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Mother-Baby > Birth Trauma & Newborn Disorders > Flashcards

Birth Trauma & Newborn Disorders Flashcards

(63 cards)

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1
Q

What is Caput

A

Edema that crosses suture lines, soft, resolves in a few days

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2
Q

What is cephalohematoma?

A

Blood between skull & periostem
Does not cross suture lines, firm and defined
Resolves over 2-3 weeks
Hemolysis of RBCs = increased risk of hyperbilirubinemia

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3
Q

Linear skull birth trauma

A

Most common, not unusual with cephalohematoma, no treatment

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4
Q

Depressed skull birth trauma

A

“Ping pong ball” indention
CT to evaluate for underlying trauma to brain

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5
Q

Clavicle birth trauma

A

Most common birth fracture
Increased risk with macrosomia, breech delivery
Signs: limited arm (unilateral) movement and absense of moro reflex on affected side, crepitus over clavicle
No treatment- comfort measures

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6
Q

Facial birth trauma of peripheral nervous system

A

Increased risk with forceps delivery or prolonged 2nd stage
Typically self-limiting, resolves within hours or days
Protect cornea, assist with feeding

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7
Q

Brachial plexus trauma

A

Most common birth related paralysis- mechanical trama to spinal nerve roots at c5-T1
Presentation: arm hangs at side, shoulder adducted and internally rotated, wrist and fingers flexed, grasp reflex typically present, absent moro reflex on affect side
Treatment: immobilization and ROM, resolves in most infants, surgery rarely indicated

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8
Q

Intracranial hemorrhage: subdural

A

Risk factors: difficult or precipitous delivery, assisted birth, LGA

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9
Q

Intracranial hemorrhage: subarachnoid

A

Risk factors:
full term: trauma
preterm: hypoxia

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10
Q

Infants of diabetic mothers: macrosomia

A

Increased birth trauma
Increased hypoglycemia
Increased hypocalcemia
Increased hyperviscosity
Increased hyperbilirubinemia

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11
Q

Infants of diabetic mothers: respiratory distress

A

Increased risk if born <38 weeks
Increased maternal hyperglycemia = decreased fetal lung maturity
-impaired surfactant synthesis: increased fetal glucose, increased fetal insulin

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12
Q

Infants of diabetic mothers: hypoglycemia causes

A

increased maternal glucose = increased fetal insulin production
After birth decreased available circulating glucose but still increased fetal insulin = hypoglycemia

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13
Q

Infant hypoglycemia S/S

A

Jittery
Weak cry
Apnea or tachypnea
Hypotonic, decreased activity
If severe could lead to seizures

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14
Q

Infant hypoglycemia management

A

Prevent with early frequent feeds - most common in 1st 1-6 hours
monitor blood sugars - ideally >40-45
IV dextrose if unable to feed or symptomatic or blood sugar <25
Keep warm

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15
Q

Infants of diabetic mothers: hyperbilirubinemia patho

A

Increased insulin –>
Increased metabolic rate –>
Increased ox demand –>
Increased RBC production =
Polycythemia =
Increased hemolysis

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16
Q

Hyperbilirubinemia management

A

Early frequent feeds: feed in first 1-2 hours then 8-12 times/24 hrs, lactation consultation early if feeding difficulties
Assess for jaundice every 8-12 hrs
If jaundice <24 hrs check transcutaneous or serum bili and follow nomogram
Otherwise predischarge screening
Phototherapy prn

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17
Q

Neonatal sepsis classifications

A

Congenital
Early onset
Late onset

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18
Q

Neonatal sepsis S/S

A

Irritable, lethargic
Poor feeding
Temperature instability
Respiratory distress, apnea, cyanosis
Jaundice
Seizures
Abnormal bleeding

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19
Q

Neonatal sepsis treatment/prevention

A

Best intervention is prevention: antenatal maternal screening, eye prophylaxis, sterile/aseptic procedures, hand hygiene, avoid sick contacts
Collect specimen- blood, urine, stool
IV fluids
Oxygen
IV antibiotics/antifungals/antivirals - possible isolation
Comfort

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20
Q

Infection: Group B Streptococcus (GBS)

A

Prenatal assessment and prevention is key
-all women screened at 36 0/7-37 6/7 weeks
–>if positive treat with intrapartum antibiotic prophylaxis: PCN or ampicillin
-if presents in labor before GBS screening or no prenatal care follow algorithm

