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NPS Review > Patient Assessment Sect. A > Flashcards

Patient Assessment Sect. A Flashcards

1
Q

What is the 1st step in the process of Neonatal and Pediatric care?

A

Patient assessment is the 1st step - including reviewing the pt’s medical record, physical exam, basic laboratory testes, and special procedures that are used to determine the primary problems and the best coarse of treatments.

2nd - oxygenation (most common problem)
3rd - circulation
4th - perfusion

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2
Q

What are the 4 critical life functions?

A
  1. Ventilation - moving air in/out of lungs
  2. Oxygenation - getting oxygen into the blood
  3. Circulation - moving the blood through the body
  4. Perfusion - getting blood and oxygen into the tissues
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3
Q

What to evaluate for ventilation?

A

Ventilation - evaluate: RR, Vt, chest movement, BS, PetCO2, PaCO2.

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4
Q

What to evaluate for oxygenation?

A

Evaluating oxygenation: HR, color, sensorium, SpO2, PaO2.

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5
Q

What to evaluate for circulation?

A

Evaluating circulation: HR, pulse strength, capillary refill, cardiac output.

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6
Q

What to evaluate for perfusion?

A

Evaluating perfusion: BP, sensorium, temp., urine output, hemodynamics.

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7
Q

What maternal age has the highest risk of complications?

A

Maternal age <16 years or >40 years.

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8
Q

What complications do very young mothers have during pregnancy?

A

They have a greater incidence of pre-eclampsia, cephalopelvic disproportion, and low birth weight infants.
* Pre-eclampsia: a serious medical condition that can occur about midway through pregnancy (20 weeks).
Can have hypertension, protein in urine, swelling, headaches, and blurred vision.
* Cephalopelvic disproportion: happens when the baby’s head doesn’t fit through the opening of the pelvis. Likely happens with babies that are large or out of position when entering the birth canal.
* Low birth weight infants: is defined by WHO as wight at birth of <2500 g (5.5 pounds).

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9
Q

What are the complications for mothers > 40 years of age?

A

They have a grater incidence of pre-eclampsia, cesarean birth, congenital anomalies, chromosomal aberrations.
* Pre-eclampsia: * Pre-eclampsia: a serious medical condition that can occur about midway through pregnancy (20 weeks).
Can have hypertension, protein in urine, swelling, headaches, and blurred vision.
* Cesarean birth: a surgical procedure where a baby is delivered through incisions in the abdomen and uterus.
* Congenital anomalies (birth defects): can be ID before or after birth. Ex: cleft lip and palate, clubfoot and hernias, heart defects, neural tube defects, and Down syndrome.
* Chromosmal aberrations: are changes to the structure or number of chromosomes, which are strands of condensed genetic material.

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10
Q

What can alcohol use during pregnancy cause?

A

It can cause teratogenic - substances that cause congenital disorders in a developing embryo or fetus. They can increase risk of - miscarriage, preterm labor or stillbirth.
Ex: drugs, medicine, chemicals, certain infections and toxic substances.

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11
Q

What is FAS and what causes it?

A

Fetal Alcohol Syndrome (FAS): growth restriction, facial anomalies, and central nervous system dysfunction.
Alcohol use can cause FAS.
Is also a major cause of developmental delays.

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12
Q

What can smoking cause during pregnancy?

A

Corbon monoxide and nicotine - decreases blood supply to fetus resulting in reduced levels of oxygen and nutrients.
These children have a higher chance of of low-birth weight, intrauterine growth retardation (restriction), and preterm birth.
* Intrauterine growth: baby in the womb does not grow as expected. Often caused by fetus not receiving enough nutrients and nourishment.

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13
Q

What can be caused with the use of addicting drugs durning pregnancies?

A

There is a higher chance of: congenital anomalies, low birth weight, neonatal drug withdrawal, and low serum bilirubin.
* Low serum bilirubin - a baby born <38 was of gestation may not be able to process bilirubin as quickly as full-term babies do. They may also feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool.

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14
Q

What is NAS?

