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NURS 4500: Final Material > Class 10: Acquired & Congenital Problems > Flashcards

Class 10: Acquired & Congenital Problems Flashcards

1
Q

define: acquired or congenital problems

A
  • conditions or circumstances superimposed on normal course of events associated w birth & adjustment to extrauterine existence
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2
Q

what are examples of acquired & congenital problems (4)

A
  • birth trauma
  • maternal substance use
  • infection
  • congenital anomalies
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3
Q

define: birth trauma

A
  • physical injury sustained during L&D
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4
Q

a small percentage of signif birth injuries are….

A
  • unavoidable depsite skilled & competent obstetrical care
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5
Q

what are examples of causes of unavoidable birth trauma (2)

A
  • difficult or prolonged labor
  • infant in abnormal presentation
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6
Q

some birth injuries cannot be anticipated until…

A
  • the circumstances are encountered during birth
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7
Q

what are risk factors for birth trauma (3)

A
  • macrosomic infant
  • shoulder dystocia
  • births requiring assistive devices
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8
Q

what are common fractures that can occur w birth trauma (4)

A
  • clavicular
  • skull (linear or depressed)
  • humerus
  • femur
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9
Q

what types of injuries can occur w birth trauma (5)

A
  • fractures
  • peripheral nervous system injuries
  • facial nerve injuries
  • neuro injuries
  • spinal cord injuries
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10
Q

what are signs of birth trauma (6)

A
  • asymmetry in limb mvmts, flaccid
  • abnormalities & crepitus on inspection
  • asymmetrical chest mvmts, unequal breath sounds
  • asymmetry in facial mvmts
  • signs of neuro injury
  • unilateral edema
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11
Q

what are some signs of neuro injury (6)

A
  • poor tone
  • asymmetry in mvmts
  • apnea
  • seizures
  • trouble w feeding
  • bulging fontanelles
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12
Q

what is a sign of damage to the phrenic nerve

A
  • unequal chest mvmts
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13
Q

what is a sign of damage to the facial nerve

A
  • unequal facial mvmts
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14
Q

what are risks for sepsis (9)

A
  • prolonged ROM
  • intrapartum fever in birther
  • prolonged labor
  • chorioamnionitis
  • prematurity
  • low socioeconomic status
  • poor prenatal care
  • poor nutrition
  • substance use
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15
Q

what are neonatal factors for sepsis (2)

A
  • low birth weight
  • prematurity
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16
Q

what is considered early onset neonatal infection? late onset?

A
  • early onset: 24-48 hrs
  • late onset: 7-30 days
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17
Q

early onset of a neonatal infection is passed from?

A
  • the birth
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18
Q

what is a common cause of early neonatal infections

A
  • group B strep
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19
Q

what causes late neonatal infection?

A
  • hospital acquired = nosocomial infection
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20
Q

what are nonspecific early signs of sepsis (4)

A
  • lethargy
  • poor feeding
  • poor weight gain
  • irritability
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21
Q

what are other signs of sepsis (6)

A
  • apnea
  • bradycardia
  • tachypnea
  • signs of resp distress
  • hypo or hyperthermia
  • jaundice
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22
Q

what is the most common infection in the neonate

A
  • pneumonia
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23
Q

bacterial meningitis is higher risk in…

A
  • preterm infants
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24
Q

gasteroeneteritis is..

A
  • sporadic
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25
Q

what is considered fever in a newborn

A
  • anything above 37.5
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26
Q

what is included in neonatal care for neonatal infections (7)

A
  • temp during labor
  • review antenatal record
  • vigilant assessment
  • prevention
  • note PROM, prolonged labor
  • more freq monitoring VS
  • monitor feeding & hydration (risk of dehydration)
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27
Q

the earliest clinical signs of neonatal sepsis are characterized by…

A
  • lack of specificity
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28
Q

diagnostics for neonatal infections include (8)

A
  • CBC
  • blood & urine cultures
  • lumbar puncture
  • CRP
  • viral cultures
  • CXR
  • liver function & enzymes
  • fungal cultures
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29
Q

neonatal infections may require..

A
  • invasive support
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30
Q

what is the TORCH complex

A
  • group of perinatal infections likely to cause fetal anomalies
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31
Q

what does TORCH stand for

A

Toxoplasmosis
Other (HBV, HIV, west nile virus)
Rubella
Cytomegalovirus
Herpes simplex virus

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32
Q

what are examples of maternal infections that can impact the newborn (9)

A
  • TORCH complex
  • HIV
  • chlamydia
  • gonorrhea
  • HBV
  • syphilis
  • GBS
  • candidasis
  • thrush
33
Q

what can chlamydia cause in the infant? (2)

A
  • conjuctivitis
  • pneumonia
34
Q

what is given for eye prophylaxis r/t chlamydia

A
  • give erythromycin drops
35
Q

if conjunctivitis is noted in the newborn, what should be done?

A
  • check for pneumonia
36
Q

what kind of prophylaxis is provided w gonorrhea

A
  • eye prophylaxis
37
Q

NBs can be infected w a maternal infection of HBV in what ways?

A
  • can be infected during birth
  • or in first few days (present in breastmilk)
38
Q

if the mother has HBV, what should be given to the infant?

A
  • HBV vaccine should be given to the infant
  • HBIG may also be given
39
Q

when is syphilis screened for? (2)

A
  • in pregnancy
  • at delivery
40
Q

when can syphilis be transmitted? (2)

A
  • during pregnancy
  • during birth
41
Q

GBS can cause what kind of infection in the newborn? (2)

A
  • early onset infection
  • late onset also possible
42
Q

how is GBS infection in the newborn treated?

