Postterm Infant

Over 42 weeks of gestation.

• 1. General aspects
  1. Labor may be hazardous for mother and fetus because:
  1. Large size of infant contributes to cephalopelvic disproportion; obtain estimate of fetal weight (EFW) by ultrasound.
  2. Placental insufficiency-fetal hypoxia; diagnosis by:
  1. Contraction stress test.
  2. Nonstress test
  3. Amniotic fluid index (AFI).
  3. Meconium passage (common physiological response) increases chance of meconium aspiration.
  2. Assessment:
  1. If postmature skin: dry, wrinkled-due to metabolism of fat and glycogen reserves to meet in utero energy needs.
  2. Long limbs, fingernails, and toenails-due to continued growth in utero.
  3. Lanugo and vernix-absent.
  4. Expression: wide-eyed, alert-probably due to chronic hypoxia (oxygen hunger).
  5. Placenta-signs of aging.
  3. Analysis/nursing diagnosis: High risk for injury related to high incidence of morbidity and mortality due to dystocia or hypoxia.
  4. Nursing care plan/implementation:
  1. During labor:
  1. Goal: emotional support of mother-may require cesarean birth due to CPD or fetal distress.
  2. Goal: continuous electronic monitoring of FHR. Report late decelerations immediately (indicate fetal distress).
  2. Afterbirth:
  1. Goal: if born vaginally, prompt identification of birth injuries, respiratory distress. Continual observation.
  2. goal: early identification/treatment of emerging signs of complications.
  1. Hypoglycemia-Dextrostix readings and behavior.
  2. Administer oral or intravenous glucose, as ordered.
  5. Evaluation/outcome criterion: successful transition to extrauterine life (all assessment findings within normal limits).

  Congenital Disorders

  1. General overview: Genetic abnormalities and environmental insults often lead to congenital disorders of the newborn. Successful transition to independent extrauterine life may pose a major challenge to infants compromised by anatomical or physiological disorders. Knowledge regarding the implications of the neonate’s structural or metabolic problems enables the nurse to identify early signs of health problems and to plan, provide, and evaluate appropriate outcome-directed care to safeguard the status of the infant with a congenital disorder.