OB Study Guide Exam 3.docx - OB Study Guide Exam 3 The High-Risk Neonate Most newborns are between 38-42 weeks and weigh in at between 6-8lbs Nurse Role

OB Study Guide Exam 3.docx - OB Study Guide Exam 3 The...

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OB Study Guide Exam 3The High-Risk Neonate-Most newborns are between 38-42 weeks and weigh in at between 6-8lbs.Nurse Role-Early observation-Accurate recording –good documentation-Reporting of abnormal findings as early as possible-Provide support & education to parentsBirth Weight Variations-Fetal growth is determined by maternal nutrition, genetics, placental function and environment-AGA- Least risk for complications-SGA - <2500 gms at term or <10thpercentile-LGA - > 4000 gms at term ar > 90thpercentile-SGA v IUGR- not interchangeableSGA- 2500gms at term or <10thpercentile-Risk factorsoMaternal- chronic HTN, diabetes, smoking including passive smoke, SA, preeclampsiaoPlacental- placental insufficiency, chronic abruption, previaoFetal- Trisomy 13 18, 21, chronic fetal infection, congenital abnormalities, Multiples-IUGR (intrauterine growth restrictionoSymmetric=< 28 weeks, poorest long term progress, all growth is equally small, never catch upoAsymmetric=> 28 weeks, brain and heart are larger, once born optimal nutrition can restore normal growth pattern-Nursing assessmentoDisproportionately large head, wasted extremities, wide skull sutures oloose dry skin, thin umbilical cord, reduce sub Q fat stores-Management: obtaining weight, length and circumferences to compare to standards, monitor VS, -Common ProblemsoThermoregulation- less muscle mass, less brown fat, less sub q fat, depleted glycogen storeoPerinatal asphyxia- Poor tolerance to labor acidosis and hypoxia, depletion of glycogen stores, impaired uterine circulationcompromised newborns inability to transition to extrauterine life, cord compression, small respiratory passagesoHypoglycemia- increased metabolic rate and not enough glycogen stored to meet needssubtle, lethargy, tachycardia, resp distress, jitters, drowsiness, poor feeding and sucking, temp instabilityhypotonia, Chronic mild hypoxia secondary to placental insufficiencyActionsAssess respiratory status, monitor glucose, maintain neutral thermal environment, observe newborn, initiate early feedings1
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LGA -> 4000 gms at term or > 90thpercentile-Risk factors- DM, multiparity, prior hx of macrosomic infant, post dates, maternal obesity, genetics-Risks at birth- traumatic birth injuries>fractured clavicle, phrenic nerve injury, brachial palsy, facial paralysisohypoglycemia-BS < 40 (45). jitters, tachypnea, lethargy, drowsiness, fetal suck, hypotonia-Nursing assessment- plump, full faced, increase in body is proportional, poor motor skills, difficulty regulating behavioral states-Nursing management- Assess for any traumatic birth injury, stabilize infant, monitor blood glucose- if low feed-Common problemsoHypoglycemia- Increased metabolic rate and not enough glycogen stores to meet needsS&S: subtle, lethargy, tachycardia, resp distress, jitters, drowsiness, poor feeding and sucking, temp instability, hypotonia, Chronic mild hypoxia secondary to placental insufficiencyActions: monitor glucose, observe newborn, initiate early feedingso
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