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NUR 439 Exam Highlighted Powerpoints
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NUR 439 Exam Highlighted PowerpointsPreterm Birth birth that occurs between 20 0/7 and 36 6/7 weeks of gestation
How is preterm labor diagnosed Regular contractions along with cervical changes with regular
contractions and cervical dilation of at least 2cm
Cause of PTL unknown, is multifactorial and it is not possible to predict with certainty which women will
experience PTB and PTL
PTL Management Although Mg+SO4 is no longer recommended for stopping PTL, ACOG still
recommends it for neuro-protection against cerebral palsy for <32 weeks. Short -term use (up to 48
hours) from 24 to 32 weeks is given to allow for the administration of Betamethasone for lung maturity.
PTL Care Management Activity restriction—modified bedrest; kickcounts
Restriction of sexual activity—pelvic rest
PROM between 34 and 36 weeks gestation Active pursuit of labor & birth, rather than expectant
management. Rationale: conservative management at this gestational age prolongs pregnancy by only a
few days, significantly increasing the risk of chorioamnionitis, and has not been shown to improve
neonatal outcomes. Immediate birth is considered the best management option.
Signs of infection with PROM and PPROM (fever, foul-smelling vaginal discharge, maternal & fetal
tachycardia) should be reported immediately. Labor is induced for chorioamnionitis.
Chorioamnionitis Most often occurs after SRM or labor begins, as organisms that are part of the normal
vaginal flora ascend into the amniotic cavity.
,Chorioamnionitis Risk Factors long labor with prolonged ROM, multiple vag exams, and use of internal
monitoring.
Women can develop bacteremia and are more likely to have dysfunctional labor resulting in a C/S.
Chorioamnionitis Treatment Ampicillin or Gentamycin are used during labor. After birth, an antibiotic
that provides coverage for anerobic organisms should be added (Cleocin of Flagyl).
Transepidermal Water Loss greater because of skin immaturity in very preterm infants <28 weeks and
can contribute to temperature instability.
Preterm infant should be transferred in a pre-warmed incubator; ELBW infants can be placed in a
polyethylene bag to decrease heat and water loss. Skin-to-skin (kangaroo care) when the preterm infant
is stable
Respiratory Distress Syndrome caused by a lack of pulmonary surfactant which leads to progressive
atelectasis, loss of functional residual capacity, and ventilation-perfusion imbalance with an uneven
distribution of ventilation.
Meconium aspiration syndrome requires NICU to be at the birth. For infants with meconium staining
who are not vigorous, endotracheal suctioning should be performed immediately. Vigorous infants need
no special handling.
If the infant is very depressed & meconium not removed from the airway at birth, it can migrate down
to the terminal airways causing MAS.
RDS treatment •Surfactant delivered via an endotracheal tube and the infant is rotated to all positions
to get all lobes of the lungs.
•Better outcomes with the use of surfactant therapy than without.
Early signs of respiratory distress Nasal flaring and grunting; may also have retractions (subcostal,
suprasternal, or intercostal
, A compromised infant's color progresses from pink to circumoral cyansosis and then to generalized
cyanosis.
Apneia WHICH is a 20-second or greater cessation of respiration, or a shorter pause accompanied by
bradycardia, cyanosis, or hypotonia.
Asphyxiated Management Care Early enteral feeding of the asphyxiated neonate with a low Apgar score
is avoided to prevent NEC; nutrition is provided parenterally.
Insensible Water Loss is an evaporative loss that occurs largely through the skin (70%) and respiratory
tract (30%). After the initial week, a preterm's loss or gain during each 24 hour period should not exceed
2% of the previous day's weight.
Elimination Pattern includes frequency, character of the stool, and any constipation, diarrhea or loss of
fats (steatorrhea). Guaiac tests done for blood in the stool; and a pH determines malabsorption
Nesting Part of developmental care - similar to the womb
Retinopathy of Prematurity (ROP) High levels of PO2 cause hyperproliferation of blood vessels
Typically develops in both eyes due to hyperoxemia, acidosis, or shock
Can cause permanent blindness
Significant fluctuations in blood oxygen levels should be avoided
NEC S/Sx Abdominal distention
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