CH 24 NEWBORN AT RISK pt 2_8th ed

CH 24 NEWBORN AT RISK pt 2_8th ed - NEWBORN AT RISK Chapter...

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NEWBORN AT RISK Chapter 24 – part II ACQUIRED & CONGENITAL PROBLEMS
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BIRTH TRAUMA INJURY SUSTAINED BY A NEONATE DURING LABOR AND BIRTH
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Predisposing factors: Caregiver Alert : Apgar score, flaccid muscle tone, weak or hoarse cry, pronounced bruising of skin
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Review Caput succedaneum Cephalohematoma
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Subconjunctival (sclera) & retinal hemorrhage: rupture of capillaries caused by increased ICP during birth. Clear 5 days Bruises: may be result of face or breech presentation, manipulation during birth Petechiae: pinpoint hemorrhagic areas. Benign if disappear within 2 days without new lesions. Prolonged may be more serious Skull fracture: linear and depressed
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Fracture of the clavicle: most common birth injury . Crepitus may be heard or felt. Crackling sound with rubbing together of bone fragments Suspect : limited use of arm, malposition of arm, asymmetric Moro, focal swelling or tenderness, crying Treat : proper body alignment, gentle handling with support, no special splinting. Support parents!
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Erb-Duchenne paralysis (brachial paralysis of upper portion of arm) most common type of paralysis associated with a difficult birth with stretching or pulling head away from shoulder. Suspect: flaccid arm with elbow extended, hand rotated inward, absent Moro, sensory loss, intact grasp reflex Treat: immobilize with brace, splint, or pinning sleeve to mattress. Position with arm abducted 90 degrees, externally rotated shoulder, elbow flexed 90 degrees, wrist supinated with palm toward face. Delay ROM exercises until latter part of first week.
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Klumpke’s palsy damage to lower plexus Facial palsy pressure on facial nerve. Affected side flattened, eye remains open, forehead won’t wrinkle. Usually transitory. TREAT assist with feeding, protect cornea, support parents. Phrenic nerve injury results in diaphragmatic paralysis. Cyanosis, irregular thoracic respirations, no abdominal movement or inspiration.
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CNS Injuries Intracranial hemorrhage (ICH)
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Subdural hematomas life threatening Subarachnoid hemorrhage most common type of ICH. Cause of trauma in term or hypoxia in preterm Supportive nursing care, monitoring ventilation & IV therapy, management of seizures, prevention of ICP. Handle minimally
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Neonatal infections
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Sepsis Presence of microorganisms or toxins in blood or other tissues Continues to be one of most significant See Table 27-2, page 890 for risk factors Maternal IgM doesn’t cross placenta IgA & IgM take time to reach optimal level after birth.
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Bacterial infections Early-onset within 24-48 hours Progresses rapidly Usually caused by normal vaginal flora,
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CH 24 NEWBORN AT RISK pt 2_8th ed - NEWBORN AT RISK Chapter...

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