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
2
Q
what are examples of acquired & congenital problems (4)
A
- birth trauma
- maternal substance use
- infection
- congenital anomalies
3
Q
define: birth trauma
A
- physical injury sustained during L&D
4
Q
a small percentage of signif birth injuries are….
A
- unavoidable depsite skilled & competent obstetrical care
5
Q
what are examples of causes of unavoidable birth trauma (2)
A
- difficult or prolonged labor
- infant in abnormal presentation
6
Q
some birth injuries cannot be anticipated until…
A
- the circumstances are encountered during birth
7
Q
what are risk factors for birth trauma (3)
A
- macrosomic infant
- shoulder dystocia
- births requiring assistive devices
8
Q
what are common fractures that can occur w birth trauma (4)
A
- clavicular
- skull (linear or depressed)
- humerus
- femur
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
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
11
Q
what are some signs of neuro injury (6)
A
- poor tone
- asymmetry in mvmts
- apnea
- seizures
- trouble w feeding
- bulging fontanelles
12
Q
what is a sign of damage to the phrenic nerve
A
- unequal chest mvmts
13
Q
what is a sign of damage to the facial nerve
A
- unequal facial mvmts
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
15
Q
what are neonatal factors for sepsis (2)
A
- low birth weight
- prematurity
16
Q
what is considered early onset neonatal infection? late onset?
A
- early onset: 24-48 hrs
- late onset: 7-30 days
17
Q
early onset of a neonatal infection is passed from?
A
- the birth
18
Q
what is a common cause of early neonatal infections
A
- group B strep
19
Q
what causes late neonatal infection?
A
- hospital acquired = nosocomial infection
20
Q
what are nonspecific early signs of sepsis (4)
A
- lethargy
- poor feeding
- poor weight gain
- irritability
21
Q
what are other signs of sepsis (6)
A
- apnea
- bradycardia
- tachypnea
- signs of resp distress
- hypo or hyperthermia
- jaundice
22
Q
what is the most common infection in the neonate
A
- pneumonia
23
Q
bacterial meningitis is higher risk in…
A
- preterm infants
24
Q
gasteroeneteritis is..
A
- sporadic
25
what is considered fever in a newborn
- anything above 37.5
26
what is included in neonatal care for neonatal infections (7)
- temp during labor
- review antenatal record
- vigilant assessment
- prevention
- note PROM, prolonged labor
- more freq monitoring VS
- monitor feeding & hydration (risk of dehydration)
27
the earliest clinical signs of neonatal sepsis are characterized by...
- lack of specificity
28
diagnostics for neonatal infections include (8)
- CBC
- blood & urine cultures
- lumbar puncture
- CRP
- viral cultures
- CXR
- liver function & enzymes
- fungal cultures
29
neonatal infections may require..
- invasive support
30
what is the TORCH complex
- group of perinatal infections likely to cause fetal anomalies
31
what does TORCH stand for
Toxoplasmosis
Other (HBV, HIV, west nile virus)
Rubella
Cytomegalovirus
Herpes simplex virus
32
what are examples of maternal infections that can impact the newborn (9)
- TORCH complex
- HIV
- chlamydia
- gonorrhea
- HBV
- syphilis
- GBS
- candidasis
- thrush
33
what can chlamydia cause in the infant? (2)
- conjuctivitis
- pneumonia
34
what is given for eye prophylaxis r/t chlamydia
- give erythromycin drops
35
if conjunctivitis is noted in the newborn, what should be done?
- check for pneumonia
36
what kind of prophylaxis is provided w gonorrhea
- eye prophylaxis
37
NBs can be infected w a maternal infection of HBV in what ways?
- can be infected during birth
- or in first few days (present in breastmilk)
38
if the mother has HBV, what should be given to the infant?
- HBV vaccine should be given to the infant
- HBIG may also be given
39
when is syphilis screened for? (2)
- in pregnancy
- at delivery
40
when can syphilis be transmitted? (2)
- during pregnancy
- during birth
41
GBS can cause what kind of infection in the newborn? (2)
- early onset infection
- late onset also possible
42
how is GBS infection in the newborn treated?
- antibiotics --> penicillin G
43
what can GBS cause in the newborn (3)
- sepsis
- meningitis
- pneumonia
44
where can thrush be developed in the infant? whats it's treatment?
