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Women's Health > 09/09/2015 Lecture > Flashcards

09/09/2015 Lecture Flashcards

1
Q

What factos affect fetal growth?

A

1) maternal nutrition
2) genetics
3) placental function
4) environment

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2
Q

What are the different terms for birthweight variations?

A

1) AGA (appropriate) about 80%
2) SGA (small)
3) LGA (large)

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3
Q

What are the premature birthrrates?

A

1) LBW
2) VLBW
3) ELBW

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4
Q

What is an early and late insult?

A

Earl: less than 28 weeks, leads to overall growth restriction and never catch up, always smaller

Late insult: greater than 28 weeks, lag for a little bit but then catch up usually

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5
Q

what is IUGR? asymmetric vs symmetric?

A

intra-uterine growth retardation

asymmetric: head and long bones are growing normally/better compared to their abdomen and internal organs
symmetric: everything growing with a poor rate

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6
Q

Look up Placenta Previa

A

has something to do with placenta not rising/growing with uterus or something, causes SGA

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7
Q

Characteristics of SGA newborns

A

1) head disproportionately large
2) wasted appearance of extremities
3) low subq fat
4) scaphoid abdomen (sunken appeareance)
5) wide skull sutures
6) thin umbilical cord

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8
Q

If a baby has yellowy colored staining, what is it? is this a common problem with SGA newborns?

A
  • meconium staining of vernix, yes
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9
Q

Problems of SGAs

A

1) perinatal asphyxia (can cause meconium staining)
2) thermoreg difficulty
3) hypoglycemia
4) polycythemia (hypercoag problems)
5) meconium aspiration
6) hyperbilirubinemia
7) birth trauma

  • remember polycethemia = lots of RBCs and trauma releases heme group causing hyperbilirubinemia, opposite of hyper is hypo + glycemia (good way to remember a lot of this stuff)
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10
Q

Nursing Management of SGAs

A

1) measurements
2) BG/vitals monitoring
3) early feedings; IV dextrose 10%
4) monitor for s/s of polycthemia
5) MONITOR FOR TACHYPNEA

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11
Q

what should you always monitor for in newborns?

A

Tachypnea

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12
Q

If SGA baby is having problems coordinating sucking, breathing, swallowing, what should you need to administer?

A

IV dextrose 10% infusion

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13
Q

Do most SGA newborns experience IUGR?

A

no, some do but not all

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14
Q

What are the risk factors for LGAs?

A

1) maternal DM or glucose intolerance
2) prior history of a macrosomic infant
3) multiparity: as mom has more and more pregnancies, babies tend to get larger
4) post-dates gestation
5) maternal obesity
6) male fetus
7) genetics

so if mom’s obese with DM having a late-term male

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15
Q

Characteristics of LGAs?

A

1) large body, plump, full faced
2) proportional increase in body size
3) poor motor skills
4) difficulty regulating behavioral states

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16
Q

with an LGA, what should we check right away?

A

blood sugars, monitor for hypoglycemia (extra, another one::: look at Hct b/c of polycthemia)

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17
Q

Common Problems of LGAs?

A

1) Birth trauma: will have fractured clavicles on the baby
2) Hypoglycemia
3) Polycethemia (hydration, Hct)
4) Hyperbilirubinemia (phototherapy)

  • just remember that hypoglyc,polyceth,and hyperbili go together
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18
Q

What are the signs of hypoglycemia in babies?

A
  • jittering (later: seizures)
  • poor at feedings
  • irritable
  • cold
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19
Q

when do we test BS of LGA?

A

30 min after delivery and then q1h

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20
Q

What are gestational ages for Preterm, early term, term, lat term

A 
wrong in slide
Term: 38-41 weeks (specific 38 week- 41, 6 days then starts late term)
Early Term: 37-37, 6 days
Preterm: before 36weeks and 6 days
Late: 41 6days-42 week 6 days

(look this slide up)

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21
Q

After 42 weeks, what physiological deficiency occurs?

A

inability of placenta to provide adequate o2 and nutrients

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22
Q

postterm babies will look how?

A
  • dry,c rack, wrinkled skin (possibly meconium stained)
  • long-thin extremities, long naies
  • creases cover entires soles of feet
  • wide-eyed, aler
  • abundant hair on scalp
  • thin umbilical cord
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23
Q

Postterm newborn common problems

A
  • perinatal asphyxia
  • hypoglycemia
  • polycythemia
  • hypothermia
  • meconium aspiration
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24
Q

What can lead to preterm birth?

