Chapter7 Nursing Care of High-Risk Newborn and Family

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Chapter7 Nursing Care of High-Risk Newborn and
Family
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1.CLASSIFICATION OF NEWBORNS AND CHARACTERISTICS
OF NORMAL NEWBORNS
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Classification of Newborns

• Neonatal period is defined as the first four
  weeks of life after birth,the infants in this
  period are named as newborns.

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(?)Gestational Classification

• 1.Term newbornnewborn who gives birth from 37 up
  to 42 completed weeks
• 2.Preterm newbornnewborn who gives birth from 28
  up to 37 completedweeks

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• 3.Post-term newbornnewborn who gives birth
  during or after 42 completed weeks

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(?)Birth Weight Classification

• 1.Normal birth weight newborn
• newborn with birth weight between 2.5kg to
  4.0kg

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• 2.Low-birth-weight(LBW) newbornnewborn with
  birth weight less than 2.5kg

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• Very low birth weight(VLBW) newbornnewborn with
  birth weight less than 1.5kg
• Extremely low birth weight(ELBW) new newborn
  with birth weight less than 1.0kg

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• 3.Giant infant newbornnewborn with birth weight
  more than 4.0kg,including normal and abnormal
  newborn

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(?)Wejight for Gestational Age

• 1.Newborn small-for-gestational
• (SGA) ) newborn with birth weight below the
  10th percentile on an intrauterine growth curve
  for that age.

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• 2.Newborn appropriate for gestational age (AGA)
  newborn with birth weight between the 10th and
  90th percentiles of same gestational age

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• 3.Newborn large for gestational age (LGA)
  newborn with birth weight above the 90th
  centile of same gestational age?

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(?)High-risk Neonate (high risk infant )
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• The high-risk neonatecan be defined as a
  newborn,regardless of gestational age or birth
  weight,who has a greater-than-average chance of
  morbidity or mortality because of conditions or
  circumstances superimposed on the normal course
  of events associated with birth and the
  adjustment to extrauterine existence.

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Characteristics of Normal Newborns
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Chapter7 Nursing Care of High-Risk Newborn and
Family

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• 1.Appearance
• 2.Respiratory System
• 3.Circulatory System
• 4.Digestive Syste
• 5.Hemotologic System
• 6.Urinary System
• 7.Nervous System

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• 8.Immunologic System(????)
• 9.Thermoregulation(????)

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• 10. Energy Requirement and Fluid and Electrolyte
  Balance
• 11. Endocrine System

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• 12.Special Physiological Phenomena
• (1)physiologic weight
• (2)physiologic jaundice
• (3)physiologicbreast enlargement during the
  first 35days,disappear 23 weeks

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• (4)fask menstruation during the first 57 days.

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NEWBORN PRIORITIES IN THE FIRST DAYS OF LIFE
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• All infants have eight needs that take precedence
  over all other in first few days of life

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(? )Initiating and Maintaining Respirations

• Resuscitation comprises three organized steps
• (a)    establishing and maintaining an airway
• (b)   expanding the lungs
• (c)  initiating andmaintaining effective
  ventilation

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• (?)Establishing Extra-Uterine Circulation

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(?)Control of body temperature
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(?)Intake of adequate nourishment

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• (?)Establishment of waste elimination

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• (?)Prevention infection

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• (?)Establishing of an infant-parent relationshi
• (?)Developmental care that balances rest and
  stimulation for mental development

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3.NURSING CARE OF THE NEWBORNS AT RISK BECAUSE OF
ALTERED GESTATIONAL AGE OR BIRTH WEIGHT
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Nursing of the Small-for-Gestational-Age Infants
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• Etiology
• Clinical Manifestation
• 1.Prenatal Assessment
• 2.Appearance
• Laboratory Finding

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• Nursing diagnosis
• 1.High risk for altered respiratory function
• 2.High risk for ineffective thermoregulation
• 3.High risk for altered parenting

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Related Interventions

• 1.Birth asphyxia is a common proble for
  small-for-gestational-age infants,because they
  are at risk for developing meconium aspiration
  syndrome due to anoxia labor

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• 2.A careful controlled environment is essential
  to keep the infants body temperature in neutral
  zone
• 3.Promote early parental bonding with the child

