High risk newborn (unit 3) Flashcards
(75 cards)
1
Q
caput succedaneum
A
- soft tissue injury sustained during birth
- FLUID edema of scalp
- benign
- DOES cross suture line
2
Q
cephalhematoma
A
- soft tissue injury sustained during birth
- collection of BLOOD b/t skull bone and periosteum
- does NOT cross suture line
- usually after vert delivery
- benign
3
Q
subconjunctival & retinal hemorrhages
A
- soft tissue injury sustained during birth
- d/t increased ICP
- benign
4
Q
lacerations during birth
A
- soft tissue injury sustained during birth
- scalpel from C/S
- episiotomy on scalp, butt, thigh
5
Q
skeletal injuries during birth
A
- skull (linear/depressed)
- clavicle- most common
- humerus/femur
6
Q
Erb-Duchenne
A
•paralysis of upper portion of arm d/t upper plexus injury during birth
7
Q
Klumphke
A
•paralysis of lower portion of arm d/t lower plexus injury during birth
8
Q
phrenic nerve injury during birth
A
- diaphragmatic paralysis
- cyanosis, irregular thoracic movements
- vent support for 1st few days
- may spontaneously resolve or need surgery
9
Q
subarachnoid hemorrhage during birth
A
- most common intracranial hemorrhage
- causes seizures
- vent support, IV, monitor ICP, minimal stim
10
Q
infants of diabetic mothers r/o
A
- congenital anomalies
- IUGR
- heart anomalies (cardiomyopathy)
- respiratory distress
- hypoglycemia
- hypocalcemia
- hypomagnesemia
- polycythemia
11
Q
hypoglycemia onset
A
•BS < 40 mg/dl (term) •BS < 25 (preterm) •jittery •RDS •apnea •lethargy •poor suck •seizures *w/in 1-3 hrs after birth -d/t inc. insulin production in utero
12
Q
hypertrophic cardiomyopathy (HCM)
A
- hypercontractile
* thickened myocardium (-> LHF)
13
Q
nonhypertrophic cardiomyopathy (non-HCM)
A
- poorly contractile
- over stretched
- tx w/ digoxin
14
Q
polycythemia
A
- Hct > 65%
- inc. blood viscocity
- impaired circulation/oxygenation
- inc. RBC to be hemolized
- additional birth trauma if macrosomia (inc. cephalhematoma/bruising)
15
Q
neonatal sepsis
A
- microorganisms/toxins (bacteria, virual, fungi) in blood/tissues
- perinatal- HSV, CMV
- during birth- GBS
- postnatally
16
Q
bacterial neonatal infection
A
•early onset -congenital -rapid progression (24-72 hr) -hypothermia common •late onset -acquired -slow progression (1-2 wk)
17
Q
neonatal group beta strep bacterial infection
A
- most common
- early onset indicates vertical transmission
- RDS, pneumonia, sepsis
18
Q
neonatal e. coli bacterial infection
A
•amp resistant strain contracted during labor
19
Q
neonatal listeriosis bacterial infection
A
- detected in meconium in amniotic fld < 37 wks
- granulomas, liver dz, meningitis (late onset)
- mom may not have s/sx, but newborn will
- found in dirt, water, unpaturized, uncooked, and ready-made
20
Q
neonatal clamydia bacterial infection
A
- opthalmia neonatorum
- conjunctivitis
- reason for erythromycin in eyes at birth
21
Q
neonatal fungal infections
A
- candidiasis (thrush)
* mouth/diaper most common site
22
Q
heroin/methadone neonatal effects
A
- IUGR
- LBW
- SGA
- w/d
- risk of SIDS 5-10x higher
23
Q
marijuana neonatal effects
A
- lowered response to light sim
- tremors
- high pitched cry
- small head
- hyperactive
- impulsive
- delinquency
24
Q
cocaine neonatal effects
A
- pre-term
- LBW
- short
- small head
- piercing cry
- low Apgar
- irritable/hypersensitive
