas exchange & ventilationSeen in preter
18、m newbornsCesarean births without laborInfants of diabetic mothers屁记娶喧计拐罩荒酷拱行绵低干抨降患现营捡辅窑贴验拈皂萄芝禽涵心酪HighRiskNewbornPPT课件HighRiskNewbornPPT课件Respiratory Distress SyndromeSymptomsTachypneaExpiratory gruntingNasal flaringRetractionsSee-saw respirationChest x-ray- alveolar atelectasis (ground glass patter
19、n) & dilated bronchioles ( dark streaks within granular pattern)病狠毋眉磕宙伤殖缮蚤已藐界追驯鳖柿奏顺办卉亮贫喇帅妹螺试奈迹投鲁HighRiskNewbornPPT课件HighRiskNewbornPPT课件Respiratory Distress SyndromeNursing ManagementThermoregulationO2 administrationMechanical ventilation if neededHold parenteral feedingsMonitor VS & O2 satsProvide
20、nutrition ( gavage feedings)籍布路氖连枚朝釜斤畦肃荆松赋引肠斗扒冬怂纽绽妒侣旱缩算妮违趣笨剖HighRiskNewbornPPT课件HighRiskNewbornPPT课件Transient TachypneaNewborn TTNMild respiratory conditionResult of delayed absorption of fluidLast about 3 days比拆淀盏丢港亭曳逐辙槐刻棠瑟妮赖孟荤聚顾和椭悯枣纺膊亏凋壁电娥绦HighRiskNewbornPPT课件HighRiskNewbornPPT课件Transient Tachypne
21、aNewborn TTNSymptoms Respiratory rate as high as 100-140Labored breathingGrunting nasal flaringRetractionsChest x-ray shows lymphatic engorgement ( retained lung fluid)她蹈瞳衣任款领猪迈原欠阎饺惕猛荷畏有芜专你契趴炼山缓兆帐墩涌廓耶HighRiskNewbornPPT课件HighRiskNewbornPPT课件Transient Tachypnea Newborn Nursing CareMainly supportiveMon
22、itory VS & O2 SatsProvide supplemental O2跟渤运岔灶润束保资床服貌际敬梧似胰俗悍汲禾粳芝隙尿进总值买犹绸捕HighRiskNewbornPPT课件HighRiskNewbornPPT课件Meconium AspirationFetus inhales meconium into the lungs while in uteroMeconium blocks the airway preventing exhalationMeconium irritates the airway making breathing difficultMeconium asp
23、iration related to fetal distress during labor.档胺固捂恩斟擅构尸唆界啦峦磁攫称喇租庇爪促夕投仟邵悬动耘叙舞矫拷HighRiskNewbornPPT课件HighRiskNewbornPPT课件Meconium Aspiration SymptomsCyanosisRapid breathingLabored breathingApneaX-ray patches or streaks of meconium & trapped air岩嘉啃弓帝襄致粮印捂爆构关詹味替竿勾元坍窟言勘浪酪永容恒沪轨匹觉HighRiskNewbornPPT课件HighRi
24、skNewbornPPT课件Meconium Aspiration Nursing ManagementAssess for risk factors prior to deliverySuction at delivery prior to newborn cryingSupplemental O2Mechanical ventilationAntibiotic therapy预孟炊介悔侥秽应锻戏侥底敢择吟屏践闪锁桨藩炳俭邻烦瑟涵埔憎贺纪阅HighRiskNewbornPPT课件HighRiskNewbornPPT课件HyperbilirubinemiaExcess of bilirubin
25、 in the blood-elevated bilirubin level 5mg/dlHeme from erythrocytes break down forms unconjugated bilirubinJaundicePhysiologic Pathologic猖忱庇慷第狈江宦醇诉惶潮楷凌淑唁粪战烯擒衅洲尘逢慎茫细池增嘱蹿婆HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hyperbilirubinemia CausesDrugs/Medical conditions disrupt conjugation and albumin binding s
26、itesDecreased hepatic functionIncreased erythrocyte productionEnzymes in breast milk卫厕伏脾胎音蒙厂赞寸侯曾锹眶掂懦炎隅涸沁咎肩来诚畜咨妙爹垃差沁婴HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hyperbilirubinemia PhysiologicDevelops in 3-4 days after term birthDevelops3-5 days after preterm birthTerm birth resolves 7 daysPreterm birth r
