Birth Injuries on Newborn Flashcards
1
Q
Health Problems of the Newborn
A
- Maternal Factors
- Dystocia
- Intrapartum Events
- Obstetric Birth Techniques
2
Q
Maternal Factors
A
- Uterine Dysfunction
- Preterm o Postterm labor
- Cephalopelvic disproportion
3
Q
Dystocia
A
- Fetal Macrosomia
- Multifetal Gestation
- Abnormal Presentation
- Congenital Anomalies
4
Q
Intrapartum Events
A
- use of intrapartum monitoring of fetal heart rate
- collection of fetal scalp blood for acid-base assessment
5
Q
Obstetric Birth Techniques
A
- Forceps Birth
- Vacuum Extraction
- Version and Extraction
- Cesarean Birth
6
Q
Types of Injury at Birth
A
- Soft Tissue Injury
- Head Injury
- Neurologic Injury
7
Q
May be sustained primarily in the form of bruises and abrasions secondary to dystocia
A
Soft Tissue Injury
8
Q
Usually occurs when there is some degree of disproportion between the presenting part and the maternal pelvis
A
Soft Tissue Injury
9
Q
cause of Soft Tissue Injury?
A
some degree of disproportion between the presenting part and the maternal pelvis
10
Q
Common Types of Soft Tissue Injury
A
- Erythema and Abrasions
- Petechiae
- Ecchymoses
- Subcutaneous Fat Necrosis
- Subconjunctival (Scleral) Hemorrhages
- Retinal Hemorrhages
11
Q
Usually the result of the application of forceps
A
Erythema and Abrasions
12
Q
discoloration the same configuration as the instrument
A
Erythema and Abrasions
13
Q
Nonraised, pinpoint hemorrhages caused by a sudden increase and then release of pressure during passage through the birth canal
A
Petechiae
14
Q
cause of Erythema and Abrasions?
A
application of forceps
15
Q
cause of Petchiae?
A
sudden increase and then release of pressure during passage through the birth canal
16
Q
Petechiae may be seen on the:
A
chest, face and head
17
Q
Small hemorrhagic areas that may occur after traumatic, precipitous, or breech delivery
A
Ecchymoses
18
Q
cause of Ecchymoses
A
traumatic, precipitous, or breech delivery
19
Q
which is larger? Petechiae or Ecchymoses?
A
Ecchymoses
20
Q
Clearly outlined masses located in the subcutaneous tissues that are firm to the overlying skin but movable over the underlying tissue
A
Subcutaneous Fat Necrosis
21
Q
most likely caused by traumatic manipulation during delivery
A
Subcutaneous Fat Necrosis
22
Q
cause of Subcutaneous Fat Necrosis?
A
traumatic manipulation during delivery
23
Q
The result of rupture of capillaries in the sclera from pressure on the fetal head during delivery
A
Subconjunctival (Scleral) Hemorrhages
24
Q
Subconjunctival (Scleral) Hemorrhages are/is most commonly located in the ?
A
limbus of the iris
25
cause of Subconjunctival (Scleral) Hemorrhages
rupture of capillaries in the sclera from pressure on the fetal head during delivery
26
Flame-shaped, irregular or round areas of bleeding in the retina from excessive pressure on the fetal head during delivery
Retinal Hemorrhages
27
in Retinal Hemorrhages, extensive areas possibly indicative of?
subdural hematoma or brain trauma
28
cause of Retinal Hemorrhages
excessive pressure on the fetal head during delivery
29
Nursing Care Management for Soft Tissue Injury
ASSESS
- Record accurate description of the injury
- Rationale: To facilitate Subsequent comparative nursing evaluation
IMPLEMENT
- Maintain asepsis of the area to prevent breakdown and infection
- Provide thorough explanation and reassurance to the parents
- Rationale: parents may be concerned and mourn the loss of the expected "perfect infant
30
Usually benign but occasionally results in more serious injury
Head Trauma
31
Three most common types of Head Injury are:
caput succedaneum, subgleal hemorrhage and cephalhematoma
32
Nursing Care Management for Head Trauma
- Assessment and observation of common scalp injuries and for complications (skin breakdown, infection, blood loss &
hypovolemia)
- Reassure parents of their usual benign nature
33
scalp lesion; vaguely outlines area of edematous tissue over the scalp; swelling consists of serum and blood
Caput succedaneum
34
Swelling extends beyond the suture line
Caput succedaneum
35
associated with overlying petechiae or ecchymosis
Caput succedaneum
36
does Caput succedaneum have a specific treatment?