A
  • antibiotics –> penicillin G
43
Q

what can GBS cause in the newborn (3)

A
  • sepsis
  • meningitis
  • pneumonia
44
Q

where can thrush be developed in the infant? whats it’s treatment?

A
  • can be developed on gums & mouth of infant
  • treat w oral anti-fungal
45
Q

what is included in nursing care for infants w infectious diseases (6)

A
  • identify causative organism
  • watch for signs of infection in the newborn
  • routine precautions
  • pregnant healthcare provider precautions
  • specimen collection
  • assist family w coping
46
Q

what are the signs of infection in the NB (10)

A
  • lethargy
  • poor feeding
  • irritability
  • poor weight gain
  • apnea
  • bradycardia
  • tachypnea
  • temp >37.5
  • temp <36.5
  • signs of resp distress
47
Q

what is included in drug exposed infants (3)

A
  • drug use
  • smoking
  • alcohol use
48
Q

what is the difference between addicted vs drug-exposed newborn terms

A
  • use drug exposed
  • do not refer to ass addicted, cannot drug seek
49
Q

define: neonatal abstinence syndrome

A
  • the physiological response of infants who are withdrawing from addictive drugs or substances they were exposed to in utero
50
Q

what should be done if there is risk for NAS based on history for birther of substance use

A
  • initiate observation of clinical signs & symptoms
51
Q

what is the onset of neonatal withdrawl

A
  • 12-72 hrs after birth (may be longer)
52
Q

what are signs of neonatal withdrawal (14)

A
  • irritability
  • seizures
  • crying
  • difficult to console
  • poor feeding
  • diarrhea
  • vomiting
  • fever
  • nasal stuffiness
  • disrupted sleep
  • tachycardia
  • tachypnea
  • temp instability
  • tremors
53
Q

what scale is used to assess for withdrawl in drug exposed infants

A
  • finnegan neonatal abstience scale
54
Q

when is the finnegan neonatal abstinence scale used

A
  • at 2 hrs of age
55
Q

who should be referred with drug exposed infants

A
  • social work
56
Q

what categories does the Finnegan neonatal abstinence scale assess (6)

A
  • muscle tone (increased)
  • tremors
  • RR>60/min, with or without retractions
  • sweating
  • excessive sucking
  • crying/consolable in 5 min and % of time spent crying (,50% versus >50%)
57
Q

the Finnegan Neonatal Abstinence scale scire ranges from?

A

0-16

58
Q

what scores on the Finnegan Neonatal Abstinence scale indicate the need to call NICU and admit infant

A
  • if scores 8 or more on 3 consecutive scores
  • or 12 or higher on 2 scores
59
Q

the following drugs if used within the 72 hrs prior to birth can cause NAS (6)

A
  • narcotics **
  • alcohol
  • barbituates
  • benzos
  • inhalants
  • SSRIs
60
Q

what are examples of narcotics that can cause NAS (4)

A
  • methadone
  • morphine
  • heroin
  • fentanyl
61
Q

what are substances that can cause neurological symptoms but not withdrawal (7)

A
  • caffeine
  • cocaine
  • meth
  • marijuana
  • hashish
  • nitrous oxide
  • nictotine (large quantities)
62
Q

what are key factors in nursing care for drug exposed infants

A
  • early identification and treatment
63
Q

what is included in mngmt for drug exposed infants (4)

A
  • calm, quiet enviro
  • skin to skin care
  • decrease sensory stimuli
  • swaddle (safely)
64
Q

if the Finnegan Neonatal Abstinence scale score is high , what should be skipped for now

A
  • bathing
65
Q

what is included in nursing care for drug exposed infants (5)

A
  • social & legal factors
  • support & encourage breast feeding (if not contraindicated)
  • degree of withdrawal
  • neonatal abstinence scoring system of Finnegan tool
  • pharmacological treatment
66
Q

in what situation might breastfeeding be a problem with drug exposed infants (2)

A
  • if ongoing drug use
  • HIV
67
Q

what is included in pharmacological treatment for drug exposed infants (2)

A
  • treat w morphine for withdrawal or narcotics
  • treat w phenobarbital if alcohol or benzos
68
Q

what is a common parental concern with drug exposed infants

A
  • that they will have their infant taken away
69
Q

describe the use of naloxone for drug exposed infants

A
  • contraindicated in infants born to women addicted to narcotics or on methadone therapy bc it may exacerbate neonatal abstinence syndrome (NAS) and cause seizures
70
Q

what are the most common major congenital anomalies that cause serious problems in neonates (7)

A
  • congenital heart disease
  • abdominal wall defects
  • imperforate anus
  • neural tube defects
  • cleft lip or palate
  • clubfoot
  • developmental dysplasia of the hip
71
Q

describe imperforate anus (4)

A
  • improperly placed anus
  • hole too small
  • anal opening weird
  • may be fistula
72
Q

what are signs of neural tube defects in the infant

A
  • assess back for dimple or sinus
  • tuft of hair at gluteal cleft
73
Q

clefts may require? (2)

A
  • assistance w feeding
  • surgical repair
74
Q

what is club foot?

A
  • deformity of ankle & foot
75
Q

club foot may be associated with? (3)

A
  • spina bifida
  • other chromosomal abnormalities
  • or independent of other issues
76
Q

what is a sign of hip dysplacia

A
  • hip clicks
77
Q

what is included in newborn screening for congenital anomalies (4)

A
  • phenylketonuria
  • galactosemia
  • hypothyroidism
  • congenital heart disease
78
Q

what is included in nursing care for congenital abnormalities

A
  • newborn care
  • parents & family info, guidance, and support
79
Q

how is congenital heart disease first screened? what indicates further investigations

A
  • with O2 sats
  • if less than 90, investigate further

NURS 4500: Final Material (16 decks)

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