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Nursing of the Large-for Gestational-Age Infant
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• Etiology

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Clinical Manifestation

• 1.Prenatal Assessment
• 2.Appearance
• 3.Cardiovascular Dysfunction
• 4.Hypoglycemia

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Nursing diagnosis

• 1. High risk for altered respiratory function
• 2.High risk for nutrition alteration
• 3.High risk for altered parenting

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Related Interventions

• 1.Careful assessment of respiration function
  should be performed,oxygen administration maybe
  necessary for some LGA infant

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• 2.Prevent hypoglycemia
• 3.A large-for- Gestational-Age infant needs the
  same developmental care that all other infants
  need

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4.NURSING OF THE PRETERM AND POST-TERM INFANTS
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4.NURSING OF THE PRETERM AND POST-TERM INFANTS
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Nursing Care of Preterm infants

• Etiology

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• Clinical Manifestation
• 1.Appearance

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• 2.Respiratory System
• 3. Fluid and Nutrients Requirement
• 4.Temperature Regulation
• 5.Immune System

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Potential Complication

• 1.Anemia of Prematurity
• 2.Kernicterus
• 3. Persistent Patent Ductus Arteriosus

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• 4.Periventricular/Intraventricular hemorrhage
• 5.Other Potential Complications

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Nursing diagnosis

• 1.High risk for altered respiratory function
• 2.High risk forfluid volume deficit

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• 3.High risk for nutrition alteration
• 4.High risk for hypothermia
• 5.High risk for infection
• 6.High risk for altered parenting

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Related Interventions

• 1.Oxygen Therapy at Birth
• 2.Intravenous Fluid Administration
• 3.Reasonable Feeding

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• 4.The Infant Must Be Kept Under a Radiant Heat
  Warmer in a Delivery Room
• 5.Linen and Equipment Used With the Preterm
  Infant Must Be Clean to Reduce the Chances of
  Infection
• 6.Developmental Care

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Appendix Nursing Care of Newborns in Incubator
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Nursing of the Post-Term Infants
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5.NURSING CARE OF NEWBORNS WITH HYPOXIC-ISCHEMIC
ENCEPHALOPATHY
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• Hypoxic-ischemic encephalopathy(HIE),
  or hypoxic-ischemic reperfusion injury,is the
  mostcommon cause of neurologic observed in term
  and preterm infant, which may result in neonatal
  death or which may be manifest later as cerebral
  palsy or mental deficieny.

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• EtiologyHypoxia?Ischemia
• Clinical Manifestation

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Related Interventions

• 1.Seizure Control
• 2.Supportive Care
• 
  
•  

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6.NURSING CARE OF NEWBORNS WITH INTRACRANIAL
HEMORRHAGE
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• Intracanial hemorrhage of the newborn is
  the most commom type of brain injury,arising from
  hypoxia or birth trauma.The incidence is high in
  preterm infant.The prognosis is not optimized

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• Etiology Hypoxia and Ischemia?BirthTrauma?Others

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• Clinical Manifestation
• General Symptoms

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• (?)Types of Intracranial Hemorrhage
• 1.Periventricular/Intraventricular
  Hemorrhage(P/IVH)
• 2.Subdural Hemorrhage(SDH)
• 3.Subarachnoid Hemorrhage(SAH)

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Therapeutic Management

• 1.The treatment of ICH is aimed at prevention
  prevention of prematurity and any events that may
  lead to ICH is foremost.
• 2. The maintenance of adequate oxygenation?

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• 3.Medical treatment
• 4.Control seizure ,calm patients by sedation,and
  reduce intracranial pressure

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Related Interventions

• 1.Nursing care is directed toward prevention of
  fluctuations in cerebral BP
• 2.Avoiding interventions that cause crying

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• 3.Rapid volume expansion following hypotension
  and administration of hyperosmolar solution such
  as NaHCO3 should be avoided

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7.NURSING CARE OF NEWBORNS WITH HYALINE MEMBRANE
DISEAS
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• Hyaline membrane disease,also termed respiratory
  distress syndrome(RDS) of the newborn,most often
  occurs in preterm infants,infants of diabetic
  mothers,infants born by cesarean birth,or those
  who for any reason have decreased blood
  perfusion of the lungs.The membrane prevents
  exchange of oxygen and dioxide at the
  alveolar-blood interface

