Price: Pediatric Nursing, 10th Edition

Open Book Quizzes Chapter 5: The High-Risk Neonate

1. Infants born at less than 38 weeks of gestation are called preterm, and those born at more than 42 weeks are called postterm. 2. Failure of the alveoli to enlarge leads to many deaths attributed to previability. The muscles that move the chest must develop. A distended abdomen causes pressure on the diaphragm, stimulation of the respiratory center in the brain is immature, and the gag and cough reflexes are weak because of inadequate nerve supply. Surfactant deficiency may also affect respiratory function. 3. Manifestations of respiratory distress syndrome include tachypnea, nasal flaring, cyanosis, intercostal and sternal retractions, and grunting. Infants with severe respiratory distress syndrome develop apnea and respiratory failure. 4. Surfactant replacement therapy is done for the very lowbirth weight infant and also for those infants who show evidence of respiratory distress during the first 24 hours. Complications of surfactant therapy include transient hypoxia and hypotension, blockage of the endotracheal tube, and pulmonary hemorrhage. 5. Early recognition of the signs and symptoms of necrotizing enterocolitis (NEC) aids in early treatment. Abdominal distention should be monitored. Temperature should not be taken rectally. Should it occur, transmission to other infants must be prevented. Strict handwashing and other infection control measures are implemented. The infant will have a nasogastric tube for abdominal decompression, receive intravenous antibiotics, and require monitoring of laboratory values. The use of parenteral nutrition may be necessary. Monitor vital signs, and report any abnormal findings. Orders for resuming feedings are followed closely. 6. Symptoms include muscle cramps, tetany, weakness, paresthesia, laryngospasm, or seizure-like activity. Serum calcium levels are monitored in all high-risk neonates. Hypocalcemia is treated by early feedings and calcium supplements when possible. Intravenous administration of 10% calcium gluconate may be necessary. 7. Pediatric ophthalmologists can treat the disorder with laser surgery or cryotherapy. The incidence rate may be reduced by decreasing constant bright environmental light and stimuli and by decreasing or avoiding events that cause fluctuations in blood pressure and oxygenation. 8. After birth, all high-risk infants should be dried immediately to eliminate evaporative heat loss. A radiant warmer should also be used with these infants. The infant is placed in the isolette or under the radiant warmer. The infants temperature is maintained at a constant level and monitored with a heat-sensitive probe. The infants axillary temperature is also monitored. Prewarm all surfaces that come in contact with the

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infant. Avoid drafts in the room. Use discretion in bathing the infant. Provide a plastic heat shield for very low-birth weight infants. Wrap the infant in a blanket if he or she is removed from the radiant warmer or the isolette. 9. Feeding of the preterm infant may be done by mouth, by gavage, or by parenteral methods. 10. In this position, the infant wears only a diaper while the parent holds the infant semi-upright against his or her skin. The parent covers the infant with his or her own clothing to facilitate temperature stability.