Unit 2 Care of Child .Edited
Unit 2 Care of Child .Edited
Unit 2 Care of Child .Edited
Objective:
1. Define the following terms—small-for-gestational-age infant, term infant, large-for-
gestational-age infant, preterm infant, and postterm infant—and describe common
illnesses that occur in these and other high-risk newborns
2. Recognize physiologic factors that compromise the preterm infant’s health status.
3. Perform a systematic assessment of a high-risk newborn.
4. Formulate nursing diagnoses related to a high-risk newborn.
5. Identify expected outcomes for a high-risk newborn and family.
6. Plan nursing care focused on priorities to stabilize a high-risk
7. newborn’s body systems.
Nursing Diagnosis
To establish nursing diagnoses for high-risk infants, it is important to be aware of newborns' normal
assessment parameters. Nursing diagnoses generally center on the nine priority areas of care for any
newborn:
1. Ineffective airway clearance related to the presence of mucus or amniotic fluid in the airway
2. Ineffective cardiovascular tissue perfusion related to breathing difficulty
3. Risk for deficient fluid volume related to insensible water loss
4. Ineffective thermoregulation related to newborn status and stress from birth weight variation
.https://www.youtube.com/watch?v=lEhQb6rliUY
https://www.youtube.com/watch?v=SOU-JW4L-s0
Prematurity
https://www.marchofdimes.org/complications/premature-babies.aspx
https://www.youtube.com/watch?v=7H7-z-TbgQA
https://www.youtube.com/watch?v=lEhQb6rliUY
https://www.youtube.com/watch?v=ktZv5ywteKo
Most organ systems' immaturity places infants at risk for a variety of neonatal complications (e.g.,
hyperbilirubinemia, respiratory distress syndrome [RDS], intellectual and motor delays). Factors such as
poverty, maternal infections, previous preterm delivery, multiple pregnancies, pregnancy-induced
hypertension, and placental problems that interrupt the normal course of gestation before completion of fetal
development are responsible for a large number of preterm births.p.25
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Symmetric: Height, weight, and head circumference are about equally affected.
Asymmetric: Weight is most affected, with a relative sparing of growth of the brain,
cranium, and long bones.
Symmetric growth restriction usually results from a fetal problem early in gestation, often
during the 1st trimester. When the cause begins relatively early in gestation, the entire body
is affected, resulting in fewer cells of all types.
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Diagnosis :
Other diagnostic procedures may include the following:
ULTRASOUND
Ultrasound (a test using sound waves to create a picture of internal structures) is a more accurate
estimating fetal size method. Measurements can be taken of the fetus' head and abdomen and
compared with a growth chart to estimate fetal weight. The fetal abdominal circumference is a
helpful indicator of fetal nutrition.
DOPPLER FLOW
Another way to interpret and diagnose IUGR during pregnancy is Doppler flow, which uses sound
waves to measure blood flow. The sound of moving blood produces waveforms that reflect the
blood's speed and amount as it moves through a blood vessel.
Blood vessels in the fetal brain and the umbilical cord blood flow can be checked with Doppler flow
studies.
MOTHER'S WEIGHT GAIN
A mother's weight gain can also indicate a baby's size. Small maternal weight gains in pregnancy
may correspond with a small baby.
GESTATIONAL ASSESSMENT
Babies are weighed within the first few hours after birth. The weight is compared with the baby's
gestational age and recorded in the medical record. The birthweight must be compared to the
gestational age. Some physicians use a formula for calculating a baby's body mass to diagnose SGA.
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Despite their size, SGA infants have physical characteristics (e.g., skin appearance, ear cartilage, sole
creases) and behavior (e.g., alertness, spontaneous activity, zest for feeding) of normal-sized infants
of like gestational age. However, they may appear thin with decreased muscle mass and
subcutaneous fat tissue. Facial features may appear sunken, resembling those of an elderly person
("wizened facies"). The umbilical cord can appear thin and small. (Robert L. Stavis, 2019)
Complications
Full-term SGA infants do not have the complications related to organ system immaturity that
premature infants of similar size have. They are, however, at risk of
a. Perinatal asphyxia
b. Meconium aspiration
c. Hypoglycemia
d. Polycythemia
e. Hypothermia
Perinatal asphyxia during labor is the most serious potential complication. It is a risk of
intrauterine growth restriction. It is caused by placental insufficiency (with marginally
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Meconium aspiration may occur during perinatal asphyxia. SGA infants, especially those
who are postmature, may pass meconium into the amniotic sac and begin deep gasping
movements. The consequent aspiration is likely to result in meconium aspiration syndrome.