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• Etiology and PathologyHMD occurs when there is
  not enough of a substance in the lungs called
  surfactant
• Clinical Manifestation

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Nursing diagnosis

• 1.Failure to maintain spontaneous respiration
• 2.Impaired gas exchange

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• 3.High risk of infection
• 4.High risk of altered nutrition,less than body
  requirement

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Management

• 1.Surfactant Replacement and Rescue
• 2.Oxygen Administration
• 3.Ventilation
• 4.Supportive Care

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8.NURSING CARE OF NEWBORNS WITH NEONATAL
PNEUMONIA
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• aspiration and infective pneumonia

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Aspiration Pneumonia

• Etiology and Pathology
• Clinical Manifestation

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Infective Pneumonia

• EtiologyInfection in Utero?Infection at
  Birth?Infection after Birth
• Clinical Manifestation

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Therapeutic Management and Nursing Care

• 1.Clean aspiration as soon as possible,and
  maintain airway patent
• 2.General treatment such as oxygen
  therapy,keeping body warm.

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• 3. Combat any potential infection
• 4.Respiratory support

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9.NURSING CARE OF NEWBORNS WITH GASTROESOPHAGEAL
REFLUX
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• Gastroesophaheal reflux is the
  spontaneous passage of acidic gastric contents
  from the stomach into the esophagus

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• Clinical Manifestationvomiting,growth,retardation
  , aspiration pneumonia, and esophagitis

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Collaborative Management

• 1.Positioning
• 2.Thickening Milk
• 3.Antiacid Drugs
• 4.Surgical Intervention

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10.NURSING CARE OF NEWBORNS WITH NEONATAL
JAUNDICE
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• Neonatal jaundice is a sign that the
  neonates blood contains an excessive amount of
  bilirubin and makes skin and eye yellowed

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Classification

• 1.Physiologic Jaundice
• 2.Nonphysiologic Jaundice

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Risk Factors for Severe Hyperbilirubinemia

• 1.Breast-Feeding
• 2. Low Birth Weigh and Prematurity
• 3.Ethnicity
• 4.Hemolytic Conditions

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• 5.Polycythemia
• 6.Extravasated Blood
• 7.Sepsis,Hypothyroidism,and Galactosemia

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Hemolytic Disease of Newborn
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• Hemolytic Disease of NewbornHemolytic
  disease of the newbornoccurs when fetal red
  cells cross the placenta and make mother to be
  immunized with the production of IgG which
  transferred to the fetus and cause hemolysis of
  fetal red cells.

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Clinical Manifestation

• 1.When the Mothers Antibodies Attack the Red
  Blood Cells,They Are Broken Down and Destroyed
• 2.Kernicterus

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Management

• 1.Treat the Underlying Disorder
• 2.Avoid Unnecessary Stimulation

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• 3.Ensure Adequate Hydration,Caloric
  Intake,Stooling
• 4.Phototherapy
• 5.Exchange Transfusion

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11.NEONATAL SEPSIS
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• infection is a major cause of fatality
  during the first month of life.Neonatal sepsis
  may be categorized as early or late onset

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• Clinical Manifestation

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Treatment and Nursing Strategies

• 1.Antibiotics
• 2.Diet
• 3.Others
• ComplicationsPneumonia?bacteremia

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12.NURSING CARE OF NEWBORNS WITH NEONATAL COLD
INJURE SYNDROME
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• Neonatal cold injury syndrome results in
  hypothermia and multiple organs dysfunction
  because of coldness.Sclerema neonatorum(SN)

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• Etiology
• Clinical Manifestation

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Collaborative Management

• 1.Rewarming the Cold Neonate,and Assess the
  Temperature Regular to Determine the Severity of
  Hypothermia

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• 2.Antibiotics
• 3.Systemic Steroids
• 4.Establishing Adequate Nutritional Intake

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• Complications(???)pulomonary hemorrhage(???)?shoc
  k(??)

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13.Nursing Care of Newborns with Neonatal
Hypoglycemia
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Management and Nursing Care

• 1.Enteral Feeding
• 2.IV Therapy
• 3.Other Agents
• 4.Close Observation