CHAPTER 8 ■ Car
Clinical Judgment Alerts help students to recognize and understand emergent or critical situations and to implement the appropriate nursing interventions.
The preterm n newborn but also acteristics (Box 8- Respiratory D Fetal lung matur term. Fetal lung m PG values, which oxygenation of th surface to decrea the alveoli open w values are often m this time, newbor RDS is a deve preterm newborn derdeveloped alve (parts of the lung edema in the lung inadequate to kee Lung compliance infant’s work of br reticulogranular p ble atelectasis, wh heart borders. Preterm infant ture developmen smaller and more for RDS; almost al tational age devel Institute, 2019). Signs and Symp The clinical signs birth and include ■ Expiratory gru ■ Use of accesso f laring ■ Cyanosis in ro ■ Rapid breathin ■ Labored breath ■ Decreased brea ■ Respiratory or ■ Periods of apn Collaborative C interventions for therapy include: ■ Humidified ox ■ CPAP NURSING CARE Airway maint ■ Conventional m ■ Bilevel ventilat ■ High-frequenc ■ High-frequenc ■ Nitric oxide (fo ■ ECMO (in the MEDICAL CARE The first actio historically been ventilation via en
Cultural and Social Considerations for Health
Social Determinants of Health and Preterm Birth Despite a slight drop in 2022, the overall U.S. preterm birth rate remains high, especially for Black mothers (14.6%) compared with White (9.4%) and Hispanic (10.1%) mothers (Centers for Disease Control and Prevention [CDC], 2023). Social determinants of health (SDOH) can significantly impact preterm birth through various interconnected pathways.The following table shows the impact of SDOH on risk for preterm birth.
Social Determinant of Health Stress and mental health
Impact on Risk for Preterm Birth
↑ Stress hormones, ↓ immune function, ↑ risk of chronic health conditions Nutritional deficiencies, ↓ fetal development, ↑ risk of chronic health conditions that predisposes risk of preterm delivery Delayed diagnosis, inadequate care, delayed or missed critical testing and evaluations, ↑ risk of complications
Focus on Safety boxes highlight important protective measures to keep mothers and children out of harm’s way.
Nutrition
Health-care access and quality
Environmental factors Exposure to toxins, ↓ fetal development, ↑ health risks (teratogen effect) Lifestyle habits Direct harmful effects on
pregnancy, ↓ fetal development or abnormal fetal development (teratogen effect)
↑ Stress, lack of coping mechanisms, ↓ access to resources
Social support and resources
Source: Centers for Disease Control and Prevention (2023).
Patient Education boxes provide relevant information to be communicated with patients and/or their families.
NEW! Cultural and Social Considerations for Health boxes consider cultural variations to evaluate health outcomes. BOX 8-5 Risk Factors for Preterm Birth Maternal smoking Maternal age: older than 35 years or younger than 20 years at delivery Maternal substance use Intimate partner violence Multiple gestations Maternal uterine abnormalities Fetal anomalies Maternal infection (especially chlamydia, gonorrhea, and bacterial vaginosis) Maternal cervical anomalies History of previous preterm birth (carries twice the risk) Black descent Genetic susceptibility
Optimizing Outcomes boxes enhance critical-thinking skills for clinical application and reinforce how to obtain the best possible outcomes for patients.
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