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Jaundice Flashcards

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1
Q

Jaundice

A

Yellow discolouration of skin and sclera cause by raised levels of bilirubin in the blood

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2
Q

Causes of physiological jaundice

A

Normal breakdown of excessive RBC needed by newborn in extra uterine life. Fetus has greater need for RBC than newborn

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3
Q

Physiological jaundice

A

Normally never appears before first 24 hrs of age

Fades between 7-10days

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4
Q

Bilirubin levels rise to

A

200mmol/l term

250 premi

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5
Q

Pathological jaundice

A

Occurs before 24 hrs
Rapid increase in bilirubin levels
Persists beyond 10 days

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6
Q

Midwife role in jaundice

A

Educate symptoms
Who to contact
What to look for

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7
Q

Causes of pathological jaundice

A

Anything that increases the production of bilirubin or inhibits the transport, metabolism or excretion of it. Eg blood group incompatibility, sepsis, hypothermia, abs, dehydration

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8
Q

The normal breakdown of bilirubin process / conjugation

A

Into haem and gloving
Haem- is catabolised into bilirubin
It is lipid or fat soluble- unconjugated bilirubin
Body transports to liver to bind with albumin
If it’s not bound to albumin it can go to Brian or skin
Once at liver, conjugation occurs with aid of liver enzymes
Once conjugated, able to excrete
Moves via Villary system into small bowel excreted in faeces and some urine via kidneys

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9
Q

If conjugation occurs, why do they develop jaundice

A

Level of bilirubin they need to transport, convert and excrete exceeds ability to do so
Lower albumin conc- less transport
Liver immature
Lack bacteria in bowel

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10
Q

How does the lack of bacteria in bowel contribute to bilirubin

A

It ensures conjugated bilirubin is excreted properly, if not reconversion to unconjugated (lipid or fat soluble) which is reabsorbed by body

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11
Q

Supportive jaundice care

A

Early feeding

Freq feeing

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12
Q

How does early / freq feeding aid in jaundice care

A 
Hydration and Glucpse for energy 
Encourages bowel flora and morality
Glucose assists anymore process in liver
Motility- dec time billirubin in bowel, dec amount it is reabsorbed 
Maintains warmth
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13
Q

Jaundice ax

A 
Every 8-12 hrs
Is visible at 80-90mms/L
Alert/ drowsy
Feeding 
Output 
Kramer rule OR transcutaneous billirubinometer
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14
Q

Kramer rule

A

Blanching of skin with finger a different zones and observing colour

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15
Q

K1

A

Head and neck

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16
Q

K2

A

Chest an shoulders

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17
Q

K3

A

Umbi lower abdo and knees

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18
Q

K4

A

Lower arms and lower legs

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19
Q

K5

A

Whole of baby

Hands feet fingers and toes

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20
Q

Trancutaneous billirubinometer

A

Screens jaundice level to determine need for serum billirubin test (SBR)
Older than 24 hrs

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21
Q

Photo therapy

A

When level needs to be supported more than early and freq feeds
Blue lights to enhance billirubinn conjugation and therefore ability to excrete

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22
Q

Photo therapy rules

A 
Intermittent or continuous 
Exposure to entire skin 
Control temp
40-50cm from baby 
Eyes protected
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23
Q

Cons of phototherapy

A

Fluid loss increase, dehydration
Separation
Skin ax unreliable when exposed
When ceased - (rebound)

