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NCMN 109A - Pedia Lecture > Physiologic Problems of the Newborn > Flashcards

Physiologic Problems of the Newborn Flashcards

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1
Q

Excessive level of accumulated bilirubin in the blood

A

Hyperbilirubinemia

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2
Q

A yellowish discoloration of the skin and other organs

A

Jaundice or Icterus

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3
Q

Hyperbilirubinemia is characterized by?

A

Jaundice or Icterus

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4
Q

Cause of Hyperbilirubinemia?

A

Results from increased unconjugated or conjugated bilirubin

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5
Q

What type is commonly seen in newborns?

A

Unconjugated

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6
Q

Possible cause of Hyperbilirubinemia?

A

Physiologic Factors
Breastfeeding/Breastmilk
Excess productine of bilirubin
Disturbed capacity of liver
Ccombined overproduction and underexcretion
Genetic Predisposition
Some disease states (G6PD, hypothyroidism, galactosemia, GDM)

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7
Q

Varying degrees of cns damage as a result of unconjugated bilirubin deposition in brain cells

A

Bilirubin Encephalopathy

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8
Q

The yellow staining of the brain cells resulting to bilirubin encephalopathy

A

Kernicterus

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9
Q

Factors That Enhance Bilirubin Encephalopathy

A

Respiratory Acidosis
Low Serum Albumin Levels
Intracranial Infections
Abrupt Fluctuations In Blood Pressure

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10
Q

Conditions That Increases Metabolic Demand for Oxygen or Glucose

A

Fetal Distress
Hypoxia
Hypothermia
Hypoglycemia

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11
Q

Signs Of Bilirubin Encephalopathy

Prodromal Factors:

A

Decreased activity
Irritability
Lethargy
Loss of interest in feeding

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12
Q

Signs Of Bilirubin Encephalopathy

Late Symptoms:

A

Rigid extensional of all extremities
Fever
Opisthotonus
Irritable Cry and Seizures

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13
Q

Mechanism of Physiologic Jaundice (Icterus Neonatorum)

A
  • sterile and less motile newborn bowel is initially less effective in excreting urobilinogen
  • in the newborn intestine, bglucoronidase converts conjugated bilirubin into unconjugated form
  • unconjugated form is reabsorbed by the intestinal mucosa and transported to the liver
  • enterohepatic circulation or enterohepatic shunting
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14
Q

Physiologic Jaundice
Feeding:

A
  • stimulates peristalsis and produces rapid passage of meconium thereby diminishing resorption of unconjugated bilirubin
  • introduces bacteria to aid in the reduction of bilirubin
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15
Q

Normal value of unconjugated bilirubin:

A

0.2-1.4 mg/dl

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16
Q

Direct bilirubin over

A

1.5-2 mg/dl

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17
Q

Physiologic Jaundice

Therapeutic Management

Primagry Goal:

A

prevent Bilirubin Encephalopathy & reverse Hemolytic Process

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18
Q

Physiologic Jaundice
Main Treatment:

A

Phototherapy

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19
Q

used to reduce dangerously high bilirubin levels in hemolyic disease

A

Exchange Transfusion

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20
Q

Pharmacological Management of Physiologic Jaundice

A

Phenobarbital

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21
Q

centered primarily on infant with hemolytic disease

A

Phenobarbital

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22
Q

Phenobarbital is most effective when

A

given to mother several days before delivery

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23
Q

what does Phenobarbital do?

A
  1. Promotes hepatic glucoronyl transferase synthesis
  2. Promotes protein synthesis
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24
Q

