Neurologic symptoms include aJitteriness bDecreased response to stimuli

Neurologic symptoms include ajitteriness bdecreased

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2.Neurologic symptoms include: a.Jitteriness b.Decreased response to stimuli c.Hypotonia d.Apnea e.Poor feeding f.Seizures 3.Obtain baseline vital signs and oxygen saturation readings. a.Provide as necessary: i.Additional oxygen ii.Assisted ventilation iii.Blood pressure support
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iv.IV access 4.If the blood glucose level is less than 40 mg/dL: a.An IV bolus of 10% dextrose solution (2 mL/kg) can be given. b.Recheck blood glucose level in about 30 minutes. c.Dextrose IV administration may need to be followed by a 10% dextrose infusion at 60 to 100 mL/kg/d. V. Family and Transport Considerations A.Transport to the nearest facility to provide the next level of care once the newborn is stabilized as much as possible. 1.Contact the facility for advice regarding care and disposition. 2.Provide ongoing communication with the family about the current care. a.Do not be specific about survival statistics. b.If you cannot answer questions, tell them you will help find those who can. 3.During transport, monitor the newborn and frequently assess for status changes. a.Vital to check: i.Thermoregulation ii.Respiratory effort iii.Airway patency iv.Skin color v.Pulse rate B.Development of new techniques for newborn care has reduced mortality among high-risk newborns. 1.It may be necessary to transfer critically ill newborns to a regional center to get needed treatment. 2.Transport of a high-risk newborn should include the following steps: a.A physician at the referring hospital initiates a request for transport. i. A physician at the region control center decides which intensive care nursery can accommodate the patient. b.A mode of transportation is chosen depending on distance, availability, and weather conditions. c.The transport team is mobilized and equipment assembled. i.Ideal team consists of: (a)A nurse with special training in neonatal intensive care (b)A respiratory therapist with similar training (c)A paramedic with an apprenticeship in neonatal intensive care (d)A physician (for particularly critical patients) ii.Highly specialized equipment includes: (a)Appropriately designed ventilation and oxygenation units (b)An incubator meeting stringent criteria d.On arrival at the referring hospital, the transport team continues to stabilize the newborn. i.Conditions that should be treated before leaving the referring hospital: (a)Hypoxemia (b)Acidosis
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(c)Hypoglycemia (d)Hypovolemia e.The team collects information while stabilizing the newborn, including: i.A copy of the mother’s and infant’s charts ii.Any radiographic studies of the newborn VI. Pathophysiology, Assessment, and Management of Specific Conditions A.Apnea 1.Common in newborns delivered before 32 weeks of gestation a.Rarely seen in the first 24 hours b.Defined as respiratory pause of greater than 20 seconds c.Can lead to hypoxemia and bradycardia d.Often follows hypoxia or hypothermia e.Other causes include: i.Maternal or infant narcotic exposure ii.Airway or respiratory muscle weakness iii.Septicemia iv.Prolonged or difficult labor and delivery v.Gastroesophageal reflux
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