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24
Q

Importance of newborn ax

A 
Monitor health / wellbeing 
Responses to physiological changes
Check growth
Behaviour 
Affects I birth 
Detect congenital malformation 
Sick baby
Baseline
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25
Principles of newborn ax
``` Communicates Quiet and alert Systematic approach Heart and lungs first Symmetry ```
26
Sequence of new born ax
``` History Heart lungs Skin Head neck Chest abdomen Spine Limbs and joints Neurological ```
27
History before nba
``` Genetic factors Maternal blood group Apgar Birth weight Mode of del ```
28
Average length
45- 50cm
29
Average weight
3500g -4500g | Normal to lose 10% normal physiological diuresis
30
Regain birth weight by day
10-14
31
Head circ average
34.5-35.5cm
32
Head circ measurement taken from
Occipitofrontal diameter
33
Normal auxilla temp
36.5-37.5
34
NBA heart lungs
RR effort rise and fall abdomen simultaneous 30-60 RR HR 110-160 regular
35
When listening to heart in NBA
Reg Diaphragm high pitch Bell low pitch S1 and s2
36
Skin NBA
``` Lanugo Millia Mottling Colour Pallor Acrocyanosis Plethora Jaundice Mongolian blue spot Vernix ```
37
Head and neck NBA
``` Symmetry shape Injury Sutures Fontanelles Plagiocephally Face Hair Moulding Caput succedaneum Cephalhamltoma ```
38
Sutures
Frontal Coronial Sagital Lanbdoidal
39
Fontanelles
Anterior- hard on palp | Posterior -flat not sunken or bulging
40
If post Frontanelle is bulging
Intracranial haemorrhage
41
If posterior Frontanelle is sunken
Dehydration
42
Cephalhaematoma
Bleeding eternal periostium and none of fetul skull
43
Most common site for Cephalhaematoma
Parietal bones | Can have more than one
44
How does Cephalhaematoma happen
Occurs from forceps, friction of fetal scull on pelvic bones Because periostrium separating from skull bone and haemorrhaging between them
45
In Cephalhaematoma the swelling is confined to
One single bone per haematoma- won't cross suture line
46
When does Cephalhaematoma occur
12-72hrs
47
Cephalhaematoma pit on pressure?
No
48
True false Cephalhaematoma may be bilateral
True
49
Cephalhaematoma enlarge or reduce after birth
Enlarges
50
Cephalhaematoma can contribute to
Jaundice | Anaemia
51
Caput succedaneum
Oedemous swelling of superficial tissues inside scalp | In unsupported part of head
52
Causes of caput succedaneum
Pressure on fetal head during contractions
53
Can caput succedaneum cross suture line
Yes
54
Caput succ reduces or enlarges afterwards
Reduces
55
Does caput succ pit on palp
Yes | Soft swelling
56
Tx for caput vs Cephalhaematoma
Caput no tx | Cephalhaematoma gentle handling and vita k
57
Face NBA
Eyes -discharge moving ocular organs gaze epicantal fold red reflex othalmascope Nose- patent Mouth- symmetrical, rooting reflex, asses lips gums palette complete, tongue tie, candida
58
Chest and abdo NBA
``` Round and soft Nipples symmetrical Exclude hernia with palp of groins Genetalia Excited undescended testes ```
59
Spine NBA
``` Palp Lumps Swelling Dimpling Butt creases Anus patent ```
60
Limbs and joints
``` Check auxilla for skin tags Open hands Webbing Equal ROM joints Flexion Tone ```
61
Neurological NBA
Alert Reflexes Grasp
62
Babinski reflex
Stimulus sole of foot | Response big toe bends back toward top of foot and other toes fan
63
Startle (mono) reflex
Stim- loud sound or movement | Red- head thrown back, extends arms and legs, pulls them back in
64
Root reflex
Stim- corner of mouth stroked | Re- head turns to touch
65
Suck reflex
Roof of mouth touched | Res sucking
66
Truncal incuration / galant reflex
Tap side of spine | Red- twitch hips towards touch
67
Tonic neck reflex
Stim - head turned to one side | Res- extremities on same side straighten Opp side flexed
68
Grasp reflex
Touch palms or fingers | Res- close fingers in grasp
69
Meconium stained liquor risk
Aspirate- infection
70
Common disorders of neonate
``` Oral thrush Sucking blister Septic spots Breast engorgement Vom mucous ```
71
True false urates normal in nappy first 24 hrs
Yes
72
Stool changes
Meconium- black green tenacious Transitional- 3-5 brownish yellow Feeding established- loose yellow offensive
73
Newborn physiological adaptations
``` Resp Haematological Thermal GIT Metabolic ```
74
Primary functional change of lungs
Lungs change from fluid excretion function to gas exchange Fluid needs to be removed for this Expelled- through oral an nasal pharynx Reabsorbed- remainder with inflation
75
The first few breaths encourage
Remaining intra alveolar fluid to move peri bronchial and peri vascular spaces to be absorbed into local vascular system
76
Establish resp
RR is irreg Apnoea 5-15 secs norm Effort is diaphormatic
77
Resp adaptations
Primary functional change of lungs Establish resp Increase expansion of terminal sacs
78
Expansion of terminal sacs
Complet inflation - complete inflation I terminal alveolar sacs- efficient gas exchange
79
Lung vol per kg
25ml
80
Haematological adap
Fetal haemoglobin - at birth 17g per decilitre of blood Fetal type has high affinity of oxygen to compensate for prev hypoxic uterine enviro After, hb no longer req, hemolysis will occur = jaundice
81
Why vita K
Newborn doesn't have adequate supply of vita k to be able to synthesis thrombin and other Clotting factors
82
What stimulates synthesis of vita k
Feeding,'colonisations of bowel | End of First week
83
Thermal adaptation
``` Need to adapt to cooler enviro Uterine temp 37.7 Dry and wrap Thermoregulation Risk of heat loss ```
84
