Genetics, Conception, and Fetal Development, High Risk Perinatal Care: Preexisting Conditions, Nonprogressive neurologic (brain) impairment caused by intrauterine or postnatal asphyxia resulting in hypoxemia or cerebral ischemia, Appears within first 6-12 hr after hypoxic episode, Hemorrhage into and around ventricles caused by ruptured vessels as a result of an event that increases cerebral blood flow to area, Sudden deterioration in condition if bleed is large, Same as for germinal matrix or intraventricular hemorrhage, No significant difference between infected and uninfected infants at birth in some instances, Transplacental; during vaginal birth; potentially in breast milk, Administer combination antiretroviral prophylaxis to human immunodeficiency (HIV)–positive mother; prophylaxis to prevent perinatal transmission may begin after first trimester. This is the so-called TORCH complex, an acronym for: • O—Other (e.g., HBV, parvovirus, HIV, West Nile). The clavicle is the bone most often fractured during birth. • Identify clinical manifestations of infection in the newborn. SOURCE The less common lower-plexus palsy, or Klumpke palsy, results from severe stretching of the upper extremity while the trunk is relatively less mobile. IgG levels in term infants are equal to maternal levels; however, in preterm infants the amount of IgG is directly proportional to gestational age. • Identify maternal conditions that place the newborn at risk for infection. Neonatal sequelae of inadequate chlamydia treatment in newborn. Sepsis. Identify the effects of maternal use of alcohol, heroin, methadone, marijuana, methamphetamine, cocaine, and tobacco on the fetus and newborn. Galactosemia Care must be taken in suctioning secretions from any newborn’s oropharynx or trachea. • The baby with a birth weight of less than 2000gm is more vulnerable and need special care. The most common signs include decreasing oxygen saturation, poor perfusion (prolonged capillary refill, cool extremities, mottling), tachycardia, respiratory distress, and hypotension. Early-onset sepsis is acquired in the perinatal period; infection can occur from direct contact with organisms from the maternal GI and genitourinary tracts. Early-onset sepsis is associated with a history of obstetric events such as preterm birth, prolonged rupture of membranes (more than 18 hours), maternal fever during labor, and chorioamnionitis. Intracerebellar hematoma Hand washing is essential to prevent nosocomial spread. The combined use of alcohol, hand hygiene, and gloves is effective in reducing the incidence of systemic infection. The O category may involve testing for several viral infections (e.g., HBV, varicella zoster, measles, mumps, HIV, syphilis, and human parvovirus). Nursing Care Plan 5. The infant is positioned on the affected side to facilitate maximum expansion of the uninvolved lung. Intraspinal hemorrhage Intrauterine exposure—congenital varicella syndrome: limb dysplasia, microcephaly, cortical atrophy, chorioretinitis, cataracts, cutaneous scars, other anomalies, auditory nerve palsy, motor and cognitive delaysSevere symptoms (rash, fever) and higher mortality in infant whose mother develops varicella 5 days before to 2 days after birth Birth trauma includes physical injuries that a neonate sustains during labor and birth. Infection rates in VLBW infants are higher in those with lower birth weights. Once the pathogen is identified, antibiotic, antiviral, or antifungal therapy may be modified. Soft-tissue injuries that commonly occur at birth (i.e., caput succedaneum and cephalhematoma) are discussed in Chapter 22. TRANSMISSION Spinal cord (cervical) • Discuss the pathophysiology of retinopathy of prematurity and bronchopulmonary dysplasia and identify the predisposing risk factors. It’s really 2 books in 1! Nursing Care Plan for Hyperbilirubinemia of the Newborn / Infant Jaundice / Neonatal Hyperbilirubinemia . in the newborn period. The clinical manifestations of Erb palsy are related to the paralysis of the affected extremity and muscles. The shoulder and arm are adducted and rotated internally. Variable manifestation from asymptomatic to severeMicrocephaly, cerebral calcifications, chorioretinitisJaundice, hepatosplenomegalyPetechial or purpuric rash (Fig. Breastfeeding is not contraindicated, but the mother needs additional assistance to help the infant grasp and compress the areolar