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NURP 1 FINAL > WEEK 11 Lecture > Flashcards

WEEK 11 Lecture Flashcards

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1
Q

When do you give “eye prophylaxis” and what is it?

A

Give 1 hr after delivery
prevents Chlamydia and Gonorrhea

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2
Q

What medication do you give for eyes?

A

0.5% erythromycin ophthalmic
1% tetracycline

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3
Q

When do you give “thighs” prophylaxis and what is it?

A

1-6hrs after delivery
prevents brain bleed or intestine bleed
ALL newborns have low vit K levels at birth

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4
Q

What medication do you give for thighs?

A

IM injection of VIT K
VIT K does NOT cross the placenta and is NOT available in breastmilk

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5
Q

Gonorrhea occurs how soon after delivery?

A

first 5 days
significant inflammation
corneal involvement
lead to blindness from rupture

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6
Q

Chlamydia occurs how soon after delivery?

A

5 day - 5 weeks
neonatal conjunctivitis has little sx except drainage
* can lead to pneumonia* cough, fever, tachypnea

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7
Q

HEP B

A

first 24hrs of life
*if mom has hep b the newborn has a 90% chance of getting HEP B

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8
Q

Mom HEP B -

A

Hep B vax within 24hrs UNLESS the newborn is <2,000 grams aka 4lbs 4 oz
if <2000 grams, administer at 1 month or until above that weight

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9
Q

Mom HEP B +

A

Hep B vaccine and immunoglobulin

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10
Q

Metabolic Disorder Screening

A

35 core screenings
26 secondary screenings
MANDATORY universal screening for rare disorders

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11
Q

How do you perform the metabolic disorder screeening?

A

heel prick 24-48hrs of live

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12
Q

Screening techniques

A

Wipe away the first drop of blood! Circles on the card need to be filled COMPLETELY.
Air dry the card for 4 hrs and 1-2 weeks for results to come back

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13
Q

Factors that affect screening

A

before 24hrs
abx
transfusion
not eating enough
non-adequate sample

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14
Q

Which 2 screening results require immediate treatment?

A

Galactosemia
Maple Syrup Urine Disease
every other result needs to be re-confirmed

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15
Q

Galactosemia

A

rare autosomal recessive disorder
cannot metabolize

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16
Q

Maple Syrup Urine

A

rare inherited metabolic disorder autorecessive
cannot metabolize amino acids

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17
Q

Glucose screening: what newborns are at risk? MATERNAL FACTORS

A

Born to mothers who were diabetic or have GD
Preeclampsia/HTN
substances (tocolytics)
received glucose

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18
Q

Which newborns are at risK? NEWBORN FACTORS

A

pre-mature (esp late preterm 34-37
LGA/SGA
HIE or injury at birth
sepsis
congenital heart defect
metabolic disorders

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19
Q

S/s of hypoglycemia

A

irritability
LOC changes
tremors
lethargy
high pitched cries
respiratory distress
feeding difficulty
hypotonia
seizures

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20
Q

Do you test all babies for glucose screen?

A

NO glucose is 70% of the maternal value
low as 25

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21
Q

RF or signs of glucose issues (symptomatic)

A

screening is required!