- poor feeding/sleeping
- high HR/RR
- tremors/startling
- dec. verbal reasoning/attention
25
methamphetamine neonatal effects
* poor growth
* LBW
* small head
* PTB
* placental problems
* w/d s/sx
26
tobacco neonatal effects
* UPI (vasoconstriction)
* SAb
* placental separation
* LBW
* PTL
* intellectual disabilities (ADHD)
27
fetal alcohol syndrome (FAS)
* poor habituation
* irritability/jittery
* feeding/sleep difficulties
* poor muscle tone
* sensitive to light/sound
* excessive crying
28
physiologic jaundice
* hyperbilirubinemia
* appears after 1st 24 hrs
* benign- not normal, but common
* s/sx 2nd-3rd day of life
* usually resolves by day 4
* bili < 12 (unless PT or BF)
29
pathologic jaundice
* hyperbilirubinemia
* appear w/in 1st 24 hrs
* r/t abnormalities that cause excessive RBC destruction (ABO/Rh incompatibility)
* bili levels higher and remain high
30
Kernicterus
* hyperbili (>25)
* long term neurological damage
* ½ infants survive
* never present at birth
31
choreoathetoid cerebral palsy
* extrapyramidal movement disorder resulting from kernicterus
* s/sx: jerking, tick twitch, slow writing
* tx: phototherapy; exchange transfusion
32
encephalocele
* rare neural tube defect characterized by sac-like protrusions of brain and meninges
* caused by failure of neural tube to close completely
* developmental delay, vision problems, mental/growth retardation
33
choanal atresia
•septum b/t nose and pharynx
34
omphalocele
* intestine or other abdominal organs stick out of the navel and are covered only by a thin layer of tissue and can be easily seen
* type of hernia.
35
gastroschisis
•birth defect in which an infant's intestines stick out of the body through a defect on one side of the umbilical cord
36
imperforate anus
•opening to the anus is missing or blocked
37
teratoma
* embryonal tumor
* may be solid, cystic, or mixed
* 80% benign
* if not resected before 1-2 months more likely to become malignant
38
preterm infant appearance
* disproportionately large head
* dec. muscle tome
* little fat
* skin thin w/ visible blood vessels (-> fld loss/dec. thermo)
* abundant lanugo/vernix
* absent plantar creases if < 32 wks
39
respiratory issues of preterm
* surfactant deficiency
* periodic resp./apnea
* RD (tachy, retractions, flaring, grunting)
* cyanosis
40
nutritional issues of preterm
* miss all/part of 3rd trimester transfer of nutrients, glycogen, Fe
* fat stores minimal
* glucose reserved used quickly
* smaller stomach capacity
* GI immaturity
41
preterm nutritional needs
* 150 kcal/kg/day
* more protein, Fe, Ca, P
* can't suck-swallow-breathe until 34 wks and 1500g
42
signs of readiness to PO feed
```
•rooting
•sucking
•+ gag
•RR < 60
•tolerate being held
*start PO feed slow
```
43
assessing tolerance of enteral feeds
* residuals
* vomiting
* abd distention
* stools
* suck-swallow-breathe coordination
* fatigue
* VS
44
preterm renal issues
* insensible fld. loss (warmer, RR rate)
* kidney can't concentrate, dilute, or conserve electrolytes
* more immature -> need more fld.
45
preterm expected UOP
* 1-3 mL/kg/her
| * 1 g= 1cc (diaper)
46
assessing preterm renal fxn
* UPO
* urine specific (1.005-1.015)
* weight
* turgor/edema
* anterior fontanelle
* Na, hct, BUN
47
preterm hematologic issues
* inc. cap friability
* inc. clotting time (bleed)
* dec. erythropoiesis
* dec. blood vol.
