Or find the perfect balance with a comprehensive all-in-one book.
AJN Book-of-the-Year! Davis Advantage for Maternal-Child Nursing Care, 4th Edition Meredith J. Scannell, PhD, MSN, MPH, CNM, CLC, SANE-A Kristine Ruggiero, PhD, MSN, RN, CPNP-BC An expertly designed, balanced presentation of evidence-based nursing care meets the needs of today’s students for both combination and separate courses with the right depth and breadth of coverage. A unique emphasis on optimizing outcomes, evidence-based practice, and research supports the goal of caring for women, families, and children in all settings. § STREAMLINED & REDESIGNED! More relevant, more student-friendly, and easier to teach with more contemporary photographs and illustrations § NEW & EXPANDED! Chapters on women’s health now in the text § NEW & EXPANDED! Content on growth and development and health promotion as well as Tanner’s Clinical Judgment Model, and the Clinical Judgment Measurement Model § NEW! “Cultural and Social Considerations for Health” and “Nutrition in Action” boxes § UPDATED! Instructor PowerPoint presentations now include notes § A thematic organization reflecting “Holistic Care,” “Critical Thinking,” “Validating Practice,” and “Tools of Care,” each with special features to foster the development of the skills and clinical judgment integral to delivering quality nursing care.
Printed Text 1,120 pages l 590 illustrations Soft cover l 2026 $183.95 (US) ISBN-13: 978-1-7196-5063-2 Access Card $163.95 (US) ISBN-13: 978-1-7196-5065-6 Or purchase online access at FADavis.com
309
CHAPTER 8 ■ Caring for the Newborn at Risk
Cultural and Social Considerations for Health boxes consider cultural variations to evaluate health outcomes. Preterm infants are at risk for RDS because of the imma- ture development of the lungs and lack of surfactant. The smaller and more preterm the newborn is, the higher the risk for RDS; almost all infants who are born before 28 weeks’ ges- tational age develop RDS (National Heart, Lung, and Blood Institute, 2019). Signs and Symptoms The clinical signs and symptoms of RDS begin shortly after birth and include: ■ Expiratory grunting ■ Use of accessory muscles such as retractions and nasal f laring ■ Cyanosis in room air ■ Rapid breathing (tachypnea) Optimizing Outcomes boxes enhance critical-thinking skills for clinical application and reinforce how to obtain the best possible outcomes for patients. The preterm newborn is not only smaller than a term newborn but also has specific abbreviated development char- acteristics (Box 8-6). Respiratory Distress Syndrome Fetal lung maturity develops in utero progressively until term. Fetal lung maturity is determined by the L/S ratio and PG values, which are essential phospholipids in promoting oxygenation of the lung alveoli. They act on the pulmonary surface to decrease surface tension and are needed to keep the alveoli open when the newborn exhales. L/S ratio and PG values are often mature at 35 to 36 weeks’ gestation; before this time, newborns are at risk for RDS. RDS is a developmental respiratory disorder affecting preterm newborns because of lack of lung surfactant and un- derdeveloped alveolar saccules. RDS causes diffuse atelectasis (parts of the lung are not expanded), with congestion and edema in the lung spaces. L/S ratio and PG levels are low and inadequate to keep the immature alveoli of the lungs open. Lung compliance is diminished and significantly adds to the infant’s work of breathing. The x-ray findings of RDS reveal a reticulogranular pattern that resembles “ground glass”; possi- ble atelectasis, which looks similar to “whiteout”; and obscure heart borders.
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
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
6 FADavis.com
Powered by FlippingBook