exposure of infant’s skin to flourescent light

A

phototherapy

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25
light promotes bilirubin excretion by photoisomerization to transform it into
lumirubin
26
NURSING CARE MANAGEMENT (PHYSIOLOGIC JAUNDICE) ASSESSMENT
- OBSERVE FOR EVIDENCE OF JAUNDICE AT REGULAR INTERVALS - BLOOD SAMPLES FOR MEASUREMENT OF BILIRUBIN - CAREFUL HISTORY TAKING
27
NURSING CARE MANAGEMENT (PHYSIOLOGIC JAUNDICE) IMPLEMENTATION
- EARLY INTRODUCTION OF FEEDINGS - FREQUENT NURSING WITHOUT WATER SUPPLEMENTATION
28
AN ABNORMALLY RAPID RATE OF RBC DESTRUCTION
HEMOLYTIC DISEASE OF THE NEWBORN
29
ANEMIA CAUSED BY THIS DESTRUCTION STIMULATES THE PRODUCTION OF RBCS, WHICH IN TURN PROVIDES INCREASING NUMBERS OF CELLS FOR HEMOLYSIS
HEMOLYTIC DISEASE OF THE NEWBORN
30
Mechanism of Physiologic Jaundice (Icterus Neonatorum) - sterile and less motile newborn bowel is initially less effective in excreting ____________________ - in the newborn intestine, __________________ converts conjugated bilirubin into unconjugated form - unconjugated form is reabsorbed by the _____________________ and transported to the ___________ This mechanism is called? enterohepatic circulation or enterohepatic shuntin
urobilinogen; bglucoronidase; intestinal mucosa; liver enterohepatic circulation or enterohepatic shunting
31
Physiologic Jaundice (Icterus Neonatorum) Feeding - stimulates __________ and produces rapid passage of ___________ thereby diminishing resorption of ___________________ - introduces _______________ to aid in the reduction of bilirubin
peristalsis; meconium; unconjugated bilirubin; bacteria
32
when does jaundice become observable?
Levels > 5 mg/dl
33
Timing of onset of Physiological Jaundice (Icterus Neonatorum)
AFTER 24 hours of birth
34
persistent clinical jaundice over __ weeks in full term, formula fed infant
2
35
Total Serum Bilirubin Thresholds: Term infants (full-term): Jaundice is concerning if total serum bilirubin exceeds
12.9 mg/dl
36
Total Serum Bilirubin Thresholds: Preterm infants: Upper limit is __________ due to immature liver function.
15 mg/dl
37
Total Serum Bilirubin Thresholds: breast-fed infants: A level of ___________ is noted because breastfeeding can increase bilirubin levels slightly due to certain compounds in breast milk.
15 mg/dl
38
major causes of HDN are?
isoimmunization and ABO incompability
39
primary aim of isoimmunization:
prevention
40
postnatal therapy for hemolytic disease of the newborn:
phototherapy exchange transfusion pericardial and pleural fluid aspiration mechanical ventilatory support inotrope therapy
41
Prevention of Isoimmunizaton:
administration of RHIg to all unsensitized RH negative mothers
42
administration of RHIg must be within _____ after first delivery, miscarriage, abortion and repeated after subsequent pregnancies
72 hours
43
administration of RHIg at __________________ further reduces risk
26-28 weeks aog
44
treatment for infants whose mothers are already sensitized
intrauterine transfusion
45
consists of infusing blood into the umbilical vein of the fetus
intrauterine transfusion
46
in exchange transfusion, infant's blood is removed in small amounts (_____________at a time) and it is then replaced with _________________
5-10 ml; compatible blood
47
what does exchange transfusion do/its purposes?
removes the sensitized erythrocytes lowers serum bilirubin level corrects anemia prevents cardiac failure
48
in exchange transfusion, a catheter is inserted into the _______________ and threaded into the _______________
umbilical vein; inferior vena cava
49
a catheter is inserted into the umbilical vein and threaded into the inferior vena cava
exchange transfusion
50
in exchange transfusion, depending on the infant's weight, _____________ of blood is withdrawn within _____________and the same volume of donor blood is infused until targeted volume is reached
5-10 ml ; 15-20 seconds
51
in exchange transfusion, __________________ may be given after infusion for citrated donor blood
calcium gluconate
52
for ABO incompability, treatment is
early detection and implementation of phototherapy
53
____________________________ are used in combination with phototherapy
intravenous immunoglobulin transfusions
54
exchange transfusion is required only when
phototherapy fails to decrease bilirubin concentration
55
present when nb's blood glucose concentration is lower than the body's requirement for cellular energy and metabolism
hypoglycemia
56
in a newborn, hypoglycemia is defined as a serum glucose level of ______________________________
less than 45 mg/dl
57
TYPES OF NEONATAL HYPOGLYCEMIA
EARLY TRANSITIONAL NEONATAL CLASSIC TRANSIENT NEONATAL SECONDARY ASSOCIATED RECURRENT, SEVERE
58
LGA or normal size infants who suffer from transient hyperinsulinism
Early Transitional Neonatal
59
infants who suffered intrauterine malnutrition that depleted glycogen and fat stores (sga, preterm, polycythemic infants)
Classic Transient Neonatal
60
response to perinatal stress that increase the infant's metabolic needs relative to glycogen stores
Secondary Associated
61
caused by enzymatic or metabolic endocrine defect such as congenital hyperinsulinism, hypopituitarism, hypothyroidism
Recurrent, Severe
62
Clinical Manifestations for Hypoglycemia Cerebral Signs
jitteriness, tremors, twitching, weak or hig-pitched cry, lethargy, hypotonia, limpness, seizures and coma
63
Clinical Manifestations for Hypoglycemia Other Clinical Manifestations
cynosis, apnea, rapid and irregular respirations, sweating, eye rolling, refusal to feed
64
hyperglycemia is blood glucose concentration greater than ________________ (full term infant) or greater than ____________ (preterm infant)
125 mg/dl; 150 mg/dl
65
hyperglycemia is treated by?
reducing the infant's glucose intake
66
untreated hyperglycemia may reduce in?
osmotic diuresis with subsequent fluid volume loss and dehydration
67
VITAMIN K DEFICIENCY BLEEDING
HEMORRHAGIC DISEASE OF THE NEWBORN
68
HEMORRHAGIC DISEASE OF THE NEWBORN IS CLASSIFIED ACCORDING TO APPEARANCE
EARLY CLASSIC LATE ONSET
69
newborn's vitamin k stores are absent and prothrombin activity is moderately deficient
HEMORRHAGIC DISEASE OF THE NEWBORN
70
vitamin k dependent coagulation factors (ii, vii, ix,x)are significantly reduced
HEMORRHAGIC DISEASE OF THE NEWBORN
71
newborn's sterile intestinal tract is unable to synthesize the vitamin until feeding is initiated
HEMORRHAGIC DISEASE OF THE NEWBORN
72
signs and symptoms of hemorrhagic disease of the newborn
blood oozing from umbilicus or circumcision site bloody or black stools hematuria ecchymoses on skin & scalp epistaxis bleeding from punctures
73
classic hemorrhagic disease usually occurs _________ after birth
1-7 days
74
late onset hemorrhagic disease usually occurs
2-12 weeks of age
75

NCMN 109A - Pedia Lecture (16 decks)

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