* dec. RBC life
48
transient tachypnea of newborn (TTN)
•delay in abs. of fetal lung fld
•risk if C/S, maternal GDM, smoker, SGA
•s/sx: RR > 60; grunt; flare; retraction; circumoral cyanosis
*resolves 24-72 hr
49
meconium aspiration syndrome (MAS)
* caused by vagal stimulation or hypoxia, resulting in meconium passage before birth
* can lead to pneumonia, obstruction of airway, and air trapping
* s/sx: RD, cyanosis, coarse sounds, barrel chest
* tx: O2 vent
50
hyaline membrane disease (HMD)/respiratory distress syndrome (RDS)
```
•most common cause is IDM
•inc. incidence/severity w/ dec. GA
•surfactant deficiency causes atelectasis
•onset w/in 1st hour of life
-Nasal flaring
-Cyanosis
-↓ breath sounds
-grunting
-Opaque “ground glass” X-ray
```
51
HMD/RDS tx
```
•surfactant
•O2
-hood or NC
-CPAP
-mechanical/high freq vent
-ECMO
```
52
when to use hood O2 therapy
•if baby can breathe on its own
53
went use CPAP O2 therapy
•can breathe on own, but have apnea > 15 sec
•forces breath
*nose breathers
54
when to use mechanical ventilator O2 therapy
* baby can't breathe on own
| * placed in trachea and set at specific breath/min
55
when to use high freq. ventilator
* extremely preterm
* frequent, small puff of air
* no pressure to lungs (passive diffusion of O2)
* vibrating chest movement
56
extracorporeal membrane oxygenation therapy (ECMO)
•artificial heart/lung machine that oxygenates blood and returns it to the heart
•allows lungs to rest
*only available @ level II hospitals
57
bronchopulmonary dysplasia
* O2 still required 28 days after birth or 36 wks post-conceptual age
* scarring of lungs, decreasing elasticity and causing chronic lung dz
58
persistent pulmonary hypertension of newborn
* increased pulmonary vascular resistance causes RHF
* caused by intrauterine hypoxia and birth asphyxia
* can also be caused by ASA or NSAIDs in 3rd trimester
59
persistent pulmonary hypertension of newborn s/sx and tx
* onset w/in 24 hrs
* RDS (w/o retrations)
* cyanosis
* tachypnea that worsens with handling
* O2, NO vent.
60
periventricular-intraventricular hemorrhage
* s/sx: lethargy, hypotonia, resp distress, ↓hct, full or bulging fontanels, seizure
* tx: shunts
* long term issues: neurologic abnormalities, developmental delay, cerebral palsy, hydrocephalus
61
retinopathy of prematurity
* blood vessels form where they shouldn't, leading to retinal detachment, glaucoma, blindness
* tx w/ laser surgery or cryotherapy
62
patent ductus arteriosus (PDA)
* closing failure of ductus arteriosus b/t L pulm artery and descending aorta
* s/sx: cyanosis, murmur, bounding peripheral pulse, tachy, crackles, CHF
* tx: PDA ligation; time
63
necrotizing enterocolitis (NEC)
```
•accumulation of gas in the submucosal layers of the bowel wall→necrosis & bowel perforation & sepsis
•S/S: Onset approx 2 weeks after birth
-Abdominal distension
-Blood in stool
-Retention of feeds
•Treatment
-antibiotics
-NPO with parenteral nutrition
-gastric decompression and serial -X-rays
-Surgery
```
64
postmature maturity syndrome
* aging placenta causes dec. O2 and malnutrition
* s/sx: ↓fetal growth; meconium staining; polycythemia; little subQ fat; little lanugo or vernix; abundant hair; long nails; dry, cracked, peeling skin
65
small for gestational age (SGA)
•BW < 10% (5.5# lb for term)
66
asymmetric growth restriction
* head and length unaffected, but weight is (disproportional)
* recover w/ adequate postnatal nourishment
* d/t MID PG complications
67
symmetric growth restriction
* weight, length, and head circumference affected
* may have long-term growth issues
* d/t EARLY PG complications
68
large for gestational age (LGA)
* BW > 90%
* risk for: longer labor, birth injury, shoulder dystocia, clavicle fracture, brachial plexus injury, facial nerve palsy, bruising, hypoglycemia, polycythemia, C/S
69
infants response to pain
* increase in levels of stress hormones (cortisol, catecholamines)
* affects growth, won healing, complications, length of stay
70
infant pain assessment
```
•HR
-inc. in normal
-dec. in compromised
•BP
•RR
•Skin- pallor, redness, cyanosis
•palmar sweating
•dilated pupils
•hyperglycemia
```
71
NIPS
* neonatal infant pain scale
* facial expression
* crying
* arm movement
* leg movement
* state arousal
72
CRIES
```
*neonatal pain scale
•crying
•requires
•oxygen to maintain O2 stat >95%
•increased VS
•Expression
•sleepless
```
73
FLACC
•UAMS pain scale
•5 criteria worth 2 puts each
*0 is pain free
74
infant nonpharmacologic pain management
* dec. stim
* position like in uterus
* swaddle/frogs
* non-nutritive suctin
* Sweet-ease
* rocking
* kangaroo care
75
infant pharmacologic pain management
* acetaminophen
* morphine, fentanyl (narcan ready)
* sedatives (chloral hydrate, midazolam)
