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Gastro-intestinal
Difficulty with digestion & absorptionPoor gag reflex, incompetent cardiac sphincterSmall stomach capacity
Requires a high concentration of whey to casinratio in formulaDeficiency of Ca & phosphorousIncreased BMR & O2 requirements r/t fatiguefrom suckingFeeding intolerance & NEC r/t blood flow tointestines
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Nutritional & FluidManagement
High caloric need (110-130kcal/kg/day)Need for supplemental vitaminsNeed Vitamin E - r/t diet high in fatswhich they needNutritional intake adequate ifgaining 20-30 gms/dayInitial weight loss 10-15%
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Nursing Care - Nutrition
120 cal/kg/dayBefore feeding Measure abdominal girth
Auscultate for bowel soundsWatch for signs of feeding intolerance + Guiac stools Lactose in stools Vomiting & diarrhea Abdominal distention Weight loss or plateau
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Nursing Care - Nutrition
Signs of readiness for oral feeding Strong gag Non-nutritive sucking Rooting 34 wk gestation or greater & 1500 grams Gaining 20-30 grams/day
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Nursing CareNutrition Bottle Fed
Soft, smaller nipple
Semi sitting position
Burp Q -1 oz
Feeding last no longer than 15-20 min
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Nursing CareNutrition - Breast Feeding
Put to breast when Suck & swallow developed Consistent weight gain Control body temp outside isolette
Football hold
May take 45 min (sleep and restperiods)Pump and gavage until able to nurse
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Nursing CareNutrition - Gavage
Adjunct to nipple feeding
Nasogastric or orogastric route Gavage Gastronomy feeding
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Complications
Apnea of prematurity 20sec or > or , 20 sec + cyanosis & bradycardPDA pulmonary arteriole musculature & hypoxeRDS surfactant
GMH-IVH - Hemorrhage Germinal matrix lines brain ventricles & is high
susceptible to hypoxia
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Complications
Anemia Rapid rate of growth Shorter RBC life Excessive blood sampling iron stores
HypocalcemiaNEC Necrotizing Enterocolitis
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Long Term Outcomes
Retinopathy of prematurity (ROP)Bronchopulmonary Dysplasia (BPD) r/tdamage to alveoli from CPAP therapy &
high O2 concentrationsSpeech defectsNeurological deficits
Auditory defects
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Nursing CareInfection Prevention
Strict hand washing
Maintain asepsis
Change position regularly
Sheepskin Avoid chemical skin preps/tape
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Post-term
> 42 weeks gestationPost-maturity syndrome
Dont tolerate prolonged pregnancy
Placenta degenerates Poor oxygenation Poor nutrition Poor waste removal
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Characteristics
Loose, dry peeling skinMeconium stainingLong fingernails
Alert facesLook old & worried
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Postmaturity Complications
Hypoglycemia Nutritional deprivationMeconium aspiration
hypoxiaPolycythemia
R/t hypoxiaSeizure activity
R/t hypoxiaCold stress sub Q fatCongenital anomalies
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Meconium Staining
Occurs in 10-15% of all live birthsPredominantly in Term, SGA, or Post-term infants
Cause may be in u tero h yp oxia Almost never observed in infants lessthan 34 weeks gestation
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Aspiration Syndromes
Fetal stress or distress ordevelopmentalProcess: Gasping of fluid, blood, meconium etc.
into lung with breathing Rapid distal migration with first breaths
Prevention Delay first breath
Intubate and suction
d
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Aspiration Signs andSymptoms
Barrel chest TachypneaGrunting, retractions,Pallor, cyanosisCO2 retention, acidosisRales, decreased breath soundsStained nails, cord & skin
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Substance Abuse
Alcohol Fetal alcohol syndrome (FAS) Fetal alcohol effects (FAEs)
HeroinMethadoneMarijuana
Cocaine
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Fetal Alcohol Spectrum Disorder
Leading cause of mental retardationSGA/IUGRLife long affecting learning, behavior,relationshipsSpeech/hearing/languageEating, sleeping
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Triad for Diagnosis
Facial abnormalitiesGrowth deficitsCNS abnormalities or Neuro-behavioral disabilities
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FAS 1 st Week 1 st Month
SleeplessnessInconsolable crying
Abnormal reflexes
HyperactivityJitterinessExcessive mouthing behaviors
Hyperactive rootingIncreased non nutritive sucking
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Long Term Complications
Failure to thrive ability to block out repetitive stimuli
Severe mental retardation or normalImpulsivityCognitive impairmentSpeech/language abnormalities
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Cocaine
Greatest impact on perinatal morbidityIncrease risk for: Spontaneous abortion/stillbirth STDs, HIV Abruptio placenta Prematurity
LBW - low birth weight
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Heroin and Methadone
Results in IUGR, prematurity , stillbirths, butno documented congenital anomalies
Methadone - better infant outcomes then
heroin such as: fewer infections, larger birthweight Withdrawal symptoms may be more severein methadone exposed infants.
Long-term - increased risk for SIDS X 10-15
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Risks to Infants with NAS
Intrauterine asphyxia maternal withdrawal fetal withdrawal
hyperactivity increased O2
consumption asphyxiaIntrauterine infection r/t addicts lifestyle
Alterations in body weight
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Observe for Withdrawal S & S
Most common Poor weight gain
diarrhea, vomiting
Tremors Seizures SIDS Irritable
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Nursing Care
Temperature regulationMonitor P & R q 15 m till stableSmall, frequent feedings
IV prn hydrationMedication-PhenobarbitalPosition on R side aids in digestionWeight Q8H during withdrawal
Swaddle with hands near mouthGentle vertical rockingQuiet, dimly lit area
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Nursing Care
Quiet dimly lit environmentExtra time & patience with fdgMonitor VS
Observe for seizuresObserve for RDSMom can breastfeed
alcohol will intoxicate newborn inhibits letdown
Support parents & reinforce + parentingskills
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Substance Abuse
Other substancesNicoteneCaffeine
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Critical thinking
Assessments on SGA, LGA,Pre/PosttermWhat causes them?
What are their major problems? System by system
Which are the priorities?
How do you solve them?Developmental delays.Parental involvement and care.
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Example
The mother admits to alcoholWhat will the baby look like?How will the baby act?
What problems is the baby likely tohave?How will you respond to them?
What are your interventions? Feeding, diapering, sleeping, stimulation,pt education, medications, collarboration
What does the mother need to know?
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Next Week
Exam 350 questions
All multiple choice
All on the high risk and complicationsof pregnancy, birth and newbornUse the critical thinking topics to helpfocus your preparationRoom 25612:30 Review at 1:45