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Clinical - Winter > 16 - Infant & Prenatal Care > Flashcards

16 - Infant & Prenatal Care Flashcards

1
Q

What are common cardiovascular changes in pregnancy?

A
  • Increased blood volume
  • Vascular distention
  • Blood vessel proliferation
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2
Q

What is a common hemodynamic change in pregnancy?

A

Increased clotting factors

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3
Q

What are common immunologic changes in pregnancy?

A
  • Altered immune response

- Decreased cell-mediated immunity (increased risk of infection for fetus and mother)

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4
Q

What are some nutritional requirements during pregnancy?

A
  • Limit caffeine intake to under 300 mg/day
  • No alcohol
  • Eat foods high in calcium, heme iron and folic acid
  • Eat foods w/ iodine
  • Eat non-heme iron sources w/ vitamin C-containing foods
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5
Q

Which women are at high risk of their fetus having neural tube defects? What is the recommended folic acid supplementation pre and post-conception?

A
  • Those who had a previous pregnancy or personal history of neural tube defects
  • Preconception = 4-5 mg at least 3 months before until 12 weeks pregnant
  • Postconception = 0.4-1 mg from 12 weeks gestation until 4-6 weeks postpartum or as long as breastfeeding
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6
Q

Which women are at medium risk of their fetus having neural tube defects?

A
  • Taking folate inhibiting medications (anticonvulsants, metformin, sulfasalazine, triamterene, trimethoprim)
  • 1st or 2nd degree relative or partner w/ history of NTD
  • GI malabsorptive conditions (celiac, IBD, gastric bypass)
  • Advanced kidney disease
  • Prior pregnancy w/ folate sensitive congenital abnormality
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7
Q

What is the recommended folic acid supplementation pre and post-conception for women at medium risk of having a fetus w/ neural tube defects?

A
  • Preconception = 1 mg at least 3 months before until 12 weeks gestation
  • Postconception = 0.4-1 mg from 12 weeks gestation until 4-6 weeks postpartum or as long as breastfeeding
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8
Q

What is the recommended folic acid supplementation pre and post-conception for women at low risk of having a fetus w/ neural tube defects?

A
  • Preconception = 0.4 mg 2-3 months before

- Postconception = 0.4 mg continued until 4-6 weeks postpartum or as long as breastfeeding

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9
Q

Which foods can carry listeria? What is a recommendation for a pregnant woman to prevent listeria?

A
  • Unpasteurized milk, soft-ripened cheeses, deli met

- Avoid these foods; reheat until steaming hot; wash raw fruit and veggies well

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10
Q

Which foods can carry salmonella? What is a recommendation for a pregnant woman to prevent salmonella?

A
  • Raw seafood and raw eggs

- Avoid raw or soft-cooked eggs

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11
Q

Is sushi safe during pregnancy?

A

Only if the raw meat has been kept at the proper temp (freezer) for the proper amount of time

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12
Q

Which foods contain methylmercury? What is the recommendation for methylmercury consumption during pregnancy?

A
  • Fish (shark, swordfish, mackerel, albacore tuna)

- Can have a max. of 2 servings of fish/week

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13
Q

Where is toxoplasma found? What is the recommendation during pregnancy?

A
  • Parasite in raw meat, soil and dirty cat litter

- Wear gloves if gardening, cook meat thoroughly, and avoid changing a cats litter box

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14
Q

Travel is safe up to ___ weeks before expected due date

A

4

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15
Q

What are some things to consider before travelling while pregnant?

A
  • Increased risk of VT
  • Comorbid conditions (respiratory and cardiac disease, pregnancy complications)
  • Air line policies
  • Medical resources and insurance at destination
  • Exposure to infectious diseases at destination
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16
Q

What is the recommendation for hot tub and sauna use during pregnancy?

A

Avoid in first trimester (associated w/ NTDs and miscarriage)

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17
Q

What is the recommendation for hair treatments during pregnancy?

