Ch 37 High Risk Newborn and 38 Loss and Grief

StudyBlue printing of Ch 37 High Risk Newborn and 38 Loss and Grief html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; font-weight:bold; color:#808285; position:relative; border-bottom: 1px solid #c5c5c5; } .logo-blue { color:#70adc4; } .logo-desc { font-weight:normal; font-size:19px; color:#cccccc; margin-top:50px; position:absolute; display: none; } .back-button { position:absolute; top:20px; right:20px; font-size:13px; line-height:25px; color:rgb(0,175,225); font-weight:normal; } .back-button a { color:rgb(0,175,225); } .instructions { padding:0; margin:0; width:100%; position:relative; color:rgb(100,100,100); } .step-holder { border-left:1px solid #ededed; margin-left:20px; } .steps { padding:15px 0; float:left; width:24%; border-right:1px solid #ededed; text-align:center; } .steps-01 { } .steps-02 { } .steps-03 { } .steps-04 { } .label { padding:5px 10px; } .print-button { } .print-button a { background-color:rgb(0,175,225); color:white; line-height: 19px; padding:9px 8px 5px 30px; font-size:14px; text-decoration:none; background-image: url(images/printer.png); background-repeat: no-repeat; background-position: 7px 50%; -moz-border-radius: 5px; -webkit-border-radius: 5px; } .print-button a:hover { background-color:black; } .theNote .content { width: 8.0in !important; margin: 5px auto; padding:20px; background-color:white; } .theNote .header { border-bottom: 1px dashed #C8C8C8; font-size: 17px; padding: 0 0 10px; line-height: 19px; color: #00ADE1; min-width:500px; } .theNote .body { font-size: 14px; line-height: 19px; padding: 10px 0; } .theNote{ padding:6px 0; clear:both; background-color: rgb(200,200,200); } .theNote h3{ color: rgb(100,100,100); } .theNote h1, .theNote h3{ background-color:white; padding:2px 20px; width:8.0in !important; margin: 0 auto; font-size: 15px; } .theNote h1{ padding-top: 10px; font-size: 15px; } .theNote h1:first-child{ font-size: 20px; } .theNote h3 { font-size: 14px; font-weight: normal; } #options { border: 3px double #ccc; padding: 5px 12px; margin: 10px 50px 10px 20px; float: left; } #info { border-top: 1px solid #ccc; padding-top: 5px; font-style: italic; } li { margin: 5px 10px 5px 25px; } ul li { list-style: disc; } ol li { list-style: decimal; } img { border: 0; } table { clear: both; width: 100%; border: 1px solid #c5c5c5; border-width: 1px 0; margin: 0; page-break-after: always; } table#page { page-break-after: auto; } td { text-align: center; font-size: 12px; border-bottom: 1px dashed #c5c5c5; height: 1.75in; width: 50%; padding-left: 15px; } .leftside { border-right: 1px solid #cccccc; padding: 0 15px 0 0; } .bottom td { border-bottom: none; } .clearfix { clear:both; line-height:1px; height:1px; } img { max-width:80%; max-height:150px; margin:20px; } @media print {.header { display: none; } .content .header{ display:inherit; } table { border: 1px dashed #bbb; border-width: 1px 0; } .theNote{ background-color:white; } } Ch 37 Chapter 37: Nursing Care of the High Risk Newborn – (Approx. 10 questions) · anticipatory grief: prepares parents who may experience loss of their infant, preterm or w debilitating disease, nurses should assess and support, use chaplain or social worker as needed · bronchopulmonary dysplasia (BPD): chronic caused by trauma from ventilation and O2 toxicity. S/S: tachypnea, retractions, nasal flaring, exercise intolerance, tachycardia. treat: O2, nutrition, fluid restriction, meds-diuretics, corticosteroids, bronchodilators. prevent: surfactant It's normal for preterm infants to breathe rapidly for 10-15 sec then pause for 10-15 sec. · corrected age: weeks at birth plus weeks extrauterine. Preterm babies may have to stay in nicu until they reach 37 wks corrected age · gavage feeding: feeding through OG or NG tube. document infant's response to feeding. · germinal matrix hemorrhage-intraventricular hemorrhage(GMH-IVH): · insensible water loss (IWL): water lost through skin and respirations · kangaroo care: Skin to skin contact