ATI Maternal Newborn Remediation

1. Management of Care a. Establishing Priorities i. Assessment and Management of Newborn Complications: Priority Finding that Requires Further Assessment (Chp 27) • Signs of alcohol withdrawal include jitteriness. Irritability, increased tones and reflex responses, and seizures. A term newborn’s blood glucose should be 30-60mg/dL. Hypoglycemia can bring about poor feeding, jitteriness/tremors, hypothermia, diaphoresis, weak cry, and lethargy. • Other reportable findings are respiratory distress which include tachypnea, nasal flaring, expiratory grunting, retractions, and cyanosis. Newborn infections like sepsis can cause an infant to have temperature instability, suspicious drainage, poor feeding, weak suck, vomiting, diarrhea, hypo or hyperglycemia, respiratory distress, and low BP. • Hyperbilirubinemia includes yellowish tint to skin, sclera, mucous membranes, observe the newborns color for yellowish tint as the skin is blanched, and assess if there is an underlying cause that needs to be fixed. Look for hypoxia, hypothermia, hypoglycemia, and metabolic acidosis. Increased risk for brain damage. Congenital anomalies involve cleft lip/palate and tracheoesophageal fistula, excessive mucous secretions and drooling, periodic cyanotic episodes and choking, distended abdomen. PKU can result in cognitive impairment if untreated, not evident at birth and it’s found in newborn screening. Hypothyroidism: hypothermia, poor feeding, lethargy, jaundice, cretinism. Spina bifida is a protrusion of meninges and/or spinal cord, tufts of hair on the spine. Patent ductus arteriosus is another neonate complication that includes murmurs, abnormal heart rate or rhythm, breathlessness, and fatigue while feeding. • Tetralogy of Fallot is a combination of four congenital abnormalities that has respiratory difficulties, cyanosis, tachycardia, tachypnea, and diaphoresis. Down syndrome, also known as trisomy 21, exhibits oblique palpebral fissures or upward slant of the eyes, epicanthal folds, flat facial profile with a depressed nasal bridge and small nose, protruding tongue, short broad hands with a fifth finger that has one flexion crease instead of two, a deep crease across the center of the palm, hyperflexibility, hypotonic muscles. ii. Medical Conditions: Priority Finding That Requires Further Assessment (Chp 9) • Cervical insufficiency is a painless opening of the cervix that results in delivery of the baby in the 2nd trimester of pregnancy. Some expected findings are pink stained vaginal discharge or bleeding, possible gush of fluid, and uterine contractions w/ expulsion of fetus. The nurse needs to evaluate the client’s support system and if assistance is available for them if they are prescribed activity restrictions or bed rest. Assess the client for any vaginal discharge, monitor client reports of pressure and contractions, and check vital signs. • For gestational HTN, some expected findings are severe continuous HA, nausea, blurring of vision, flashes of lights or dots before the eyes, HTN, proteinuria, edema, vomiting, and epigastric pain. The nurse should assess their LOC, obtain pulse oximetry, monitor urine output, and obtain a clean catch urine sample to assess for proteinuria. Also, obtain the client’s daily weight, monitor vital signs with careful attention to BP, encourage lateral positioning, perform non-stress test and daily kick counts, and instruct the parents to monitor I&Os. 2. Safety and Infection Control a. Accident/Error/Injury/Prevention i. Assessment and Management of Newborn Complications: Caring for a Newborn Who Has Abstinence Syndrome (Chp 27) • Neonatal abstinence syndrome is what happens when babies are exposed to drugs in the womb before birth. Babies can then go through drug withdrawal after birth. The syndrome most often applies to opioid medicines. • Monitor newborn's ability to feed and digest intake, offer small frequent feedings, swaddle newborn with legs flexed, looser than normal, reduce environmental stimuli (lights off, lower noise level), and educate the mom on SIDS prevention strategies. ii. Nursing Care and Discharge Teaching: Evaluating Understanding of Car Seat Safety (Chp 26) • Infant should be using an approves rear facing car seat until age 2 or until they reach maximum height and weight for seat. Rear facing car seat should preferably be placed in the middle of the back seat because they are away from the air bags and side impact. No hand me downs should be used! Set the seat at a 45-degree angle because if the car seat is too flat, the baby may slide out through the straps. If it is too upright, the head may flop forwards too much and make it difficult for the baby to breathe. b. Standard Precautions/Transmission-Based Precautions/Surgical Asepsis i. Nursing Care of Newborns: Personal Protective Equipment (Chp 24) • Before caring for a newborn, scrub arms with antibacterial soap from your elbows to your fingertips. For a newborn’s first bath, gloves need to be worn to prevent exposure to body secretions. Individual bassinets need to be equipped with diapers, T-shirts, and bathing supplies. Nurses must follow facility hygiene protocols in between caring for newborns. All nurses must know that cover gowns and special uniforms are used to prevent direct contact with clothes. 3. Health Promotion and Maintenance a. Ante/Intra/Postpartum and Newborn Care