A
  • Very limited systemic absorption, so unlikely to reach fetus
  • Avoid if burns or open wounds present
  • If pregnant woman is a hairdresser - wear gloves and ensure adequate ventilation in workplace
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18
Q

What are common prenatal discomforts?

A
  • N/V, heartburn, constipation, hemorrhoids
  • Leukorrhea (white-yellow mucous vaginal discharge)
  • Gingivitis
  • Edema
  • Varicose veins
  • Cutaneous changes (spider angioma’s, melasma)
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19
Q

What must you advise the px to do when you recommend a tx for a prenatal discomfort?

A

Must inform her to inform her prenatal provider at the next visit

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20
Q

What is normal vaginal discharge during pregnancy?

A

Thin, white, milky, mild smelling or odourless

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21
Q

What are symptoms of pregnancy gingivitis?

A

Increased redness and bleeding of gums

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22
Q

What causes physiological edema during pregnancy?

A
  • Hormone-induced Na retention (increased plasma volume)

- Uterine compression of inferior vena cava

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23
Q

What are some differential diagnoses to consider when a pregnant woman is experiencing physiological edema?

A
  • Pre-eclampsia
  • DVT
  • Cellulitis
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24
Q

What are sx of physiological edema?

A
  • Bilateral

- Lessens w/ elevation

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25
Q

What sx can edema and varicose veins cause?

A
  • Numbness
  • Mild pain
  • Aching or “heavy feeling”
  • Itching
  • Throbbing
  • Irritation around vein
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26
Q

What causes varicose veins?

A
  • Hormone-induced Na retention (increased plasma volume)
  • Uterine compression of inferior vena cava
  • Progesterone relaxes blood vessels
  • Blood vessel valve weakens and blood stagnates in vein, causing distension
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27
Q

What are some non-pharms for edema and varicose veins?

A
  • Compression stockings
  • Sleep on left side
  • Maintain adequate fluid intake
  • Avoid prolonged standing
  • Rest w/ legs elevated
  • Don’t cross legs when sitting
  • Maintain physical activity
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28
Q

What is melasma/chloasma? What causes it?

A
  • Dark skin discolouration on sun exposed areas

- Due to excess melanin in skin

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29
Q

What are spider angiomas? When do they normally occur? Where are they most common on the body?

A
  • Central red puncti w/ radiating braches
  • Usually appear in 2nd to 5th month of pregnancy
  • Most common around eyes and areas drained by SVC (neck, face, upper chest, arms, hands)
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30
Q

What are striae gravidarum?

A

Stretch marks

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31
Q

What are risk factors for stretch marks?

A
  • Degree of abdominal distension
  • Maternal weight gain
  • Genetic predisposition
  • Younger maternal age
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32
Q

What is the tx for melasma?

A
  • Prevention is key (broad spectrum sunscreen)
  • Pharm options = hydroquinolone, azelaic acid, tretinoin
  • Other = chemical peels, laser treatment, microdermabrasion
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33
Q

What is the tx for angiomas?

A

Tx not required b/c most resolve in 3 months

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34
Q

What is the tx for striae gravidarum?

A
  • Common agents for prevention = cocoa butter, hyaluronic acid, vitamin E
  • No evidence supporting use of topical preparations in prevention
  • Possible tx options = tretinoin cream, laser therapy
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35
Q

What are some prenatal signs of potential complications?

A
  • Severe vomiting
  • Signs of infection (fever, diarrhea, pain on urination)
  • Abdominal cramping
  • Vaginal bleeding
  • Sudden loss or continued leakage of fluid from vagina
  • Decreased fetal activity
  • Signs of preterm labour (dull backache, increased uterine activity; menstrual-like cramps; diarrhea, spotting or bleeding)
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36
Q

What is the most common cause of premature discontinuation of breastfeeding?

A

Breast and nipple pain

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37
Q

What are common causes of breast and nipple pain?

