NURS 221 - Final Exam
What are some non-pulmonary causes of respiratory distress in neonates?
Sepsis, cardiac defects (structural or functional), hemolytic disease, CNS defects, exposure to cold, airway obstruction (atresia), intraventricular hemorrhage, hypoglycemia, metabolic acidosis, acute bl...
NURS 221 - Final Exam
What are some non-pulmonary causes of respiratory distress in neonates?
Sepsis, cardiac defects (structural or functional), hemolytic disease, CNS defects, exposure to cold,
airway obstruction (atresia), intraventricular hemorrhage, hypoglycemia, metabolic acidosis, acute
blood loss and drugs.
What appears to be the principle factor in the development of Respiratory Distress Syndrome?
Surfactant deficiency.
What are the clinical manifestations of Respiratory Distress Syndrome?
1.) Tachypnea (greater than or equal to 60 breaths/min) initially
2.) Dyspnea
3.) Pronounced intercostal or substernal retractions
4.) Fine respiratory crackles
5.) Audible expiratory grunt
6.) Flaring of the external nares
7.) Cyanosis or pallor
8.) Apnea
9.) With progression of condition, deteriorating vital signs including blood pressure, apnea, body
temperature instability
In addition to Respiratory Distress Syndrome, what is surfactant therapy also being used in?
Infants with meconium aspiration, infectious pneumonia, sepsis, persistent pulmonary hypertension,
and pulmonary hemorrhage.
How is surfactant administered?
Via an endotracheal (ET) tube directly into the infant's trachea.
What is Acrocyanosis?
The bluish discoloration of the hands and feet that is a normal finding within the first 24 hours after
birth.
What are the clinical manifestations of Infants of Diabetic Mothers (IDMs)?
1.) Large for gestational age (>4g)
2.) Very plump and full faced
3.) Abundant vernix caseosa
4.) Plethora
5.) Listless and lethargic
6.) Possibly meconium stained at birth
7.) Hypotonia
What are the risk factors for hypoglycemia in the infant?
Hypoglycemia in IDMs is related to hypertrophy and hyperplasia of the pancreatic islet cells and the
transient state of hyperinsulinism. High maternal blood glucose levels during fetal life provide a
continual stimulus to the fetal islet cells for insulin production (glucose easily passes the placental
barrier from maternal to fetal side, however, insulin does not cross the placental barrier).
When the neonate's glucose supply is removed abruptly at the time of birth, the continued
production of insulin soon depletes the blood of circulating glucose, creating a state of
, hyperinsulinism and hypoglycemia within 0.5 to 4 hours, especially in infants of mothers with poorly
controlled diabetes.
What is the single most important factor that influences fetal well being in a diabetic mother?
The euglycemic status of the mother.
What serum glucose level should be maintained in an infant with abnormal clinical symptoms?
Above 40 mg/dL and as high as 55 to 65 mg/dL in other infants.
What are the signs and symptoms of hypoglycemia in the newborn?
Jitteriness, lethargy, poor feeding, abnormal cry, hypotonia, temperature instability (hypothermia),
respiratory distress, apnea, and seizures.
What are the characteristics of meconium stained amniotic fluid?
It is green, and it is either thin (light) or thick (heavy), depending on the amount of meconium
present.
What are the three possible reasons for the passage of meconium in the amniotic fluid?
1.) It is a normal physiologic function that occurs with maturity (meconium passage being infrequent
before weeks 23 or 24, with an increased incidence after 38 weeks) or with a breech presentation.
2.) It is the result of hypoxia induced peristalsis and sphincter relaxation.
3.) It can be a sequel to umbilical cord compression induced vagal stimulation in mature fetuses.
SAFETY ALERT (pg. 454):
Every birth should be attended by at least one person whose only responsibility is the baby and who is
capable of initiating resuscitation. Either that person or someone else who is immediately available
should have the skills required to perform a complete resuscitation, including endotracheal suctioning
to remove meconium, if necessary.
What is the immediate management of the newborn with meconium stained amniotic fluid before
birth?
1.) Assess the amniotic fluid for the presence of meconium after rupture of membranes.
2.) If the amniotic fluid is meconium stained, gather equipment and supplies that might be necessary
for neonatal resuscitation.
3.) Have at least one person capable of performing endotracheal intubation on the baby present at
the birth.
What is the immediate management of the newborn with meconium stained amniotic fluid after
birth?
1.) Assess the baby's respiratory efforts, heart rate, and muscle tone
2.) Suction only the baby's mouth and nose, using either a bulb syringe or a large bore suction
catheter if the baby has: strong respiratory efforts, good muscle tone, heart rate >100 beats/minute
3.) Suction the trachea using an endotracheal tube connected to a meconium aspiration device and
suction source to remove any meconium present before many spontaneous respirations have
occurred or assisted ventilation has been initiated if the baby has: depressed respirations, decreased
muscle tone, heart rate <100 beats/minute
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