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21
Q

Gonorrhea

A

Eye prophylaxis with erythromycin ointment to prevent opthalmia neonatorium

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22
Q

Syphilis

A

Congenital syphilis rate increaseing- associated with SAB/stillbirth, early infant death if no maternal treatment
Mother should be treated with PCN G to prevent placental transmission

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23
Q

HIV

A

Rare to be symptomatic at birth
25% chance of transmission if mom untreated
All infants born to seropositive moms presumed positive
Bathe ASAP
Prompt antiretroviral administration within 12 hours of birth to slow the progression
Breastfeeding is contraindicated

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24
Q

Intrauterine risk of tobacco

A

SAB
Placental abruption and placenta previa
SGA, LBW infant, preterm birth

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25
Extrauterine risks of tobacco
Ear infections Chronic respiratory infections SIDS
26
Patient teaching of tobacco
Smoking cessation No smoking around infant
27
Fetal Alcohol Syndrome
1. Dysmorphic facial features: small eyelids fissures, thin upper lip, missing vertical groove in median portion of upper lip 2. Growth deficiency: pre & postnatal, IUGR, LBW, short birth length, <10th percentile 3. CNS abnormalities (structural, developmental & functional): microcephaly, low cognitive functioning, attention or hyperactivity, poor social & language skills
28
Opioids/Neonatal Abstinence Syndrome (NAS) Manifestations
1. CNS Dysfunction - tremors -generalized seizures -hyperactive reflexes -irritability -hypertonic muscle tone, constant movement -shrill, high-pitched cry -disturbed sleep patterns 2. Metabolic, Vasomotor, and Respiratory Disturbances -fever -frequent yawning -mottling of the skin -sweating -nasal stuffiness -temperature instability -frequent sneezing 3. Gastrointestinal dysfunction -poor feeding -frantic sucking or rooting -uncoordinated sucking -poor weight gain -loose or watery stools -regurgitation or projectile vomiting
29
RH incompatibility
Rh - mom and Rh + fetus Sensitization: fetal RBCs with Rh antigens pass through placenta to maternal circulation causing maternal antibody production Affect on fetus = relative number of antibodies produced, increased antibodies increased destruction of fetal RBCs --> anemia/hyperbilirubinemia Most cases mild resulting in little to no anemia or hyperbilirubinemia
30
Prenatal RH incompatibility
Indirect Coombs test on mom If + check antibodies q 2-4 weeks
31
At birth Rh incompatibility
Direct Coombs on fetal cord blood If + follow H&H and bilirubin more closely, ensure early and frequent feeds, avoid stressors
32
Treatment of Rh incompatibility
phototherapy for hyperbilirubinemia, if severe exchange transfusion
33
Severe Rh incompatibility
Erythroblastosis fetalis- excessive fetal RBC (hemolysis) and fetal hyperbilirubinemia Hydrops fetalis- severe hemolytic anemia with fetal cardiac decompensation, hepatomegaly, edema
34
ABO incompatibility
Most common cause of hemolytic dz in the newborn: pathologic hyperbilirubinemia Fetal blood type A, B, AB and mom O Maternal anti- A and anti- B antibodies are transferred across placenta from mom to baby Anemia: mild if occurs Hyperbilirubinemia: typically resolved with phototherapy, exchange transfusion is rare
35
Cardiac congenital anomalies
Most common congenital anomaly Often associated with anomalies of other systems or chromosomal abnormalities
36
S/S of cardiac congenital anomalies
Central cyanosis, pallor at birth Cyanosis or pallor with crying or feeding Lethargy Irregular HR Murmur Bonding pulses, decreased capillary refill, >20mmHG difference in BP between upper and lower extremities Tachypnea
37
Nursing actions cardiac congenital anomalies
Modify feeds to reduce energy expenditure Elevate head and shoulders to reduce cardiac workload Knee-chest if respiratory distress
38
Newborn CCHD Screening
24-48 hrs of life Pulse ox Preductal (r. hand) Postductal (L or R. foot) Pass: SpO2 > or = 95% in hand OR foot AND hand-foot difference < or = 3%
39
Nursing actions of meningocele & myelomeningcele CNS congenital anomalies
Prone positioning Sterile dressing and plastic to prevent drying of exposed defects Reduce infection risk- diaper care Head circumference NO LATEX
40
Choanal Atresia