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22
Q

Symptomatic and BS <40

A

give IV glucose

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23
Q

Asymptomatic birth-4hrs

A

early and frequent feedings
feed within 1 hr
screen 30 min later

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24
Q

Asymptomatic birth 4-24hrs

A

feeds every 2-3 hrs and screen prior to each feed

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25
target glucose screen
>45 or higher before feeds
26
Jaundice screen
ALL newborns university screened *if they are d/c prior to 72 hrs follow up with PCP 1-2 days
27
Further down the body the higher the level of bilirubin? T/F?
TRUE. starts at head to toes, more it spreads the more there is
28
what causes jaundice?
insufficient oral intake tongue tied mom's milk has not come in yet fam hx "did a sibling have hyperbilirubinemia?"
29
Hearing screening
hearing loss is the most common disorder at birth *newborn must be sleeping
30
2 test of hearing screening?
Otoacustic emission test and Automated Auditory Brainstem Response
31
Otoacoustic emission teset
measuring sound waves produced in the inner ear, clicking sounds
32
Automated Auditory Brainstem
electrodes on head measures brains response to sound
33
Why do newborns sometimes lack hearing if they are delierved via C-section?
do not pass the hearing screen bc they don't have pressure from being squeezed out of the vaginal canal
34
what if they don't pass and are being d/c'd?
re-screened at 3 MONTHS goal is to prevent speech/language delays
35
Congenital Heart Disease Screening
When the umbilical chord is clamped, the arteries and veins constrict and systemic vascular resistance is greater than pulmonary vascular resistance
36
closure of 3 main fetal shunts
ductus venosus foreman ovale ductus arteriosus
37
Screening for Congenital Heart Disease
at least 24hrs after delivery done by pulse OX RIGHT HAND EITHER FOOT R/L
38
Pulse oxygen screening
both >95% difference between hand and foot <3% test both at the same time *MUST BE >24hr after delivery!!!!!!!!!
39
Caregivers for newborns?
influenza and TDAP vaccines need to be up-to-date
40
can feedings go in the microwave? formula/breastmilks?
NO
41
NO BM for 7-10 days?
normal
42
Normal bowel and bladder?
43
sleeping position?
back to sleep
44
safety?
pre-mature infants car seat fit test
45
Newborn d/c criteria
stable VS -axillary 97.7-99.0 RR <60 HR 80-180 bmp no signs of respiratory distress fed 2x voided, urine/stool 1x screening completed parent education
46
first pre-natal visit fam gentics
3 generations! family genetics (first relatives) parents, children, siblings 2nd degree grandparents, uncles/aunts, half-siblings neices/nephews/ great-grandparents 3rd cousins/ great grand hemochromatosis, mental health, heart disease, cancers, stroke autosomal recessive disorders: both parents 3 copies aneuploidy
47
Autosomal recessive disorders (both parents)
cystic fibrosis beta sickle Tay-Sachs disease
48
Aneuploidy
downs syndrome trisomy 12/18
49
X
hemophilia A and B recessive Huntington dominant Neurofibromatosis dominant
50
APGAR scores
transition from intra-extra uterine life indicates cardiac and respiratory tested at 1 min and 5 min
51
APGAR 1-5
A appearance P pulse G grimace A activity R respirations
52
1 min
how well baby tolerated birthing
53
5min
information on neonatal transition
54
7-10
normal
55
<7
REPEAT* 5min intervals for the next 20 min
56
does it indicate a need for recessive measures?
no quantifies response to environment
57
how many arteries/veins?
Arteries 2 Veins 1
58
single artery
twins >40 female newborn caucasian mom *mostly not a big dealio*
59
VACTREL
25% of 1 artery can cause disorders: vertebral anomalies anal atresia cardiovascular anomalies tracheal-esophageal fistula esophageal atresia rental/radial anomalies limb defects
60
2 vessels
draw labs chromosomal analysis
61
FLACC scale
pain face, legs, activity, cry, consolibility *ideally want a 0*
62
rectal temp?
never per text book axillary instead
63
Auscultation
80-180 bmp = normal Listen at PMI
64
BPs in newborns?
not usually routinely if cardiac issues, do the BPs
65
Normal RR
30-60
66
WHO
WHO growth standards healthy infants in optimal conditions *use until age 2*
67
CDC
growth reference certain kids at a particular time *2-18 years old*
68
Head circumference
12-15 inches
69
When do you age correct up until?
age correct until TWO
70
Length
18-22 inches
71
Weight
average full-term 5lbs 8oz to 8lbs 13oz
71
Cardiac
5 different areas in chest s1/s2 s3/4 murmurs heaves /thrills perfusion
71
Acrocyanosis
blue-ish discoloration after birth in hands and feet normal in first 48hrs >48hrs due to COLD STRESS not cardiac
72
Still's
most common innocent murmur vibratory and musical heard in the L sternal border, supine position
72
unequal pulses
coarctation of aorta
72
Innocent murmers
>90% of murmurs are benign
73
Red flags
holosystolic, diastolic, grade 3 or higher, harsh *refer to cardiology
73
PDA
machine-like continuous upper left SB 4th intercostal space
74
Bad murmurs?
GRADE 3 OR HIGHER URGENT REFERRAL thrill at least a 4
75
VSD