A
  • Engorgement and plugged ducts
  • Nipple trauma/injury
  • Breast/nipple infections
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38
Q

What is the main difference between engorgement and plugged ducts?

A
  • Engorgement = bilateral; plugged duct = unilateral

- Pain in generalized in engorgement and localized in plugged duct

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39
Q

What is the main difference between mastitis and engorgement/plugged duct?

A
  • Mastitis = sudden onset, localized intense pain, red/hot/swollen, flu-like symptoms
  • Engorgement/plugged duct = gradual onset, mild pain, no fever or systemic sx
40
Q

What is the recommended tx for engorgement and plugged ducts?

A
  • Optimize feeding technique and encourage frequent feeding
  • Avoid tight or restrictive clothes
  • Warm compresses may facilitate milk removal
  • Cool compresses between feeding to decrease swelling (ice 15 min on and 45 min off)
  • Analgesics (acetaminophen, ibuprofen)
  • For plugged ducts, massage breast from affected area toward nipple
41
Q

What are risk factors for mastitis?

A
  • Previous mastitis
  • Engorgement
  • Poor milk drainage
  • Nipple damage
42
Q

What is the tx for mastitis?

A
  • Supportive measures as for engorgement
  • Antibiotics if fever is present or if sx don’t improve w/in 12-24 h w/ supportive measures
  • Tx duration = 10-14 days; sx should improve w/in 48-72 h of initiating antibiotics
43
Q

What are signs and symptoms of normal nipple pain?

A
  • Pain subsides w/in 30-60 seconds of initiation of feeding
  • Often peaks around 3-6 days postpartum
  • Usually resolves in about 1 week
44
Q

What are signs and sx of nipple trauma?

A
  • Pain persists or increases throughout feeding
  • Lasts over 1 week
  • Cracks, fissures, bleeding
45
Q

What are signs and sx of a nipple bleb?

A
  • Shiny, white bump at tip of nipple (blocked nipple pore)

- Pinpoint pain on feeding

46
Q

What are signs and sx of nipple eczema?

A
  • Bilateral
  • History of eczema, assess for exposure to new irritant
  • Red scaly rash usually not centered around nipple
47
Q

What are signs of sx of Raynaud’s or nipple vasospasm?

A
  • Triphasic colour change (white, gray, red)
  • Intense pain, burning, numbness, prickling, stinging
  • Pain on exposure to cold
48
Q

What are signs and sx of nipple candidiasis?

A
  • Sharp shooting pain, out of proportion to physical findings
  • Affected nipple appears pink/red and shiny or skin may be flaky
  • Exclusion of other causes of breast pain
49
Q

What is the tx for nipple trauma?

A

Refer to lactation consultant to ensure proper latch

50
Q

What are some non-pharms for nipple pain?

A
  • Nipple care (avoid harsh cleansers and excessive moisture)
  • Cool or warm compresses
  • Acetaminophen or ibuprofen
  • Lanolin or hydro-gel dressings
51
Q

What is the tx for a nipple bleb?

A

Warm soaks, frequent feeding

52
Q

What are predisposing factors to nipple candidiasis?

A
  • History of infant oral or diaper candidal infection
  • History of maternal VVC
  • Previous antibiotic use
  • Nipple damage
53
Q

What is the first line tx for nipple candidiasis?

A
  • Non-pharms to prevent reinfection and cross contamination
  • Manage nipple trauma if present
  • Treat mother and infant simultaneously (mother - topical antifungals; child - oral candidiasis)
  • Improvement should be seen w/in 3-7 days
  • Continue for 1 week after px is sx free
54
Q

What are the common reasons for breast pump use?

A
  • Stimulate milk production
  • Maintain milk supply
  • Provide infant w/ breast milk
55
Q

What are some tips to give on pumping?

A
  • Wash hands w/ soap and water before pumping
  • Ensure that pump pieces and milk collection containers are clean
  • Ensure flanges are appropriate size
56
Q

What can be done if having difficulty pumping?