A

Neonatal Abstinence Syndrome (NAS): is a withdrawal syndrome of infants caused by in uteri exposure to drugs that cause dependence.

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15
Q

What can caffeine use cause in pregnancies?

A

Excessive maternal caffeine consumption may result in low birth weight.

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16
Q

What is Gravida?

A

It is any pregnancy, regardless of duration, includes current pregnancy.

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17
Q

What is Para?

A

Is a birth after 20 weeks gestation regardless of whether the infant is viable.

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18
Q

What is Primigravida?

A

This refers to a woman’s first pregnancy.

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19
Q

What does the following mean? Mother’s obstetrical history is described as: G5, P1.

A

This is her 5th pregnancy and only 1 of the previous pregnancies was carried past 20 weeks. This would be considered a high-risk pregnancy.

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20
Q

What can malnutrition cause?

A

Malnutrition may affect fetal brain growth and lower the intellectual level of the child.

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21
Q

Pregestaional Diabetes Mellitus cause what?

A

There is an increased risk of pre-eclampsia, hypertension, hypo- and hyperglycemia and are more likely to require a cesarean section.

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22
Q

What does Gestational Diabetes Mellitus cause?

A

These infants have a higher risk of macrosomia, congenital anomalies, and respiratory distress syndrome.
* Macrosomia - is used to describe a newborn who’s much larger than average. This infant weighs more than 8 pounds, 13 oz (4000 grams), regardless of their gestational age.
* About 9% of babies worldwide weigh more than 8 lbs, 13 oz.

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23
Q

What are 2 routes of maternal infections?

A

Transplacental (congenital) - results from microbes circulating in the mother’s blood.
Ex: Bubella (German measles), Cytomegalovirus (CMV) common virus like chickenpox/herpes simplex/mononucleosis, syphilis, toxoplasmosis is an infection with a parasite called Toxoplasma gondii/infected from uncooked meat.

Perinatal - acquired during or after delivery.
Ex: infected genitalia area from Neisseria gonorrhea (eyes), harpies simplex virus, HIV, Hep-B virus, and group B streptococcus infection.

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24
Q

What 4 things can maternal hypertension lead to?

A

May lead to decreased placental blood flow, intrauterine growth retardation, intrauterine asphyxia, or fetal death.

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25
Q

What is pregnancy induced hypertension (PIH)?

A

Elevated blood pressure after 20th wk of gestation.

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26
Q

What is pre-eclampsia?

A

Maternal hypertension accompanied by proteinuria and edema.

27
Q

What is eclampsia?

A

Maternal hypertension accompanied by seizures or coma.

28
Q

What are the 7 conditions that can help cause maternal hypertension?

A
  1. Underlying chronic hypertension
  2. Renal disease
  3. Diabetes Mellitus
  4. Low socioeconomic background
  5. Multiple births
  6. Mother younger than 20 years of age
  7. 1st pregnancy
29
Q

What are 4 treatment for maternal hypertension?

A
  1. Balanced diet
  2. Bed rest
  3. Anti hypertensive agents
  4. Anticonvulsant agents
30
Q

What 2 things is magnesium sulfate used for?

A
  1. To lower blood pressure
  2. Delay preterm delivery
31
Q

What 3 family disease history should be noted for maternal hypertension?

A
  1. Congenital abnormalities
  2. Genetic disorder - cystic fibrosis
  3. Hereditary and chronic condition - sickle cell anemia
32
Q

How do you use Nagele’s Rule (by dates) to estimate gestational age?

A
  1. Estimated date of birth is calculated from the 1st day of the mother’s last menstrual period.
  2. Subtract 3 months and add 7 days.
33
Q

How is fetal ultrasound used to estimate gestational age?

A

Gestational age estimated from measurement of bi-parietal diameter of fetal head or length of fetal femur.

34
Q

With Biophysical Profile (BPP) what are the variables used to evaluate placental function and fetal well being?

A

Variables = fetal breathing movements, fetal movements, fetal tone, reactive fetal heart rate, and amniotic fluid volume.
Normal score = 2
Abnormal score = 0

35
Q

How do you interpretation of Biophyssical Profile (BPP) results?