Blockage of posterior nares Infants are obligate nose breathers first 4-6 weeks of life Respiratory distress, decreased SaO2, cyanosis at rest, feeding, or pacifier use With cry, color, SaO2 improve and distress resolves
41
Congenital diaphragmatic hernia
Often diagnosed with prenatal ultrasound Commonly associated with chromosomal abnormalities or defects of cardiac and MSK systems, male > female Severity of symptoms depends on size of defect -large defects associated with significant respiratory distress at birth, cyanosis, mottling, pulmonary hypertension
42
Cleft Lip/Palate
Genetic and environmental Mild to severe Cosmetic and functional Risk for compromised airway, feeding, speech development
43
Omphalocele
Covered herniation of abdominal contents into base of umbilical cord
44
Gastroschisis
Herniation of abdominal contents through defect in abdominal wall with no covering membrane
45
Nursing care of omphalocele/gastroschisis
Sterile moist dressing over defect, polyethylene bag over torso Side lying Replogle gastric tube for decompression Thermoregulation, fluid balance, infection risk reduction
46
Esophageal atresia & Tracheoesophageal fistula
Esophagus with a blind pouch (dead end) and/or fistula to trachea Infants with excessive oral secretions, drooling, respiratory distress and feeding intolerance are suspicious for TEF -do not feed orally and notify provider Raise HOB, replogle to LIS, anti-reflex/antacid meds Surgical intervention
47
Four components of congenital clubfoot
1. inversion and adduction of the forefoot 2. inversion of heel and hindfoot 3. limitation of extension of the ankle 4. internal rotation of the leg
48
Ponseti method for clubfoot
Stretching and casting Move infant's foot into a correct position and then place it in a cast to hold it there Reposition and recast the infant's foot once a week for several months Possibly a minor surgical procedure to lengthen the Achilles tendon toward the end of this process
49
Congenital hip dysplasia
Hip joint laxity Demonstrated with Barlow and Ortolani maneuvers during newborn assessment but most reliable at 2-3 months
50
Hip dysplasia treatments
Infants are usually treated with a soft brace, such as a Pavlik harness, that holds the ball portion of the joint firmly in its socket for several months. This helps the socket mold to the shape of the ball Double diapering is no longer recommended as interferes with proper hip development
51
Hypospadias
Abnormally located urinary meatus on the underside of the penis Increased severity results in urinary and infertility problems Surgery at approx 6 months
52
Epispadias
Urethra opening at the top or side of the penis Often occurs with exstrophy of the bladder
53
Bladder exstrophy
Prevent infection (cover) Preserve renal fxn Maintain skin integrity
54
Ambiguous genitalia
Discrepancy between the chromosomal sex and external genitalia External genitalia anatomy is unclear Karyotyping Counseling
55
Phenylkeonuria (PKU)
Genetic disorder caused by a deficiency of the liver enzyme, phenylalanine hydroxylase Results in increased levels of amino acid phenylalanine leads to CNS damage which leads to intellectual disability
56
Symptoms of PKU
Vomiting Poor feeding FTT Overactivity Irritability Musty-smelling urine
57
Treatment of PKU
Lifelong low protein diet- special infant formula without phenylalanine Breastfeeding only in conjunction with phenylalanine free formula
58
Galactosemia
Genetic disorder resulting in deficiency of enzyme that convert galactose to glucose
59
Early symptoms of galactosemia
Vomiting, poor weight gain Hypoglycemia Liver damage, hyperbilirubinemia Frequent infections CaTaracts
60
Treatment of galactosemia
Lifelong galactose free diet and calcium supplementation Breastfeeding is contraindicated due to presence of. lactose
61
Congenital hypothyroidism
Multiple causes: defects with thyroid gland and/or thyroid hormone --> decreased levels of T4 & elevated levels of TSH Ideally screen at 3 days of life and repeat at 2 weeks of age
62
Symptoms of congenital hypothyroidism
Large protruding tongue, distended abdomen, constipation, poor feeding Slow reflexes Large, open posterior fontanelle Hypothermia Hoarse cry Dry skin, coarse hair Goiter, jaundice
63
Treatment of congenital hypothyroidism
Untreated: irreversible cognitive & motor impairment Treatment: lifelong thyroid replacement hormone

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