area. Neonatal infections may be acquired in utero, at birth or shortly thereafter, and as a health care–associated infection (HAI). Nonprogressive neurologic (brain) impairment caused by intrauterine or postnatal asphyxia resulting in hypoxemia or cerebral ischemiaHypoxic-ischemic encephalopathy—the resultant cellular damage that causes the clinical manifestations Except for use of gentle rather than vigorous handling and containment of the limb against the chest, no accepted treatment for fractured clavicle of the newborn exists, and the prognosis is good. Pressure on the facial nerve (cranial nerve VII) during birth may result in injury to it. Appears within first 6-12 hr after hypoxic episodeSeizuresAbnormal muscle tone (usually hypotonia)Disturbance of sucking and swallowingApneic episodesStupor or comaMuscular weakness in hips and shoulders (full term), lower-limb weakness (preterm) Rubella, Congenital (Rubella Virus) Cytomegalovirus (CMV) Spinal cord transection or injury A nursing care plan (NCP) is a formal process that includes correctly identifying existing needs, as well as recognizing potential needs or risks. SYSTEM A small percentage of significant birth injuries such as in especially difficult or prolonged labor or an abnormal fetal presentation are unavoidable despite skilled and competent obstetric care. • Live birth—Birth in which neonate manifests any heartbeat, breathes, or displays voluntary movement, regardless of gestational age For injuries that do not improve by 3 months, surgical intervention may be needed to relieve pressure on the nerves or repair the nerves with grafting (Carlo, 2011b). TABLE 25-4 In dressing the infant, preference is given to the affected arm. The primary clinical manifestations are loss of movement on the affected side such as an inability to completely close the eye, drooping of the corner of the mouth, and absence of wrinkling of the forehead and nasolabial fold (Fig. Found inside – Page 336NICU environment: see Environmental Concerns section, Nursing Care Plan—High-Risk Preterm Infant, and Fig. 34-8. A. Common stressors. Differential diagnosis may be difficult because signs of sepsis are similar to signs of noninfectious neonatal problems such as hypoglycemia and respiratory distress. Fungal infections are of greatest concern in the immunocompromised or preterm infant. A plan for follow-up therapy is developed with the parents so the times and arrangements for therapy are acceptable to them. Poor nutrition Transplacental; can be anytime during pregnancy or at birth, May be asymptomatic at birth (70%-90% of cases) or have maculopapular rash, lymphadenopathy, hepatosplenomegaly, jaundice, thrombocytopenia. Because evidence of some birth injuries may not be apparent at the initial examination, assessment continues during each contact with the neonate. Other trauma requires some degree of intervention; few are serious enough to be fatal. Review the prenatal record for risk factors associated with infection and the signs and symptoms suggestive of infection. This is most severe form of syphilis.Treatment consists of IV aqueous penicillin or IM procaine penicillin.Diagnostic evaluation depends on maternal serology testing, maternal therapy and response, maternal and infant serologic titers, results of nontreponemal infant tests, and infant physical examination (including ophthalmologic examinations and long-bone radiographs) and laboratory examination results (e.g., LFTs, CBC, platelets, CSF protein and cell count). 5. Found inside – Page 685These subscales are also useful in describing at-risk fullterm infants, ... and intervention planning for high-risk preterm and full-term infants. It is normally started from the beginning of the second trimester up to the 37 th week of pregnancy. Desired Outcome: The patient will demonstrate proper use of a blood glucose monitoring machine. Bradycardia Epidural hematoma In high risk infants with significant illness, antiviral or antibiotic treatment may begin once cultures are obtained. The nursing team may use a fiber optic blanket and place it under the baby if advised by the physician. Except for use of gentle rather than vigorous handling and containment of the limb against the chest, no accepted treatment for fractured clavicle of the newborn exists, and the prognosis is good. The infant with phrenic nerve paralysis requires the same nursing care as any infant