A

Score: Interpretation: Comments:
8-10. Normal. CNS is functional and fetus is not hypoxic
6. Equivocal Repeat within 24 hours
<4. Abnormal. Repeat test same day if <32 wks, then delivery if BPP < 6, labor induction if gestational

age > 32 wks.

36
Q

What is amniocentesis?

A

It is a procedure in which a needle is inserted through the mother’s abdominal wall into the amniotic sac in order to withdraw a sample of amniotic fluid.

  • Procedure is very invasive.
37
Q

What is Amniotic fluid index (AFI) used for?

A

It is used to quantify amniotic fluid volume.

38
Q

How do you calculate Amniotic Fluid Index (AFI)?

A
  1. Calculated by measuring the depth of the largest pocket of fluid in each of the four uterine quadrants during ultrasound.
  2. AFI between 8-18 is considered normal.
  3. AFI <5-6 is considered as oligohydramnios.
  4. AFI >20-24 is considered as polyhydramnios.
39
Q

What does oligohydramnios do?

A

It reduces amount of amniotic fluid.

40
Q

What 4 things is oligohydramnios associated with?

A
  1. With postmaturity
  2. IUGR secondary to postmaturity
  3. poor lung development
  4. renal malformations.
41
Q

What is Potter’s syndrome?

A

It is renal agenesis and oligohydramnios

42
Q

What is polyhydramnios?

A

Excessive amount of amniotic fluid.

43
Q

What is polyhydramnios associated with?

A
  1. Is associated with esophageal atresia
  2. T-E fistula
  3. Hydros fetalis
44
Q

What does an increase of Bilirubin levels mean and may lead to?

A

Increased bilirubin may indicate Rh incompatibility, which may lead to fetal erythroblastosis.

45
Q

What does increased Creatinine indicate?

A

It should increase with advancing gestational age and indicate fetal maturity.

46
Q

What is cellular abnormalities?

A

it is cells shed by the developing fetus are present in the amniotic fluid and can be examined to determine the presence of genetically transmitted disorders and can also help determine the sex of the fetus.

47
Q

List the 3 cellular abnormalities?

A
  1. Genetic tests - cystic fibrosis
  2. Chromosome abnormalities - Down syndrome (Trisomy 21)
  3. DNA - paternal testing
48
Q

What is Lecithin/sphingomyelin (L/S) ratio used for?

A

It is used to determine lung maturity.
1. Measured from amniotic fluid obtained during amniocentesis.

49
Q

What can cause lecithin/sphingomyelin (L/S) ration unreliable?

A

It is unreliable if mother has diabetes or Rh incompatibility.

50
Q

How do you interpret the results from the L/S ratio?

A

2:1 or higher - indicates pulmonary maturity (low risk of RDS)

Less than 2:1 - indicates a high risk of RDS

51
Q

What is the percent of false-negative L/S ratio and when does it occur?

A

Incidence of false-negative L/S ration is high (from 20-25%) and occurs with an immature L/S ration with no sighs of respiratory distress.

52
Q

What is phosphatidylglycerol (PG) and what is it used for?

A
  1. Phospholipid - appearing at about 35 wks gestation and rising unit term.
  2. Most reliable - indicator of “pulmonary maturity”, even with diabetes, heroin addiction, hypertension, placenta abruptio, insufficiency, infection, etc.
  3. Absent in immature lungs; present in mature lungs.
53
Q

What is Surfactant/Albumin (S/A) Ratio?

A
  1. Concentrations of surfactant and albumin measured against a standard curve of S/A calibrators.
  2. Can be performed in 40 minutes with a 1.0ml sample.
  3. Less expensive than L/S ratio testing with comparable accuracy.
  4. Levels > than 55mg/g indicates lung maturity.
54
Q

What is Lamellar Body Counts?

A
  1. Lamellar bodies 1st appear in amniotic fluid at 20-24 wks of gestation and are released into alveolar spaces.
  2. Fetal breathing movements distribute the lamellar bodies into amniotic fluid.
  3. Fetal lung maturity can be assumed when LBC reaches 35,000 counts/uL.
55
Q

What is Shake Test (Foam Stability Test)?