A
  • Gently massage breasts before pumping
  • Apply warm wet cloth to breasts before pumping
  • Pump in a quiet, dark room to avoid distractions
  • Look at picture of baby or smell baby’s blanket
57
Q

What are signs of perineal pain that require referral?

A
  • Pain is severe or associated w/ foul-smelling discharge
  • Burning, bleeding
  • High fever
58
Q

What is lochia? What are the different stages?

A
  • Uterine discharge after childbirth
  • Lochia = 2-3 days postpartum; bright red, small clots
  • Lochia serosa = 3-10 days postpartum; brown or pink
  • Lochia alba = 10 days to 6 weeks postpartum; white or pale yellow
59
Q

What are signs of lochia that require referral?

A
  • Bleeding beyond 6 weeks
  • Increasing bleeding or clots large than a loonie
  • Increasing pain
60
Q

What is the typical onset and duration of the postpartum “blues”?

A

Onset = day 3 or 4; duration = max. 2 weeks

61
Q

What are some postnatal red flags?

A
  • Abnormal vaginal bleeding
  • Malodorous vaginal discharge
  • Fever/chills
  • Painful, difficult or frequent urination
  • C-section incision site - increasing pain, redness, swelling or leakage
  • Signs of mastitis
  • Any worsening pain
  • Signs of postpartum depression
  • Signs of DVT (pain, redness, warmth, firmness in lower leg)
62
Q

What does a normal umbilicus look like?

A
  • Clean and dry
  • Falls off 5-15 days after birth
  • Slightly moist/sticky w/ slight mucoid discharge and odour
  • Small amount of blood on separation
63
Q

What are signs and sx of omphalitis?

A
  • Erythema, edema, and tenderness extending beyond 5 mm => requires medical attention
  • Accompanied by fever, lethargy, and/or poor feeding => requires urgent care
64
Q

What are some tips to care for the umbilicus?

A
  • Keep clean and dry
  • Wash hands w/ soap and water before and after contact w/ umbilical area
  • Clean around base of cord w/ water on cotton tipped applicator or soft washcloth after bathing and at diaper changes
  • Fold diaper below cord stump
  • Expose to air or cover w/ loose clothing
  • Avoid cleaning w/ alcohol (delays falling off) and anti-microbials (increased risk of resistant bacteria)
65
Q

What are some tips to care for a circumcised penis?

A
  • Ensure effective pain relief (topical or local anesthetic during procedure; acetaminophen 24-48 h post-procedure)
  • Apply non-stick gauze after procedure; apply petrolatum underneath to prevent sticking
  • Remove and replace gauze w/ every diaper change for 24 hours
  • Gently wash w/ warm water 1-2 times daily
  • Continue to apply petrolatum for 3-5 days (no gauze)
66
Q

How long does it take for a circumcised penis to fully heal?

A

7-10 days

67
Q

What are red flags for a circumcised penis?

A
  • Bleeding more than quarter size on diaper
  • Worsening of redness/swelling (not starting to decrease w/in 48 h)
  • Fever, lethargy/poor feeding
  • No urination w/in 12 h of procedure
68
Q

Should the foreskin of an uncircumcised penis be forced back?

A
  • No, not fully retractable until age 3-5

- Can lead to tearing, which leads to scarring, which affects retraction later on

69
Q

What are tips to care for an uncircumcised penis?

A
  • Wash penis regularly during bathing, use mild soap
  • As foreskin naturally retracts, clean and dry underneath foreskin during bathing
  • As foreskin retracts, skin cells shed which may appear as white, cheesy lumps (smegma)
70
Q

What is the standard recommended formula?

A

Cow milk based formula

71
Q

What are sx of cow’s milk allergy?

A
  • Vomiting
  • Wheezing
  • Hives
  • Rash
  • Bloody diarrhea
72
Q

Are lactose intolerance and cow’s milk allergy the same?

A

No, lactose intolerance develops later in life

73
Q

Does lactose-free cow milk based formula help w/ colic?

