High risk newborn (unit 3) Flashcards Preview

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Flashcards in High risk newborn (unit 3) Deck (75)
1

caput succedaneum

•soft tissue injury sustained during birth
•FLUID edema of scalp
•benign
•DOES cross suture line

2

cephalhematoma

•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

subconjunctival & retinal hemorrhages

•soft tissue injury sustained during birth
•d/t increased ICP
•benign

4

lacerations during birth

•soft tissue injury sustained during birth
•scalpel from C/S
•episiotomy on scalp, butt, thigh

5

skeletal injuries during birth

•skull (linear/depressed)
•clavicle- most common
•humerus/femur

6

Erb-Duchenne

•paralysis of upper portion of arm d/t upper plexus injury during birth

7

Klumphke

•paralysis of lower portion of arm d/t lower plexus injury during birth

8

phrenic nerve injury during birth

•diaphragmatic paralysis
•cyanosis, irregular thoracic movements
•vent support for 1st few days
•may spontaneously resolve or need surgery

9

subarachnoid hemorrhage during birth

•most common intracranial hemorrhage
•causes seizures
•vent support, IV, monitor ICP, minimal stim

10

infants of diabetic mothers r/o

•congenital anomalies
•IUGR
•heart anomalies (cardiomyopathy)
•respiratory distress
•hypoglycemia
•hypocalcemia
•hypomagnesemia
•polycythemia

11

hypoglycemia onset

•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

hypertrophic cardiomyopathy (HCM)

•hypercontractile
•thickened myocardium (-> LHF)

13

nonhypertrophic cardiomyopathy (non-HCM)

•poorly contractile
•over stretched
•tx w/ digoxin

14

polycythemia

•Hct > 65%
•inc. blood viscocity
•impaired circulation/oxygenation
•inc. RBC to be hemolized
•additional birth trauma if macrosomia (inc. cephalhematoma/bruising)

15

neonatal sepsis

•microorganisms/toxins (bacteria, virual, fungi) in blood/tissues
•perinatal- HSV, CMV
•during birth- GBS
•postnatally

16

bacterial neonatal infection

•early onset
-congenital
-rapid progression (24-72 hr)
-hypothermia common
•late onset
-acquired
-slow progression (1-2 wk)

17

neonatal group beta strep bacterial infection

•most common
•early onset indicates vertical transmission
•RDS, pneumonia, sepsis

18

neonatal e. coli bacterial infection

•amp resistant strain contracted during labor

19

neonatal listeriosis bacterial infection

•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

neonatal clamydia bacterial infection

•opthalmia neonatorum
•conjunctivitis
•reason for erythromycin in eyes at birth

21

neonatal fungal infections

•candidiasis (thrush)
•mouth/diaper most common site

22

heroin/methadone neonatal effects

•IUGR
•LBW
•SGA
•w/d
•risk of SIDS 5-10x higher

23

marijuana neonatal effects

•lowered response to light sim
•tremors
•high pitched cry
•small head
•hyperactive
•impulsive
•delinquency

24

cocaine neonatal effects

•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)