A
  1. Mix amniotic fluid with 95% ethanol in test tube and shake.
  2. Results available in 15 minutes.
  3. Presence of foam/bubbles indicates the presence of pulmonary surfactant.
  4. Not as specific as the L/S Ratio.
56
Q

What is Coombs Test?

A
  1. Evaluates blood type incompatibility.
  2. Infants may be at risk for hemolytic disease (erythroblastosis fetalis, hydrops fetalis).
    * Rh-positive infants of Rh-negative mothers.
    * Type A or B infants of type O mothers.
  3. Mother can be treated with RhoGAM injections after 1st delivery.
57
Q

What is Alpha Fetoprotein?

A
  1. Measured in maternal blood or amniotic fluid.
  2. Screening test for certain developmental abnormalities.
    * Omphalocelel
    * Gastroschisis
    * Neural tube defects - Myelodysplasia (meníngomyelocele, spina bifida).
  3. Normal value is < than 10ng/mL
58
Q

What is Intrauterine Stress Testing (two types)?

A
  1. Non-stress Testing - recording fetal heart rate externally through the mother’s abdominal wall.
    * A reactive test - when the fetal heart rate increases during movement.
    * A non-reactive test - when the fetal heart rate doesn’t increase with movement.
  2. Stress Testing/Oxytocin Challenge Test (OCT)/Contraction Stress Test (CST).
    * Used to asses the placenta’s function - during uterine contractions and this ability to withstand labor and delivery.
    * A normal (-) Test - if the fetal heart rate is stable.
    * An abnormal (+) Test - if fetal heart rate decelerated after onset of uterine contractions (late deceleration, Type 11), which is associated with uteri-placental insufficiency.
59
Q

What are 3 ways labor is induced?

A
  1. Amniotomy - artificial rupture of the membranes (AROM).
  2. Stripping, or sweeping - of amniotic membranes.
  3. Administre oxytocin (Pitocin or Syntocinon).
60
Q

Why are Cesarean sections performed?

A
  1. Repeat C-sections are done for women who have previously had one done, because there is a chance that labor could rupture the uterus at the site of the previous incision.
  2. Primary c-sections - are done because of numerous complications that may threaten the mother and/or fetus (pelvic disproportion, placental accidents, fetal distress, toxemia, diabetes, etc.).
  • These infants are at risk because of the condition that necessitated the section, plus they have higher incidence of RDS, transient tachypnea of the newborn and depression from the mother’s anesthesia.
  • Assisted deliveries (forceps or vacuum) - present a risk of trauma to the neonate.
61
Q

Describe the type of Anesthetic done?

A
  1. Local Anesthesia (Epidural or Spinal anesthesia) - injection of anesthetic agent into the epidural space or spinal fluid to provide pain relief during labor and delivery.
  2. General Anesthesia - induced unconsciousness.
62
Q

What are the advantages and disadvantages of Local Anesthesia?

A

Advantages - mom is awake during delivery and fetus is not exposed to the anesthetic agent.

Disadvantages - may cause hypotension in mother, perhaps compromising placental blood flow.
* Misplacement - results in poor pain control.

63
Q

Why is General Anesthesia done and what complications can occur?

A
  1. It may be necessary for cesarean section or for surgical treatment of complications.
  2. Usually a combination of inhaled and intravenous anesthetic agents.
  3. Primary complication is fetal depression resulting from exposure to the anesthetic agents.
64
Q

Why is Tocolytic Agents administered?

A
  1. It is used to inhibit uterine contractions by relaxing smooth muscle in the uterine wall.
    * Magnesium sulfate
    * Beta-adrenergic agonists (terbutaline [Brethine] or ritodrine [Yutopar]).
    * Prostaglandin synthetase inhibitors (indomethacin [Indocin}).
    * Calcium channel blocker (nifedipine [Procardia].
  • Most commonly used are terbutaline and magnesium sulfate.

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