A

1) infections/inflammation in mom: can even be things like gingavitis or a lot of times UTI
2) maternal or fetal distress
3) bleeding (ex placenta previa)
4) stretching (ex: extra amniotic fluid or triplets)

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25
Q

So a preterm newborn is born before when?

A

born before end of 37th weeks

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26
Q

What is the second cause of infant deaths?

A

preterm birth (look up)

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27
Q

Preterm characteristics

A

1) weight less than 5.5lbs
2) plentiful lanugo
3) lack of plantar creases
4) poorly formed ear pinna
5) fused eyelids

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28
Q

What is the last system to develop?

A

respiratory

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29
Q

surfactant deficiency leads to ____

A

respiratory distress synbdrome

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30
Q

unstable chest wall leads to __________

A

atelectasis

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31
Q

immature respiratory control center leads to _______

A

apnea

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32
Q

smaller respiratory passageways leads to ___________

A

respiratory obstruction

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33
Q

there may be increased BP in a premie, what complication can occur?

A

intracranial hemmorhage

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34
Q

preniatal hypoxia in a premie can cause what?

A

oxygen shunting to heart and brain resulting in GI ischemia damage

35
Q

lots of premies have infection and what do we treat with? what can be a complication with a premia?

A

1) gentomyacin/IV antibiotics

- impaired renal function increases risk of drug toxicity

36
Q

When does IgG transplacental tansfaer mostly occur for fetus? what does this mean if born before?

A

after 34 weeks, weakened immune system

37
Q

When a newborn fails to establish adequate resp after birth, what is this called? What does this chain effects

A

asphyxia -> hypoxia -> acidosis/hypercarbia -> inhibition of the transition to extrauterine circulation -> cyanosis -> hypotonic and unresponsive

38
Q

We give resusitation to babies with an Apgar score of what?

A

less than 7

39
Q

What do we do to minimize oxygen consumption in premies?

A

1) maintain neutral thermal environment

2) decrease stimulation: turn lights down, swaddle, limit visitors, cluster care

40
Q

If we need to resusciatte what are the 4 things we might do?

A

1) stabilization
2) ventilation
3) Chest compression
4) admin of epi and or volume expansion

41
Q

We continue to resuscitate until what happens?

A

HR is greater than 100bpm, vigorous cry, pink tongue

42
Q

If depression of airway is due to narcotics what do we giv (what if metabolic acidosis?)

A

narcotics - give naloxone (Narcan)

- if metab acidosis: give sodium bicarbonate

43
Q

to increase HR in baby, what should w administer?

A

-admin epi (Adrenalin) via ET tube and repeat

44
Q

look up ABCDs of Newborn Resuscitation

A

…..

45
Q

When administer oxygen to premies, to what factors do we need to adjust the levels we admin>

A

1) condition
2) gestational age
3) postnatal age of newborn

46
Q

What can too much o2 admin cause in a premie?

A

Retinopathy of Prematurity

47
Q

for short-term resp distress or cyanosis what should we treat baby with?

A

oxygen hood or blow-by oxygen, o2 should always be humidified

48
Q

What is used to prevent alveoli collapse in babies?

A

CPAP

49
Q

If NG tube is bloody what could be happening?

A

necrotizing bowel

50
Q

Do we need to do daily weights on a premie?

A

yes and plot on growth curve chart

51
Q

What is the most common cause of morbidity and mortality in NICU population? what factors contribute?

A

INFECTION!

  • lack of antibodies from breast milk and transplacenta
52
Q

Infectio PRevention in NICU

A
  • remove jewelry and srub prior to entering NICU
  • wash hands between babies
  • no ill persons
  • avoid tape on newborns
  • monitor for s/s
53
Q

what are the s/s of infection in newborn?

A
  • elevated temp, cool extremities
  • tachycardia
  • TACHYPNEA
  • pallor
  • jaundice
  • poor feeding
  • hypotonia
  • hypoglycemia
54
Q

What are some sensory interventions that encourage normal development?

A
  • kangaroo care
  • rocking
  • singing/music
  • gentle massage/touch
  • waterbed mattress (like feeling of in-utero)
  • non-nutritive sucking

(remember to reduce stimulation)

55
Q

Should pain in newborn be considered same sort of things as those that cause pain in the adult?

A

yes!

56
Q

non-pharm methods for pain management? pharm?

A
  • swaddling
  • sucrose and non-nutritive sucking
  • kangaroo care
  • gentle massage

pharm
- morphine, fentanyl, acetaminophin, ECLA

57
Q

What’s the tool used to assess newborn pain?