A

No

74
Q

Is lactose-free cow milk based formula recommended for acute gastroenteritis?

A

No

75
Q

Is lactose-free cow milk based formula recommended for galactosemia or congenital lactase deficiency?

A

No

76
Q

When are soy-based formulas recommended?

A
  • Vegan diets
  • Galactosemia or congenital lactase deficiency
  • Cow’s milk allergy
  • Cannot consume dairy-based products for cultural or religious reasons
77
Q

Are partially hydrolyzed protein formulas recommended?

A

No, little evidence of benefit

78
Q

When are extensively hydrolyzed protein formulas recommended?

A
  • Physician-confirmed food allergies
  • Those that can’t tolerate cow milk or soy protein
  • Malabsorption syndromes (short bowel syndrome, liver disease, cystic fibrosis)
79
Q

When are amino acid based formulas recommended?

A

Those w/ severe allergies and malabsorption disorders that can’t tolerate extensively hydrolyzed formulas

80
Q

What are the 3 types of therapeutic formulas? When are they recommended?

A
  • High medium chain triglycerides and higher energy for pre term infants
  • Low PRSL (potential renal solute load) for renal insufficiency
  • Human milk fortifiers added to mother’s milk in premature infants
81
Q

What are the recommendations for vitamin D in infants? What is the upper limit?

A
  • 400 IU/day
  • 800 IU/day between October and April for most Manitobans (esp. those w/ deficiency risk factors = non-white, antiepileptic therapy, and malabsorption conditions)
  • Upper limit = 1000 IU/day for infants up to 12 months
82
Q

1 ounce = ____ mL

A

30 mL

83
Q

___ is the most common nutrient deficiency in children

A

Iron

84
Q

What can iron deficiency cause?

A

Diminished mental, motor, and behavioural functioning

85
Q

What are sx of iron deficiency?

A
  • Pallor
  • Irritability
  • Poor appetite
  • Delayed growth/development
86
Q

Which infants are at risk of iron deficiency?

A
  • Low birth weight
  • Premature
  • Born to iron-deficient mothers
  • Those older than 6 months who don’t have adequate supply of iron-rich foods
87
Q

Is breast milk or formula a better source of vitamin D?

A

Formula

88
Q

Is breast milk or formula a better source of iron?

A

Breast milk b/c higher bioavailability

89
Q

What can be done to prevent iron deficiency?

A
  • Breastfeeding
  • Iron-fortified formulas
  • Start iron-rich foods at 6 months
  • Don’t introduce cows milk until after 1 y/o
90
Q

When does infant colic normally resolve?

A

60% by 3 months; 80-90% by 4 months

91
Q

What is the Wessel’s rule of three regarding infant colic?

A
  • Lasts 3 or more hours per day
  • Occurs on 3 or more days per week
  • Persists for 3 or more weeks
92
Q

What is different about normal crying and colic crying?

A
  • Louder, higher more variable pitch, more turbulent (distressed, urgent)
  • Paroxysmal
  • Hypertonia (baby gets rigid)
  • Difficulty consoling
93
Q

What are some other causes of prolonged/excessive crying?

A
  • Inadequate feeding
  • GERD
  • Constipation
  • Otitis media
  • Trauma
94
Q

When should infant colic be referred?

A
  • Breathing difficulties
  • Watery stools/blood in stool
  • Fever
  • Poor weight gain
  • Signs of dehydration
  • Excessive vomiting
95
Q

What are the goals of therapy for infant colic?

A
  • Decrease crying
  • Minimize parental stress/frustration
  • Minimize impact on infant-family relationship
96
Q

What is the first line tx for infant colic?

A
  • Parenteral support
  • Feeding techniques
  • Soothing techniques (physical methods, behavioural management, environmental manipulation)
97
Q

When is dietary management recommended for infant colic?

A

If px has confirmed allergies

Clinical - Winter (24 decks)

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