between parent and infant >30 wks, can improve baby and mom. · minimal enteral nutrition (MEN): tube feeding on 1 ml/hr keeps GI tract prepped for actual feedings · Necrotizing enterocolitis (NEC): Acute inflammatory disease of the GI mucosa (often fatal) Diagnosis confirmed by x-ray. Abdm distention, gross bloody stools, temp instability. o Three primary conditions: Intestinal ischemia from asphyxia/hypoxia, Colonization of intestine with harmful bacteria before normal flora, Enteral feeding (provides a medium for bacteria to grow) o GI symptoms: Abdominal distention, bile stained GI fluid, grossly bloody stools, abdominal tenderness, erythema of abdominal wall o Treatment is supportive: Oral feedings stopped to rest GI tract, TPN, OG tube to suction to relieve pressure, Infectious disease—control spread of infection, Antibiotics, possible bowel resection, Breastfeeding, probiotics and MEN decrease incidence · nonnutritive sucking, calming effect, Pacifier improves oxygenation & weight gain (better sucking skills) in preterm · patent ductus arteriosus (PDA): Ductus arteriosus is a normal muscular contractile structure in fetus connecting the left pulmonary artery and the dorsal aorta, diverts blood from lungs to placenta for gas exchange, Constricts after birth · Causes systolic murmur, active precordium, bounding peripheral pulses, tachycardia, tachypnea, crackles, hepatomegaly. Fluid restriction and diuretics to decrease volume overload · respiratory distress syndrome, · retinopathy of prematurity (ROP): affects retinal vessels. baby’s eyes and eyelids are immature, or can be caused by hyperglycemia, use low lighting or masks. Closely monitor blood oxygen levels. · total parenteral nutrition (TPN): nothing by mouth- gavage feedings · Box 37-1 Classification of High Risk Infants (size, gestational age, mortality)—need to know definitions in this box: o LBW: <2500 g(5.5 lbs) o VLBW: <1500 g (3.3 lbs) o ELBW: <1000 g(2.2 lbs) o SGA is less than 10 th percentile for GA, LGA is over 90 th percentile for GA. o Symmetric IUGR: whole body small(weight, length, head circumference), asymmetric: head is normal, weight below 10 th percentile. infants with asymmetric IUGR have potential for normal growth and development. o Preterm: <37wks, late preterm: 34-36 wks, full term: 38-42, posterm: >42. o Live birth: has heartbeat, breathes, moves voluntarily o Fetal death: fetus dies after 20 wks and before birth o Neonatal death: first 27 days of life. Early neonatal death=first 7 days of life. o Perinatal mortality: total number of fetal and early neonatal deaths per 1000 in live births · Compare the respiratory& cardiovascular systems & thermoregulation of preterm infant with that of healthy NB · Signs of hypothermia : apnea, bradycardia, coag defects, hypogylc, hypotonic, hypoxic, bad feeding/metab, irritable/lethargic, met acidosis, vasocontric, poor weight gain, shivering, weak cry · Sings of hyperthermia (Box 37-2): apnea, CNS depression, dehydration, flushed, hypernatr, irrtib/lethargy, poor feeding, seizures, sweating, tachycardia, tachypnea, warm to touch, weak cry. · Signs and symptoms of infection (Box 37-3): temp instablility, CNS changes, cyanosis, jaundice, poor perfusion, hypotension, brady.tachycardia, apnea, tachypnea, retractions, feeding issues, vomit, diarrhea, glucose instability, met acidosis. · Preterm growth & development potential. Correcting for gestational age. · Oxygen therapy. Common methods of delivery(don’t worry about mechanical ventilation) o Surfactant administration and medication guide p. 905 · Gavage and gastrostomy feeding and procedure box p. 909 · Strategies to help parents deal with NB in NICU. · RDS. S/S. Nursing care for RDS. ABG values for neonates (table 37-2). Risk: perinatal asphyxia, hypovolemia, male, Caucasian, DM, twin, fam hx, C/S, maternal hypotension, VLBW, 3 rd trimester bleeding, preterm. Surfactant deficiency, compromised lung capacity and residual capacity, S/S within 6 hrs birth ,self limiting-72 