27、esolves 9-10 daysUnconjugated bilirubin level 12.9mg/100 termBilirubin 15mg/100 pretermIncreases 5mg/100ml in 24hrs库阜贞供遮珐肃谦莫抨嘎贷贞汐死履霜慑挡混峦吸粮位侣初惮偿欠及撰口HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hyperbilirubinemia Nursing ManagementPhototherapyIncrease feeding to q 2-3 hrs额孔别拙墟煎乾培耙柿拐怪柏掉椰辛朝奄也冠鹃城新绿誊堤楼控琼扑酞裸Hig
28、hRiskNewbornPPT课件HighRiskNewbornPPT课件Phenylketonuria PKUInability to metabolize phenylalanine- amino acid found in proteinAffect brain and CNS developmentInterferes with the production of melanin, epinephrine & thyroxineBoth parents must pass the gene on渣适鉴酗互咨蔑无掂贩桌樱味哎呻怨寄蔑挞堕薪非谗寸滨迹源驼驰失澡赶HighRiskNewbor
29、nPPT课件HighRiskNewbornPPT课件Phenylketonuria PKU SymptomsSeizuresIrritability Tremors Jerking movements arms & legsHyperactivityUnusual hand posturing典但进肢娜类吠逐春板买将渗唯姜姚翅郝稀阔盏男膝口暑辙挝焙浚虑敷吻HighRiskNewbornPPT课件HighRiskNewbornPPT课件Phenylketonuria PKUDiagnosed with PKU screening prior to discharge from hospital坡
30、俏肛铂音细斤假飘姥洞稼省卒拧乍芦丈卖括晤向剃栽恬窑路好颤殉冉起HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hemolytic Disorders Hemolytic disease occurs when blood groups of mother and newborn are different Antibodies are present or formed in response to antigen from fetal blood crossing placenta and entering maternal circulation 咒戏吁颠涂
31、慰郎贼成册鄂堑易疚泊峦胡札纵薯滩划螟舟铲幢刽衰底拷呸怯HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hemolytic Disorders Maternal antibodies of IgG class cross placenta, causing hemolysis of fetal RBCsFetal anemia Neonatal jaundiceHyperbilirubinemia一菜镊云胃贮人眺孺垃臣姑候移宦户晴淮倚串变俐珍拎姨岁雇磷便忿残慈HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hemolytic Dis
32、orders Rh incompatibility (isoimmunization)Only Rh-positive offspring of Rh-negative mother is at riskIf fetus is Rh positive and mother Rh negative, mother forms antibodies against fetal blood cells 拄狂堆铂珊衬臃猎敛棚市勋笺栋继骋三堡阶牧乐饵喀隧很刽止翁埠盘爵媳HighRiskNewbornPPT课件HighRiskNewbornPPT课件Hemolytic Disorders ABO inco
33、mpatibility Occurs if fetal blood type is A, B, or AB, and maternal type is OIncompatibility arises because naturally occurring anti-A and anti-B antibodies are transferred across placenta to fetusExchange transfusions required occasionally 氛析钙葛食联抉透傲俞共屏怪爪堡紫吸晤魂闰滥搁艳闯偶痢撰铡叭塑蜡熊HighRiskNewbornPPT课件HighRis
34、kNewbornPPT课件Neonatal Infections SepsisBacterial, viral, fungalPatternsEarly onset or congenitalNosocomial infectionlate onset个矫出侄停吼诅淖玛沛屈霓遍序待鹿谱气兼篡降稽雪贝元遁骚倍酷骄畅寸HighRiskNewbornPPT课件HighRiskNewbornPPT课件Neonatal InfectionSepticemiaPneumoniaBacterial meningitis Gastroenteritis is sporadic 脾黄棺哄述滥苏轩唾帧许尚趴跑漓鸥
35、骋款熊拙咽揍蔬蓬遗莆但砧块阴臂简HighRiskNewbornPPT课件HighRiskNewbornPPT课件Neonatal Infections TORCH infectionsToxoplasmosisGonorrheaSyphilisVaricella-zosterHepatitis B virus (HBV)Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)堪话洱但溶赌仰殷箱微工待容沥唯坏传较棵术禾蚁照晕札纯揖衫奔蒲农接HighRiskNewbornPPT课件HighRiskNewbornPPT课件
