ASSESSMENT AND MANAGEMENT OF HIGH RISK NEW BORN

GESTATIONAL AGE GA ,the number of weeks the neonate remained in utero

FACTORS AFFECTING FETAL GROWTH…..Contd MATERNAL FACTORS PLACENTAL FACTORS FETAL FACTORS

CLASSIFICATION OF NEONATE ACCORDING TO GESTATIONAL AGE AND BIRTH WEIGHT ACCORDING TO GA PRE TERM – Before 37th week TERM – Between 38 and 42 weeks POST TERM - After 42 weeks

CLASSIFICATION OF NEONATE ACCORDING TO GESTATIONAL AGE AND BIRTH WEIGHT ACCORDING TO BIRTH WEIGHT Large for gestational age (LGA) Appropriate for gestational age (AGA) Small for gestational age (SGA)

CLASSIFICATION OF NEONATE ACCORDING TO GESTATIONAL AGE AND BIRTH WEIGHT ACCORDING TO BIRTH WEIGHT Low birth weight Moderately low birth weight Very low birth weight Extremely low birth weight

NURSING PROCESS IN HIGH RISK NEONATAL CARE NURSING ASSESSMENT Identification of associated factors Maternal characteristics Reproductive history Substance abuse Environmental hazards Medical problems Complications of present pregnancy Immediately after birth Apgar scoring Maternal history of anesthesia and analgesia

APGAR SCORING SCORE SIGNS 1 2 RESPIRATORY EFFORT Apneic Slow irregular Good crying HEART RATE Absent Low (Below 100) Over 100 MUSCLE TONE Flaccid Flexion of extremities Active body movements REFLEX IRRITABILITY No response Grimace Cough or sneeze COLOUR Blue,pale Body pink extremities blue Complete pink Total score – 10 , No depression – 7-10 , Moderate depression – 4-6 Severe depression – 0-3

PLANNING AND INTERVENTION….Contd Resusitation Transport of the neonate at risk Providing neutral thermal environment Maintaining skin integrity Prevention of infection Respiratory care Nutritional need

NURSING DIAGNOSIS Impaired gas exchange related to lack of surfactant Fluid volume deficit related to insensible water loss and inadequate fluid intake Altered nutrition less than body requirement related to actual intake less than caloric requirement

NURSING DIAGNOSIS Impaired skin integrity related to the presence of tapes and other abrasive materials used with monitoring device Altered comfort related to invasive painful procedure Risk for injury Risk for infection