hrs, ventilation and oxygenation, surfactant admin, maintain fluid and nutrition parenterally. Labs: good ranges. pH 7.35-7.45, PaO2 60-80, PaCO2 35-45, HCO3 18-26, base excess -5 to +5, O2 sat 92-94%. · MAS: Meconium staining can indicate fetal distress. With meconium-stained amniotic fluid, skilled team must be present and ready to resuscitate. If infant is depressed and meconium remains in the airway at birth, it can migrate down to the terminal airways causing mechanical obstruction leading to MAS. Causes chemical pneumonitis and my lead to persistent pulmonary hypertension of the newborn Posterm babies: }Associated with placental insufficiency · Wasted appearance (dysmaturity),Skull looks large in comparison to smaller body, Dry, cracked, parchment-like skin, Long hair and nails, Loose skin from depleted fat reserves (old person), Long, thin body, Absence of vernix, Meconium staining of skin, nails and cord, alert, wide-eyed appearance from chronic intrauterine hypoxia, Perinatal mortality significantly higher, Large fetus’ increased O 2 may not be met during birth,Placental insufficiency increases risk for meconium in utero. SGA/IUGR: · }Physical Characteristics of SGA infant o Normal skull but smaller body makes head look large o Reduced fat stores o Loose, dry skin o Diminished muscle mass (esp over buttocks and cheeks) o Sunken (scaphoid) abdomen o Thin, yellowish, dry, dull umbilical cord o Sparse scalp hair o Wide skull sutures (inadequate bone growth) · }Perinatal Asphyxia · }IUGR—chronic hypoxia in utero, difficulty compensating after birth · }SGA—from smoking, preeclampsia, poverty, maternal infections, diabetes, cardiac problems · }Hypoglycemia · }Any stressed infant at risk for hypoglycemia · }Hyperglycemia (in VLBW and ELBW infants) · }Polycythemia · }Fetus makes too many blood cells to compensate for hypoxia compromising circulation to organs and oxygenation · }Heat Loss · }Susceptible to temperature instability LGA: }Oversized infant (>4000 g at birth or >90 th percentile on growth chart) · }Increased incidence of birth injuries, asphyxia and congenital anomalies · }LGA infants can be preterm, term, postterm or infant of mom with diabetes · }Discharge planning (for all high-risk infants) · }Begins early in hospitalization · }Parents are taught infant home care (gastrostomy feeding, oxygen) · }Age appropriate car seat (test infant for bradycardia, apnea and decreased o2 sats in car seat) · }Instruction in CPR is essential for parents of preterm infants · }Requires a multidisciplinary approach including community resourcestemp Ch 38 Do say: I'm sorry. What are you thinking about? I understand your need for.... Refer to counseling if grief is prolonged. Warn that many people will say the wrong things. Use "miscarriage" over spontaneous abortion. I'm sad for you. Im here to listen. How are you. Counsel extended family if present as well. When it comes to deciding to name or hold the baby, ask, dont impose, say "some parents find it helpful to...would you like to?" Help in decision making. Physical needs of mom are similar to normal postpartum-bleeding, cramping, breast tenderness. Create some memories to take home: footprint, id band, maybe pictures, info on weight. Don't say: God has a purpose, she/he is in heaven. I know how you feel. Be thankful for your other child(ren). You can try again/have more. For the best/would have had birth defects. Special losses: negative diagnosis in utero. loses one in multiple birth- treat sensitively, still a loss. loss in adolescent mother- still grieving process. complicated grief: prolonged or different from normal grief. chronic mourning. PTSD a possibility. refer to counseling. Grief model acute distress: shock, numbness, intense crying, depression intense grief: loneliness, guilt, anger, fear, disorganization, depression reorganization: after the first two, searches for meaning, stress reduces, reenters normal life activities, depression ceases, can start thinking about another pregnancy