A

NIPS: Neonatal Infant Pain Scale

58
Q

What sort of position do we want to put a baby in when possible?

A

flexed positioning (simulates in utero position)

59
Q

Acquired vs Congenital Disorders?

A
  • occur at or soon after birth are acquired

- congenital are present at birth (usually inheritance, genetic factors)

60
Q

when baby still has fluid in lungs what occurs? what majorly assists with removal of fluid?

A

transient tachypnea, usually resulves by 72 hours of age
- passage through vaginal canal removes a lot of the fluid (so look out with a C-section)

(look up s/s of transient tachypenia)

61
Q

What is respiratory distress syndrome?

A

breathing disorder resulting from lung immaturity and lack of alveolar surfactant; have “stiff lungs”

62
Q

what does x-ray of RDS baby look like? s/s?

A
  • looks like ground glass
  • HR >150 to 180,
  • tachypnea (rates over 60)
  • crackles
  • Silverman index score > 7
63
Q

what tool is used to assess RDS?

A

Silverman Index

64
Q

What is MAS?

A

Meconium aspiration syndrome
- meconium released into amniotic fluid and then aspirated, can block resp passageways -> causes overexpansion of lung and then eventual rupture then collapse

65
Q

What are some treatments for MAS?

A

1) antibiotics
2) chest physiotherapy
3) mechanical ventilation

66
Q

what is PPHTN? what does it cause

A

persistent pulmonary HTN

- R-L extrapulmonary shunting of blood which leads to hypoxia

67
Q

S/s of PPHTN

A
  • tachypnea w/in 12 hours after birth
  • marked cyanosis, grunting, retrations
  • systolic ejection murmur
  • ECG shows R->L shunting of blood
68
Q

what is BD?

A

bronchopulmonary dysplasia

- a chronic lung disease in newborns who have lung injur, , need continued o2 after initial 28 days of life

69
Q

what’s treatment of BD?

A

-admin of steroids in mother (antepartal period)

70
Q

do males or females have BD more?

A

males

71
Q

What is ROP

A

Retinopathy of PRematurity
- developmental abnormality affecting immature blood vessels of the retina
( five stage from mild to severe)
0 usually develops in both eyes due to hyperoxemia, acidosis or shock

– look up on slides

72
Q

ok having trouble concentrating….notes might end soon

A

………..

73
Q

PVH/IVH is most common in what infants? when does it usually occur?

A

it is bleeding in brain due to fragility of cerebral vessels, most commin in infants born under 30 weeks, within first 72 hours after birth

-grades I-v

74
Q

What’s nursing assessment of PVH/IVH

A

look up

75
Q

What is necrotizing enterocolitis? 3 patho mechanisms that can lead to NEC?

A
  • occurs typically in babies that are formula-fed, serious GI disease marked by distended abdomen, have air in bowel walls

3

1) Bowel Ischemia
2) Bacterial Flora (from formula)
3) Effect of feeding

76
Q

what’s the most common anomaly in an infant born to a diabetic mother?

A

cardiovascular anomalies

77
Q

be familiar with substance abuse of 3 susbstance that are asterisked in slides

A

………..

78
Q

What are the three specific findings associated with FAS

A

Fetal Alcohol Syndrome

1) Growth restriction
2) Craniofacial structural (wide set eyes, epicanthal folds, thin upper lip, flatter face
3) CNS dysfunction

  • lots of times on a spectrum so fetal alcohol syndrome are at the severe end of the fetal alcohol spectrum disorder
79
Q

UUUUUGGGHHH

A

gggggghhh

80
Q

How do we monitor bilirubin levels?

A

Can rise 5 mg/dL/day up to 15, then we treat
so 1st day: 5 and less is ok
2nd day: 10 and less is ok
3rd: less than 15 is ok but greater than or equal to we treat (but on slide says something about 17 mg/dL)

81
Q

what is conicterus (sp?)?

A

result from Rh incompatbility

82
Q

where do you want to take the measurement with the bilirubinmeter?

A

on forehead b/c jaundice moves from forehead to toe

83
Q

horizontal vs vertical transmission of infections in infants

A

vertical: from one generation to another (mom gives baby something say via breastmilk or during birth)
horizontal: from one person to another (usually through contact with body fluids)

84
Q

What are primary organisms causing infection in infants?

A

GBS, E. Coli, Staphylococcus

Women's Health (9 decks)

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