Flashcards in Newborn Hyperbilirubinemia Deck (51):
Causes of NB hyperbilirubinemia?
- decreased serum albumin binding
- Impaired liver function
Condition resulting from a deposition of yellow pigmentation in the basal ganglia of the brain in NB?
Kernicterus (bilirubin > 25)
Therapy for hyperbilirubinemia?
- protect the eye
- observe for:
- dehydration, diarrhea, rashes
The NB presents with dimished Moro reflex, poor sucking, high-pitched cry, setting sun eyes, a sunken anterior fontanel and green stool, what do you suspect?
How does phototherapy help tx hyperbilirubinemia in a NB?
speeds up conjugation of bilirubin
What is Iso-Immunization?
development of antibodies against antigens from the same species
What is the medication given to prevent Iso-immunization from Rh factor?
What is Erythroblastosis Fetalis?
when the fetus produces large amounts of immature erythrocytes to replace those lost due to anemia
What is hydrops fetalis?
- severe form of Erythroblastosis Fetalis
- fetus has marked anemia, cardiac decompensation, cardiomegaly, and hepatosplenomegaly
- tx is done in utero with a transfusion via the umbilical cord after 17 weeks of gestation
Why is a COOMBS test done?
- to determine presence of Rh/ABO serum antibodies
- Direct - tests cord blood
- Indirect - tests mom's serum
Why is the Kleihauer-Betke test done?
- measures the amount of fetal hemoglobin transferred to mothers bloodstream
- to test for the need for RhoGam
When is RhoGam given?
- only if woman is Rh- and not sensitized
- Anterpartum at 28 weeks
- Within 72 of:
- significant 1st or 2nd timester bleeding
- abortion or miscarriage
- CVS or amniocentesis
- birth of Rh+ baby
How long do the effects of Rhogam last?
Baby presents with elbow ectended, hand rotated inward, no moros' reflex and intact grasp in one arm. What do you suspect and how to treat?
- Erb Duchennes palsy
- immobility for 1st week, then passive ROM
What is the vector for toxoplasmosis?
cat feces (garden soil) and raw or undercooked beef or pork
How is an infection with toxoplasmosis dx in an NB?
elevated cord blood serum IgM
Group B Strep can lead to what in a newborn?o
sepsis, pneumonia, meningitis
How long is the NB observational period for GBS?
48 hrs after delivery
How is fetal alcohol syndrome diagnosed?
- facial characteristics
- growth delays
- developmental delays
- mental retardation
- behavioral problems
- learning disabilities/hyperactivity
FAS facial features?
- short palpebral fissures
- flat midface
- low nasal bridge
- epicanthal folds
NB withdrawal symptoms (CNS)?
- high pitched cry
- seizure activity
NB withdrawal symptoms (Resp)?
tachypnea, tachycardia, nasal stuffiness
4 defects of the Tetralogy of Fallot?
- pulmonary stenosis
- right ventricular hypertrophy
- ventricular septal defect (VSD)
- over riding aorta
Spina bifida; meningocele?
exposed sac contains meninges & CSF, no nerves
Spina bifida: myelomeningocele?
meninges, CSF and nerve
When does the neural tube normally close?
17-30 days after gestation
What is an Omphalocele?
abd organs are protruding from umbilicus, but covered by peritoneal membrane
What is a Gastroschisis?
abd organs are protruding from umbilicus and uncovered
The post partum period can last how long?
up to 6 weeks
What is the avg blood loss during a vaginal delivery and c-section?
300 - 500 mL & 500- 1000 mL
A positive Hohman's sign is an indicator of what?
Uterus fundal height changes after birth:
1) by 12hr
2) day 1-8
3) day 9
4) by 5-6 weeks
1) 1 cm above umbilicus
2) decreases 1 cm / day
3) not palpable
4) near non-pregnant size
A "boggy" uterus is a sign of what?
What does methergine do?
causes sustained uterine contractions
What is Lochia?
fleshy smelling, vaginal discharge after delivery
Lochia color changes:
1) 1st 2-3 days
2) 3 - 10 days
3) 10 - 21 days
1) rubra - dark red, some clotts
2) serosa - pink, brown
3) alba - yellow, clear
1) < 2.5 cm
2) < 10 cm
3) > 10 cm
4) 1 pad saturated w/in 1 hr
What is the acronym for the episiotomy scale?
What does REEDA stand for?
3 types of placental adherent?
accreta, increta, percreta
Placental penetration into the uterine wall but not through to the muscle
placental penetration to the uterine muscle?
placental penetration through the entire uterine wall and attaches to another organ?
Initial care of post partum hemorrhage?
massage the fundus
What is a cardinal sign of a pp infection?
fever on 2 consecutive days during first 10 days pp
What is subinvolution?
uterus does not return to normal size pp and a major sign of endometritis
What is the most common PP infection?
Symptoms of endometritis?
- foul smelling lochia
- tender, boggy uterus
- fever (chills)
- increased pulse
Mastitis usually occurs when?
2-4 weeks PP
How to differentiate mastitis from engorgement?
mastitis is unilateral with a fever, engorgement is bilateral without fever