2. Aqueous gentian violet, 1-2%: apply to infected area with swab.

7. Evaluation/outcome criteria:
   1. Oral mucosa intact, lesions healed, no evidence of infection.
   2. Feeds well; maintains weight or regains weight lost, if any.

3. Neonatal sepsis
   1. Pathophysiology—generalized infection; may overwhelm infant’s immature immune system.
   2. Etiology:
      1. Prolonged rupture of membranes.
      2. Long, difficult labor.
      3. Resuscitation procedures.
      4. Maternal infection (e.g., beta-hemolytic streptococcus vaginosis).
      5. Aspiration—amniotic fluid, formula, mucus.
      6. Iatrogenic (nosocomial)—caused by infected health personnel or equipment.
   3. Assessment:
      1. Respirations—irregular, periods of apnea.
      2. Irritability or lethargy.
   4. Analysis/nursing diagnosis:
      1. Fatigue related to increased oxygen needs.
      2. High risk for infection related to septic condition.
   5. Nursing care plan/implementation:
      1. Cultures (spinal, urine, blood).
      2. Check vitals.
      3. Monitor respirations.
      4. Give medications, as ordered.
   6. Evaluation/outcome criteria:
      1. Responds to medical/nursing regimen (all assessment findings within normal limits).
      2. Parent(s) verbalize understanding of diagnosis, treatment; demonstrate appropriate techniques in participating in care (as possible).
      3. Parent(s) demonstrate effective coping with situation; express satisfaction with care.

4. Disorders affecting nutrition: infant of the diabetic mother (IDM)
   1. Pathophysiology—hyperplasia of pancreatic beta cells —> increased insulin production —» excessive deposition of glycogen in muscles, subcutaneous fat, and tissue growth. Results in fetal:
      1. Macrosomia—LGA infant.
      2. Enlarged internal organs—common.
         1. Cardiomegaly.
         2. Hepatomegaly.
         3. Splenomegaly.
      3. Neonatal—inadequate carbohydrate reserve to meet energy needs.
      4. Associated with increased incidence of:
         1. Congenital anomalies (five times average incidence with pregestational diabetes) includes cardiac, pelvic, and spinal anomalies.
         2. Preterm birth: respiratory distress syndrome (RDS); increased insulin needs prenatally lead to decreased surfactant production.
         3. Fetal dystocia—due to CPD.
         4. Neonatal metabolic problems:
            1. Hypoglycemia.
            2. Hypocalcemic tetany.
            3. Metabolic acidosis.
            4. Hyperbilirubinemia.
   2. Etiology—high circulating maternal glucose levels during fetal growth and development; loss of maternal glucose supply following birth; decreased hepatic gluconeogenesis.
   3. Assessment:
      1. Characteristics of IDM.
      2. Hypoglycemia—Dextrostix or Chem-strip to heel stick at:
         1. 30 min X 2.
         2. 1,2, and 4 hr of age; before meals X 4 or until stable.
         3. Chemstrip: if <20 mg/dl, must draw glucose stat.
         4. Hypoglycemia laboratory values for term infant: under 40 mg/dl.
         5. Hypoglycemia laboratory values for preterm infant: under 40 mg/dl.
         6. Behavioral signs—tremors; twitching, hypotonia, seizures.
      3. Gestational age, since macrosomia may mask prematurity.
      4. Hypocalcemia—usually within first 24 hr
         1. Irritability.
         2. Coarse tremors, twitching, convulsions.
      5. Birth injuries.
         1. Fractures: clavicle, humerus, skull.
         2. Brachial palsy.
         3. Intracranial hemorrhage/signs of increased intracranial pressure.
         4. Cephalohematoma.
      6. Respiratory distress.
         1. Nasal flaring.
         2. Sternal retraction.
         3. Intercostal retractions.
         4. Cyanosis—central.
         5. Expiratory grunt.
      7. Jaundice.
   4. Analysis/nursing diagnosis:
      1. High risk for injury related to CPD, dystocia.
      2. Altered cardiopulmonary tissue perfusion related to placental insufficiency, RDS.
      3. Impaired gas exchange related to RDS.
      4. Altered nutrition, less than body requirements, related to hypoglycemia, hypocalcemia.