harsh, holostysolic Left lower sternal border thrill so 4/6
76
ASD
grade 2/3 systolic ejection murmur upper left sternal border split s2
77
Respiratory
depth and regularity crackles in lungs within first few hrs (amniotic fluid)
78
inspiratory to expiratory
1:1 count for 1 FULL MIN
79
respiratory distress
retractions, accessory muscles grunting or noisy breathing
80
Skin
port-wine stain normal
81
Hemangioma
incorrectly formed blood vessels that multiply more than they should increases in size first few months decreases slow disappears before 10 yrs old *if near eye *refer*
82
cafe-au-lai
irregular shape light brown *****6 more more >1cm: further workup for neurofibromatosis (tumors on the nerve tissue)
83
Erythema toxicum
rash that occurs yellow/white papules on erythematous base 1-3mm diameter NO treatment
84
Milia
exposed sebacous glands disappear within 1 months
85
Mongolian spots/slate blue patches
lower back shoulder/hips/legs *document location/size each time confused with bruises
86
petechiae
normal on presenting parts (on head/butt) if elsewhere-sx f or infection or growing = concerning for infection resolves within 24-48hrs of birth does not grow
87
vesicular rash
herpes/varicella IV of acyclovir ASAP. no waiting for culture
88
Head
anterior and posterior fontanells 3rd fontanelle (located along saggital suture) can either be a normal variant or infection or trisomy 21
89
Palpating the head
palpate all 5 suture lines for firmness and mobility open or overlap d/t molding of the head in labor and birth within 48hrs overlapping and molding should resolve
90
Microcephaly
CNS malformation, infection, genetic syndrome
91
Macrocephaly
CNS disorder (brain tumor, hydrocephalus, hereditary)
92
Caput Succedaneum
scalp edema not limited by suture lines (crosses) usually pitting resolves in 48hrs
93
Cephalohematoma
collection of blood caused by pressure during birth, labor, delivery w suction can WORSEN before it gets better does NOT cross suture lines 4-8wks resolves but can be up to 4 months
94
Eyes
size, shape, and placement on the face sclera blue/gray brown in infants with
95
permanent eye color
3-6 months of age
96
Red Reflex
intact lens/retina one pupil with red reflex and one gray/dull white (leucorrhea) congenital infection/retinoblastoma and REFER Hazy-glaucoma
97
Normal eyes
strabismus subconjunctival/scleara hemorrhages tearless crying
98
ears
firm, flexible, good recoil inner canthus to the outer canthus to the ocipt - pinna touches the line
99
Ear pit/tag
100
Epstein pearls
normal, contain keratin
101
Natal teeth
early teeth eruptions, need to be removed
102
Neck
freely mobile NO WEBBING
103
Torticolis
stiff neck *most common anomaly* ask parents "do they favor one side" can cause plagiocephaly or ear misalignment
104
Nose or mouth breathers?
obligatory nose breathers
105
Abdomen
round/dull bowel sounds present by 2hrs of age palpate soft liver can be palp at 1-2 cm R costal margin tip of spleen L side 2-3cm L costal margin
106
Chord
loosens in 4-5 days falls off in 10 days (2 weeks) Do not need to clean it
107
Diastasis recti
1cm gap, budges when cries, resolves in the first few weeks normal
108
Hypospadias
urethral opening at the underneath cannot be circumcised use the skin to correct at 6 months-1 yr
109
Epispadias
located at the top
110
Hydrocele
fluid into inguinal canal transilluminates and self-resolves/spontaneously in 1-2 yrs
111
Inguinal hernia
want to make sure it is reducible *refer for correction
112
Cryptorchidism
non-descended testicles associated with an increased risk of testicular cancer and reduced fertility *descended by 6 months or refer orchiopexy (surgery) if not distended by 1 year
113
discharge from female newborn
blood first 3-4days, white discharge is normal withdrawal of hormones
114
Vag skin tag
normal, visible hymenal ring
115
term infants/pre term infants
prominent labia majora preterm infants prominent labia minor and clitoris
116
ambiguous genitalia
chromosomal analysis
117
alignment of spine
straight/Flexible vertebrae palpate each one Dimple tufts of hair
118
Barlow and Ortalani
Dislocate and re-locate with Ortalani *assess for hip dysplasia symmetry of gluteal skin folds
119
Neuro
watching the newborn cry, suck, rooting, response to the environment
120
CN V11
facial symmetry crying
121
CN IX (9) and X (10)
quality strength of cry
122
CN V (5), VII (7), IX, X
feed, suck, swallow
123
CN III, IV, VI
Eye movements vestibulo-ocular reflex (doll's eye)
124
CN II
optic blink reflects, in response to bright light
125
CN I
under nose alc pad
126
CN V
glabela tap between eyes symmetrical blink NOT unilateral
127
CN VIII
clap and the infant will blink if hearing is intact acoustic blink reflex
128
moro
6-8 months
129
sucking
2-3 months
130
rooting
by 4 months
131
planter grasp
8-10 months
132
palmer grasp
5-6 months
133
no reflex or continues past the age
issues with the CNS
134
tonic neck
by 6 months
135
grasping
5-6 months
136
truncal incurvation/galant
6 months
137
babinski
normal up until 2 years, usually will diminish at 1 yr big toe goes up. hyperextending of big toe

NURP 1 FINAL (2 decks)

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