Why are babies at risk of heat loss
Less subcutaneous fat Large surface area to mass ratio Thin epidermal layer Blood vessels superficial decrease ability to shiver
85
Loss of heat from baby
Convection to moving air Conduction to cold surface Evaporation to air through wet skin Radiation to cold structures
86
How do babies gain heat
Brown adipose tissue- provided heat through chemic thermogenesis Withdrawal of prostaglandin and adenosine which prevents shivering ``` Decrease ability to sweat Flexed posture Chemical thermogenesis- metabolic activity Limb movement Sucking ```
87
To use brown fat
SNS stimulates release of adrenaline, TSH, & catecholamines which increase metabolism of brown fat, enhance production of bfat and make extra glucose to fuel this conversion Rapidly metabolised and produces heat- transfers through vascular system by strategic placement around bodies with high circulation (kidneys adrenal glands head and neck)
88
GIT adaptations
Sucking and swallowing- reflexes present at birth Stomach capacity- 6mL/kg meaning 3.5kg=21 ml normal increases rapidly Cardiac sphincter immature at birth- causes positing so this plus size of stomach and competition of ingested air in stomach = regurgitation of milk
89
Digestion adaptations
Milk feeding stimulates production of enzymes within the git tract and stimulates rapid proliferation of cells lining the tract At term has the ability to digest simple carbs, protein and fat
90
Glucose adaptations
Maternal glucose withdrawn In 3rd try feotus lays down stores of glycogen to ensure enough in first few days More efficient in synthesis rather than using it- need for ketones and ffa as immediate source of energy - gluconeogenesis Decrease in serum insulin- NB ability for fat metabolism (lipolysis) increases- supports while gluconeogenesis occurs The release of ffa and ketones relies on lipolysis
91
Metabolic adaptations
Fat metabolism | Protein metabolism
92
Protein metabolism
Learns to digest milk proteins to provide source of amino acids to so in remodelling urging rapid cell differentiation to Feed rapid cell growth
93
Adult hb
180
94
Fetal hb
220
95
Fetal circulation
Structures of fetal circ enable efficient transport of gases to and from placenta Aimed at quick transport of O2 and nutrients to vital organs
96
Why is there a greater need for 02 to be transported quickly in fetal
Gas exchange not as effective in placenta than lungs
97
Why do fetid have different hb
Fetal hb allows 20-30% greater 02 carrying capacity than adult and O2 disengages easily from this - supplies tissues more effectively
98
Why is fetal circ a temporary thing
Minimises circ to I rgans that are less improtant in fetal life like lungs and git- must be temporary to allow for rapid transition
99
When does cvs develop
En of 3rd week (5wks gestation) Fetal placental villi forming along with fetal placental vessels. A rudimentary umbi cord can be seen. Fetal vessels are made of mesoderm- one of the basic layers of the tri laminae embryo
100
At week four (6wks gest) CVS
Rudimentary two chambered heart begins to beat
101
Critical time for cardiac Dev is
20-50 days after fertilisation
102
6wks (8g)
Umbi cord developed Carries 02 rich blood to embryo 2 umbi arteries carry deox to placenta
103
8 was (10g)
Structures making up fetal circ in place | Whartons jelly protects vessels in cord
104
Feto-placental circ
Deox to placenta via 2 umbi arteries away from fetal heart. Umbi arteries divide and subdivide entering into villi of placenta for gas exchange Return circ through umbi vein 02 blood fetus toward fetal heart
105
Temporary structures of fetal circ
``` Umbilical vein Ductus venosus Foramen ovale Ductus arteriosus Umbilical arteries ```
106
Umbilical vein
From the umbi cord to underside of the liver. Has branch that joins portal vein. Half the blood supplies from Vein enters this branch- other half shunted through temp structure ductus venosus
107
Ductus venosus
Connects umbilical win to inferior vena cava high in 02 directed toward the heart
108
Foramen ovale
Opening between r and L atria of heart Allows blood entering heart to bypass pulmonary circ Has flap which can open or close with changing pressures of heart
109
Ductus arteriosus
Connection between pulmonary artery and the aorta | Allows like entering pulmonary circ to be diverted before entering lungs
110
Umbilical arteries
From hypo gastric arteries to the umbilical cord Carries 02 rich blood back to placenta via hypo gastric artery which are branches of the internal illiacs Pic
111
Foramen ovale at birth
Functional closure 1-2 hrs after permanent within 6 months know as fossa ovalis
112
Ductus arteriosus changes a birth
Functional closure in 15 hrs- fibroses takes within 3 weeks becoming known as ligamentum arteriosum
113
Ductus venosus changes a birth
Functional closure soon after birth | Fibroses takes within 2 months belong known as ligamentum venosum
114
Umbilical vein & arteries (intra abdominal) changes
Constricts and fibrose to become the ligamentum teres and the medial umbilical ligaments and superior vesicular artery (supplying the bladder)
115
Signs functional structures changing
``` Take a breath Crying Peaks up Umbi cord apps pulsating Pink Warm ```
116
What physiological factors can interfere with adaptations
Hypothermia- lowers bsl | Will revert back to fetal circ
117
Apgar score
``` 1 activity (tone) 2 pulse (hr) 3 grimace (reflexes) 4 appearance (colour) 5 resps (rate and effort) ```

Postnatal (3 decks)

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