NO
37
Caput succedaneum's swelling will subside within?
a few days
38
Bleeding in the subgaleal compartment
Subgaleal Hemorrhage
39
injury occurs as a result of forces that compress and then drag the head through the
Subgaleal Hemorrhage
40
Can be associated with the use of vacuum extractor
Subgaleal Hemorrhage
41
bleeding extends beyond bone (often posterior into the neck) and continues after birth
Subgaleal Hemorrhage
42
what is vital for Subgaleal Hemorrhage?
Early detection
43
what is essential for Subgaleal Hemorrhage?
head circumference measurements and inspection at the back of the neck for increasing edema and a firm mass
44
early signs of Subgaleal Hemorrhage:
boggy scalp, pallor, tachycardia & increasing head circumference, forward and lateral positioning of the newborn's ears
45
used to confirm diagnosis for Subgaleal Hemorrhage
CT Scan or MRI
46
what is is required in acute cases of Subgaleal Hemorrhage?
Replacement of loss blood and clotting factors
47
for infants with Subgaleal Hemorrhage, monitor for:
changes in level of consciousness and a decrease in hematocrit
48
In subgaleal hemorrhage, ____________________ may result
from the degrading blood cells in the hematoma
increased serum bilirubin levels
49
How is cephalhematoma formed?
formed when blood vessels rupture during labor or delivery causing bleeding in the area between the bone and periosteum
50
a birth injury wherein blood vessels rupture during labor or delivery causing bleeding in the area between the bone and periosteum
Cephalhematoma
51
is the covering of a bone that consists of connective tissue, osteogenic cells, and osteoblasts
periosteum
52
is essential for bone growth, repair, and nutrition.
periosteum
53
Predisposing Factors in Cephalhematoma?
- Primiparity
- Forceps and vacuum delivery
54
Characteristics of Cephalhematoma
- Boundaries are sharply demarcated and do not extend beyond the limits of the bone
- May involve one or both parietal bones, occipital bones are less commonly affected; frontal bones are rarely affected
- Swelling is minimum or absent at birth and increases in size on the 2nd or 3rd day
- Blood loss is not significant; hyperbilirubinemia may result during resolution
55
Cephalhematoma may involve ____________ parietal bones,
____________ are less commonly affected; _______________ are rarely affected
one or both; occipital bones; frontal bones
56
in Cephalhematoma, swelling is _____________ at birth and increases in size on the _______________
minimum or absent; 2nd or 3rd day
57
in Cephalhematoma, blood loss is _____________; ________________ may result during resolution
not significant; hyperbilirubinemia
58
Nursing Considerations for Cephalhematoma
- No treatment indicated for uncomplicated cephalhematoma since most lesions are absorbed within 2 weeks to 3 months
- Further evaluation for lesions that result in severe blood loss to the area or that involve and underlying fracture
- Watch out for sudden increase in swelling (indicative of local infection)
59
in Cephalhematoma, if there is sudden increase in swelling, it is indicative of?
local infection
60
No treatment indicated for _______________________ since most lesions are absorbed within _____________________
uncomplicated cephalhematoma; 2 weeks to 3 months
61
____________________ is the most common birth injury often associated with difficult vertex or breech deliveries of infants greater-than-average size.
Fractures of the clavicle
62
Fractures of the clavicle is the most common birth injury often associated with
difficult vertex or breech deliveries of infants greater-than-average size
63
Fractures of ______________ is uncommon
neonatal skull
64
usually follow a prolonged, difficult delivery or forceps extraction
Skull fractures
65
depressed indentations that compress or decompress like a Ping-Pong ball; cranial bone(s) move freely on palpation and may easily compress
Craniotabes
66
usually benign and may be associated with prematurity, rickets or hydrocephalus
Craniotabes
67
Craniotabes is usually benign and may be associated with
prematurity, rickets or hydrocephalus
68
Characteristics of Craniotabes
- Presence of crepitus
- Palpable spongy mass (localized edema and hematoma)
- Limited use of affected arm, malpositioning of arm, asymmetric moro reflex
- Focal swelling or tenderness or cries when the arm is moved
69
Contraindications of Craniotabes
Eliciting Scarf Sign
70
Nursing Care Management for Craniotabes
- Proper body alignment
- Handling and carrying techniques that support the affected bone
- Careful dressing and undressing of the infant
71
Nursing Care Management for Fractured Clavicle
- Support upper and lower back
- Immobilize affected arm by securing it against the body by pinning the sleeve to the shirt or applying a triangular sling or figure-8 bandage
72
what type of Skull Fracture usually require no treatment?
