NURSING CARE OF

AT RISK/HIGH RISK
SICK CLIENT
NEWBORN
• High risk neonate can be defined as a newborn, regardless of
gestational age or birth weight, which has a greater-than-
average chance of morbidity or mortality because of conditions
or circumstances associated with birth and the adjustment to
extrauterine existence.

• The high-risk period encompasses human growth and

development from the time of viability (the gestational age at
which survival outside the uterus is believed to be possible, or as
early as 23 weeks of gestation) up to 28 days after birth; thus, it
includes threats to life and health that occur during the prenatal,
perinatal, and postnatal periods.
• High risk infants are most often classified according to
birth weight, gestational age, and predominant
pathophysiologic problems.

• The more common problems related to physiologic status

are closely associated with the state of maturity of the
infant and consequences of immature organs and usually
this are Meconium Aspiration Pneumonia, Sepsis, and
Hyperbilirubinemia
LEARNING OUTCOMES
1.Integrate relevant principles of social and health sciences
in the care of women at risk or with problems (PO1a),
2. Assess with the patient and family her health status
(PO2a),
3.Formulate with the client and family a plan of care to
address health conditions, needs, problems, and issues
based on priorities (PO2b),
4. Implement safe and quality interventions with the client
to address the health needs, problems, and issues (PO2c),
LEARNING OUTCOMES
5. Provide appropriate evidence- based nursing care
based on: theories and standards relevant to health and
healing, research, and clinical practice (PO3a),
6. Implement strategies/approaches to enhance/support
the capability of the client and care providers to
participate in decision- making by the inter-professional
team (PO7b),
7. Provide health education using selected planning
models to high-risk women and their family (PO2d), and
8. Document nursing services rendered and processes/
outcomes of the nurse client working relationship (PO6a).
MECONIUM ASPIRATION
Meconium Aspiration occurs when a fetus has been
subjected to asphyxia or other intrauterine stress that causes
relaxation of the anal sphincter and passage of meconium
into the amniotic fluid
Meconium staining occurs in approximately 10% to 20%
of all births; in 2% to 4% of these births, infants will
aspirate enough meconium to cause MAS
Aspiration of thick meconium leads to obstruction of
airways resulting in a more severe hypoxia. Pneumonia
can occur due to an infection or meconium aspiration.
MECONIUM ASPIRATION

Meconium can cause severe respiratory

distress in three ways: it causes
inflammation of bronchioles because it is a
foreign substance, it can block small
bronchioles by mechanical plugging, and it
can cause a decrease in surfactant
production through lung trauma.
 NEONATAL SEPSIS
Neonatal Sepsis is an infection in the bloodstream that poses
severe health risks to newborns, including permanent brain
damage. It can be caused by a variety of bacteria, viruses,
and other pathogens. A baby can acquire neonatal sepsis
through either vertical or horizontal transmission. In vertical
transmission, a maternal infection is spread to the baby
shortly before or during the birthing process. In horizontal
transmission, the baby acquires an infection after birth, from
contact with caregivers, medical personnel, or environmental
contaminants.
HYPERBILIRUBENEMIA
• Neonatal hyperbilirubinemia, defined as a total serum bilirubin
level above 5 mg per dL (86 μmol per L), is a frequently encountered
problem.
• Although up to 60 percent of term newborns have clinical jaundice
in the first week of life, few have significant underlying disease.
• About 60% of full-term newborns get jaundice. So do 80% of
premature babies. Babies born to mothers with diabetes or Rh
disease are more likely to have this condition.
• Infant jaundice is yellow discoloration of a newborn baby's skin and
eyes. Infant jaundice occurs because the baby's blood contains an
excess of bilirubin , a yellow pigment of red blood cells. Jaundice
typically results from the deposition of unconjugated bilirubin
 TYPES
1. Physiologic jaundice
During the first few days of life, babies aren’t able to get rid of much
bilirubin. This normal type of jaundice happens as a response to a
baby’s reduced ability to remove bilirubin. But it may be hard at first to
tell if jaundice is being caused by another problem. Physiologic
jaundice in healthy term newborns follows a typical pattern. The
average total serum bilirubin level usually peaks at 5 to 6 mg per dL (86
to 103 μ mol per L) on the third to fourth day of life and then declines
over the first week after birth. Bilirubin elevations of up to 12 mg per
dL, with less than 2 mg per dL (34 μ mol per L) of the conjugated form,
can sometimes occur. Infants with multiple risk factors may develop an
exaggerated form of physiologic jaundice in which the total serum
 TYPES
2. Breastmilk jaundice
About 2% of breastfed babies get jaundice. This happens later in their
first week of life. It peaks at about 2 weeks of age. It can last 3 to 12
weeks. It is not dangerous, but tests may need to be done for other
problems that are dangerous. This issue may be caused by a
substance in breastmilk. This substance may increase how much
bilirubin the baby's body can reabsorb. Early-Onset Breastfeeding
Jaundice Breast-fed newborns may be at increased risk for early-onset
exaggerated physiologic jaundice because of relative caloric
deprivation in the first few days of life. Decreased volume and
frequency of feedings may result in mild dehydration and the
delayed passage of meconium.
 TYPES
3. PATHOLOGIC JAUNDICE All etiologies of jaundice beyond
physiologic and breastfeeding or breast milk jaundice are
considered pathologic. Features of pathologic jaundice include the
appearance of jaundice within 24 hours after birth, a rapidly rising
total serum bilirubin concentration (increase of more than 5 mg per
dL per day), and a total serum bilirubin level higher than 17 mg per
dL in a full-term newborn. Other features of concern include
prolonged jaundice, evidence of underlying illness, and elevation of
the serum conjugated bilirubin level to greater than 2 mg per dL or
more than 20 percent of the total serum bilirubin concentration.
Pathologic causes include disorders such as sepsis, rubella,
toxoplasmosis, occult hemorrhage, and erythroblastosis fetalis.
 TYPES
4. HEMOLYTIC JAUNDICE

The most common causes of hemolytic jaundice include (a)

Rh hemolytic disease, (b) ABO incompatibility and (c)
Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
and minor blood group incompatibility.