Meconium aspiration syndrome is often most severe in growth-restricted or postmature
infants because the meconium is contained in a smaller volume of amniotic fluid and thus
more concentrated.
Hypoglycemia often occurs in the early hours and days of life because of a lack of adequate
glycogen synthesis and decreased glycogen stores and must be treated quickly with IV
glucose.
Polycythemia may occur when SGA fetuses experience chronic mild hypoxia caused by
placental insufficiency. Erythropoietin release is increased, leading to an increased rate of
erythrocyte production. The neonate with polycythemia at birth appears ruddy and may be
tachypneic or lethargic.
Nursing Diagnosis:
Ineffective breathing pattern related to underdeveloped body systems at birth
Outcome Evaluation:
Newborn maintains respirations at a rate of 30 to 60 breaths per minute after resuscitation at birth.
Birth asphyxia is a common problem for SGA infants, both because they have underdeveloped chest
muscles and are at risk for developing meconium aspiration syndrome due to anoxia during labor.
Fetal hypoxia causes a reflex relaxation of the anal sphincter and increased intestinal movement.
When gasping for breath in utero, the fetus draws meconium that was discharged from the intestine
into the amniotic fluid down into the trachea and bronchi. Acting as a foreign substance, this blocks
airflow into the alveoli, leading to hypoxemia, acidosis, and hypercapnia.
For this reason, many SGA infants require resuscitation at birth. Closely observe both respiratory
rate and character in the first few hours of life. Underdeveloped chest muscles can make SGA
infants unable to sustain the rapid respiratory rate of a normal newborn.
Nursing Diagnosis:
Risk for ineffective thermoregulation related to lack of subcutaneous fat
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Large gestational age means that a fetus or infant is larger or more developed than normal for the
baby's gestational age. Gestational age is the age of a fetus or baby that starts on the first day of the
mother's last menstrual period.
Large for gestational age (LGA) refers to a fetus or infant larger than expected for their age and
gender. It can also include infants with a birth weight above the 90th percentile.
The LGA measurement is based on the estimated gestational age of the fetus or infant. Their actual
measurements are compared with normal height, weight, head size, and development of a fetus or
infant of the same age and sex.
a. LGA weight- Larger than 9 lbs and above the 90th%
b. Large body-plump full face
c. Body size is proportionate.
d. Poor motor skills
e. Difficulty in regulating behavioral state (arouse to quiet alert state)
Common causes of the condition are:
a. Gestational diabetes
b. Obese pregnant mother
c. Excessive weight gain during pregnancy
A baby that is LGA has a higher risk of birth injury. There is also a risk for complications of low
blood sugar after delivery if the mother has diabetes.
Large for Gestational Age Common Problems
a. Birth Trauma-
b. Hypoglycemia
c. Polycythemia
d. Hyperbilirubinemia
Symptoms of large-for-gestational-age newborns are mainly related to any complications that
occur.
Kernicterus. Kernicterus is the destruction of brain cells by an indirect bilirubin invasion (Symons
& Mahoney, 2008).
Complications
Common complications, according to R. Stavis, in large-for-gestational-age newborns include the
following:
Birth injuries: Common injuries include stretching of the shoulder's nerves (brachial plexus
injuries) and fractures.
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c. Newborns with hypoglycemia are treated with frequent feedings or sometimes are
given glucose by vein.
d. Respiratory distress and meconium aspiration are treated with supplemental oxygen or
other supportive devices such as continuous positive airway pressure (CPAP—a
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Nursing Diagnosis: Risk for imbalanced nutrition, less than body requirements, related to
additional nutrients needed to maintain weight and prevent hypoglycemia
Outcome Evaluation: Infant’s weight follows percentile growth curve; skin turgor is good; specific
gravity of urine is 1.003 to 1.030; serum glucose is above 45 mg/dL.
As a rule, an LGA infant needs to be breastfed immediately to prevent hypoglycemia. The infant may
need supplemental formula feedings after breastfeeding to supply enough fluid and glucose for the
larger-than-normal size for the first few days. Newborns who are offered bottles often have more
difficulty than do others learning to breastfeed. Offer both the mother and baby support to
overcome this hurdle.
References
Marilyn J. Hockenberry and David Wilson (2013) WONG’S ESSENTIALS OF PEDIATRIC NURSING
ISBN: 978-0-323-08343-0 Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
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distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods,
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