- can be developed on gums & mouth of infant
- treat w oral anti-fungal
45
what is included in nursing care for infants w infectious diseases (6)
- identify causative organism
- watch for signs of infection in the newborn
- routine precautions
- pregnant healthcare provider precautions
- specimen collection
- assist family w coping
46
what are the signs of infection in the NB (10)
- lethargy
- poor feeding
- irritability
- poor weight gain
- apnea
- bradycardia
- tachypnea
- temp >37.5
- temp <36.5
- signs of resp distress
47
what is included in drug exposed infants (3)
- drug use
- smoking
- alcohol use
48
what is the difference between addicted vs drug-exposed newborn terms
- use drug exposed
- do not refer to ass addicted, cannot drug seek
49
define: neonatal abstinence syndrome
- the physiological response of infants who are withdrawing from addictive drugs or substances they were exposed to in utero
50
what should be done if there is risk for NAS based on history for birther of substance use
- initiate observation of clinical signs & symptoms
51
what is the onset of neonatal withdrawl
- 12-72 hrs after birth (may be longer)
52
what are signs of neonatal withdrawal (14)
- irritability
- seizures
- crying
- difficult to console
- poor feeding
- diarrhea
- vomiting
- fever
- nasal stuffiness
- disrupted sleep
- tachycardia
- tachypnea
- temp instability
- tremors
53
what scale is used to assess for withdrawl in drug exposed infants
- finnegan neonatal abstience scale
54
when is the finnegan neonatal abstinence scale used
- at 2 hrs of age
55
who should be referred with drug exposed infants
- social work
56
what categories does the Finnegan neonatal abstinence scale assess (6)
- 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
the Finnegan Neonatal Abstinence scale scire ranges from?
0-16
58
what scores on the Finnegan Neonatal Abstinence scale indicate the need to call NICU and admit infant
- if scores 8 or more on 3 consecutive scores
- or 12 or higher on 2 scores
59
the following drugs if used within the 72 hrs prior to birth can cause NAS (6)
- narcotics **
- alcohol
- barbituates
- benzos
- inhalants
- SSRIs
60
what are examples of narcotics that can cause NAS (4)
- methadone
- morphine
- heroin
- fentanyl
61
what are substances that can cause neurological symptoms but not withdrawal (7)
- caffeine
- cocaine
- meth
- marijuana
- hashish
- nitrous oxide
- nictotine (large quantities)
62
what are key factors in nursing care for drug exposed infants
- early identification and treatment
63
what is included in mngmt for drug exposed infants (4)
- calm, quiet enviro
- skin to skin care
- decrease sensory stimuli
- swaddle (safely)
64
if the Finnegan Neonatal Abstinence scale score is high , what should be skipped for now
- bathing
65
what is included in nursing care for drug exposed infants (5)
- social & legal factors
- support & encourage breast feeding (if not contraindicated)
- degree of withdrawal
- neonatal abstinence scoring system of Finnegan tool
- pharmacological treatment
66
in what situation might breastfeeding be a problem with drug exposed infants (2)
- if ongoing drug use
- HIV
67
what is included in pharmacological treatment for drug exposed infants (2)
- treat w morphine for withdrawal or narcotics
- treat w phenobarbital if alcohol or benzos
68
what is a common parental concern with drug exposed infants
- that they will have their infant taken away
69
describe the use of naloxone for drug exposed infants
- 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
what are the most common major congenital anomalies that cause serious problems in neonates (7)
- congenital heart disease
- abdominal wall defects
- imperforate anus
- neural tube defects
- cleft lip or palate
- clubfoot
- developmental dysplasia of the hip
71
describe imperforate anus (4)
- improperly placed anus
- hole too small
- anal opening weird
- may be fistula
72
what are signs of neural tube defects in the infant
- assess back for dimple or sinus
- tuft of hair at gluteal cleft
73
clefts may require? (2)
- assistance w feeding
- surgical repair
74
what is club foot?
- deformity of ankle & foot
75
club foot may be associated with? (3)
- spina bifida
- other chromosomal abnormalities
- or independent of other issues
76
what is a sign of hip dysplacia
- hip clicks
77
what is included in newborn screening for congenital anomalies (4)
- phenylketonuria
- galactosemia
- hypothyroidism
- congenital heart disease
78
what is included in nursing care for congenital abnormalities
- newborn care
- parents & family info, guidance, and support
79
how is congenital heart disease first screened? what indicates further investigations
- with O2 sats
- if less than 90, investigate further