with respiratory distress. • Large-for-gestational-age (LGA) infant—Infant whose birth weight falls above the 90th percentile on intrauterine growth charts b. Neonatal sequelae of inadequate chlamydia treatment in newborn. Vomiting, diarrhea Nursing Care Plan A Client with Malnutrition. Vigilant assessment continues during and after treatment. Clusters of lesions are common. Risk for Aspiration (Breast Milk, Formula, or Mucus) related to anatomic defect The infant will have no episodes of gagging or aspiration. Early-onset or congenital sepsis usually manifests within 24 to 48 hours of birth, progresses more rapidly than later-onset infection, and carries a mortality rate as high as 50%. Passive range-of-motion exercises of the shoulder, wrist, elbow, and fingers are initiated in the latter part of the first week. For injuries that do not improve by 3 months, surgical intervention may be needed to relieve pressure on the nerves or repair the nerves with grafting (Carlo, 2011b). Additional diagnostic tests that may be used to identify or exclude neonatal sepsis include sedimentation rate, interleukins (IL-8, IL-2, IL-6, and IL-1β), and nucleic acid amplification testing (NAAT). Plan developmentally appropriate care for the high risk infant. Laboratory studies are important. : Diabetes Mellitus. Factors that contribute to have a High- risk Neonate: A) High-risk pregnancies: e.g. Birth trauma (injury) is physical injury sustained by a neonate during labor and birth. Those weighing 1000 to 1500 g are very-low-birth-weight (VLB). (Courtesy David A. Clarke, Philadelphia, PA.), (Courtesy Mahesh Kotwal, MD, Phoenix, AZ. The Moro reflex is absent on the affected side for all of the forms of brachial palsy. Follow-up is also essential because of the extended length of recovery. 25-5) (usually after first few weeks of life), mucous membrane patches, hair loss, nail exfoliation, snuffles (syphilitic rhinitis), profound anemia, poor feeding, pseudoparalysis of one or more limbs, dysmorphic teeth (older child) Found inside – Page 1... and the newborn during these periods. This book features more than 65 common and high-risk nursing care plans based on the nursing process approach. Isolation protocols change rapidly, and the nurse is urged to participate in continuing education and in-service programs to remain up to date. Warm water may be used to remove blood and meconium from the neonate’s face, head, and body. Found inside – Page 827... of the newborn: erythroblastosis fetalis, 95, 96f, 340–344, 341b diagnosis ... 722b breastfeeding and, 222 immunization, 104–105 persons for higher risk ... These depressed fractures, or Ping-Pong ball indentations, may occur during difficult births from pressure of the head on the bony pelvis. A nurse is caring for a newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight. Vernix caseosa is not scrubbed vigorously for removal, since this further disrupts the skin barrier properties (see Guidelines box, pp. It is incumbent on caregivers to strictly adhere to recommended guidelines for hand hygiene. High risk infants are most often classified according to birth weight, gestational age, and predominant pathophysiologic problems. Identify potential antenatal complications for the woman, the fetus, and the newborn. Maggie is breastfeeding and states that she was diagnosed and partially treated for a couple of sexually transmitted infections in late gestation; she does not remember the name but says one started with a “C.” The medications made her stomach sick, so she quit taking them after 2 days. And since he is the 1 st child hospitalized in their family, the parents might still be unsure on how to take care of the baby. This is only to provide an idea about the condition of the client. Measures to be taken include Standard Precautions, careful and thorough cleaning of contaminated equipment, frequent replacement of used equipment (e.g., changing IV and nasogastric [NG] tubing per hospital protocol and cleaning resuscitation and ventilation equipment, IV pumps, and incubators), and appropriate disposal of contaminated linens and diapers. Wrist flexion contractures may be prevented with the use of a wrist splint with padding in the fist. They can also occur as a result of injudicious application of forceps. Considerable force is required to fracture it. In newborns, jaundice is detected by blanching the skin with digital pressure so that it reveals underlying skin and subcutaneous tissue. Search the Internet for the latest developments in the provision of nursing care for high-risk premature newborns. Antibiotic therapy initiated during labor should be noted. • Using the nursing process, plan nursing care that includes the six competencies of Quality & Safety Education for Nurses (QSEN): Patient-Centered Care, Teamwork & Collaboration, Evidence-Based Practice (EBP), Quality Improvement (QI), Safety, and Informatics. Elective cesarean birth can be chosen for some pregnancies to prevent significant birth injury. Found inside – Page 368A systematic assessment is carried out after the high-risk newborn is stable. Diagnosis (Problem Identification) Many nursing diagnoses may be evident after ... Fragility and increased permeability of capillaries and prolonged prothrombin time predispose preterm infants to trauma when delicate structures are subjected to the forces of labor. Description. • H—Herpes simplex The vulnerability of infants to common mucosal pathogens such as RSV may be reduced by passive transfer of maternal immunity in the colostrum and breast milk. The range of pathologic conditions produced by infectious agents is large, and the difference between the maternal and fetal effects caused by any one agent is also great. Only gold members can continue reading. Depressed fracture Measures to be taken include Standard Precautions, careful and thorough cleaning of contaminated equipment, frequent replacement of used equipment (e.g., changing IV and nasogastric [NG] tubing per hospital protocol and cleaning resuscitation and ventilation equipment, IV pumps, and incubators), and appropriate disposal of contaminated linens and diapers. This increases their confidence and knowledge and facilitates attachment. Subdural hematoma (laceration of falx, tentorium, or superficial veins) Other trauma requires some degree of intervention; few are serious enough to be fatal. In high risk infants with significant illness, antiviral or antibiotic treatment may begin once cultures are obtained. Nurse care planning for a client with prenatal hemorrhage include assess maternal/fetal condition, maintain circulatory fluid volume, assist with efforts to nurture the pregnancy, if possible, avoid complications, provide emotional support to the client/couple, and provide knowledge on short- and long-term complications of the hemorrhage. Ascending infection may occur after prolonged PROM, prolonged labor, or intrauterine fetal monitoring. The earliest clinical signs of neonatal sepsis are characterized by a lack of specificity. Prolonged administration of antibiotics to ELBW neonates without positive cultures in the first week of life is associated with an increased incidence of necrotizing enterocolitis (NEC), mortality, and late-onset infection; therefore careful use of antibiotics and close observation of such infants are recommended (Cotten, Taylor, Stoll, et al., 2009; Kuppala, Meinzen-Derr, Morrow, et al., 2011). Plan nursing care to augment normal development of a newborn, such as ways to aid parent-child bonding. Maternal Newborn Nursing Care Plans, Second Edition teaches students and professional nurses how to assess, plan, deliver, and evaluate care for normal and abnormal pregnancy, including delivery and recovery for both the mother and baby. Human Immunodeficiency Virus Guidelines for space, visitation, and general infection control in areas where newborns receive care have been established and published (AAP and ACOG, 2007). Polin, Denson, Brady, et al. Additional diagnostic tests that may be used to identify or exclude neonatal sepsis include sedimentation rate, interleukins (IL-8, IL-2, IL-6, and IL-1β), and nucleic acid amplification testing (NAAT). Treatment of the affected arm is aimed at preventing contractures of the paralyzed muscles and maintaining correct placement of the humeral head within the glenoid fossa of the scapula. Cerebral contusion Place your findings in a report to share with the rest of the class in a class discussion. Transplacental; during vaginal birth; potentially in breast milk Pancreatic Cancer. Congenital anomalies include such conditions as gastrointestinal (GI) malformations, cleft lip and cleft palate, genitourinary defects, neural tube defects, abdominal wall defects, and cardiac defects.

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