Linear skull fractures
73
what type of Skull Fracture may require decompression via surgery (vacuum extractor suction device)?
Ping-Pong type
74
CAUSED BY PRESSURE ON THE FACIAL NERVE DURING DELIVERY
FACIAL PARALYSIS
75
Clinical Manifestations of Facial Paralysis
- Loss of movement on the affected side
- Inability to close the eye
- Drooping of the corner of the mouth
- Absence of wrinkling of the forehead & Nasolabial fold
76
Nursing Care Management: Facial Nerve Paralysis
- Aid infant in sucking
- Help mother with feeding techniques
- Refer patient for comprehensive evaluation of the infant’s oral motor skills (infant feeding specialist)
- Careful use of soft rubber nipple with a large hole
- Artificial tears can be instilled if unable to close eyelids and tape shut to prevent accidental injury
- Partial gavage feeding and supplemental oral stimulation with a minimum amount of formula
- Teach parents the procedure for administering eye drops for eye care needed at home
- Breastfeeding is not contraindicated but mother will need assistance in helping infant grasp and compress areolar area
77
INJURY IN THE BRACHIAL PLEXUS FROM FORCES THAT ALTER THE NORMAL POSITION & RELATIONSHIP OF THE ARM, SHOULDER & NECK; ABSENT MORO REFLEX
Brachial Palsy
78
what reflex is absent in Brachial Palsy?
Moro Reflex
79
Caused by damage to the upper plexus and usually results from stretching or pulling away of the shoulder from the head
ERB-DUCHENNE PARALYSIS
80
Related to the paralysis of the affected upper extremity and muscles
ERB-DUCHENNE PARALYSIS
81
The shoulder and arm are adducted and internally rotated
ERB-DUCHENNE PARALYSIS
82
Elbow is extended and the forearm is pronated, with the risk and fingers flexed
ERB-DUCHENNE PARALYSIS
83
in Erb-Duchenne Paalysis, __________ may be present because finger and wrist movement remain norma
Grasp reflex
84
Lower plexus palsy
KLUMPKE PARALYSIS
85
Muscles of the hand are paralyzed, with consequent wrist drop and relaxed fingers
KLUMPKE PARALYSIS
86
Results from severe stretching of the upper extremity while the trunk is relatively less mobile.
KLUMPKE PARALYSIS
87
The entire arm and hand are paralyzed and hang limp and motionless at the side
TOTAL PLEXUS INJURY
88
The second most common type of plexus injury
TOTAL PLEXUS INJURY
89
Nursing Care Management: Brachial Palsy
- Primary concern: proper positioning of affected arm
- Passive range of motion exercise of the shoulder, wrist, elbow and fingers (latter part of the first week)
- Gently immobilize affected arm on the upper abdomen
- Use supportive splints
90
Primary concern in Nursing Care Management: Brachial Palsy
proper positioning of affected arm
91
RESULTS IN DIAPHRAGMATIC PARALYSIS AS DEMONSTRATED BY ULTRASONOGRAPHY; WITH PARADOXICAL CHEST MOVEMENT AND ELEVATED DIAPHRAGM
PHRENIC NERVE PARALYSIS
92
SOMETIMES OCCUR IN CONJUNCTION WITH BRACHIAL PALSY
PHRENIC NERVE PARALYSIS
93
IS THE MOST COMMON AND IMPORTANT SIGN OF PHRENIC NERVE PARALYSIS
Respiratory Distress
94
USUALLY UNILATERAL IN AFFECTATION; LUNG ON THE AFFECTED SIDE DOES NOT EXPAND; BREATHING IS THORACIC, AND CYANOSIS, TACHYPNEA OR COMPLETE RESPIRATORY FAILURE MAY BE SEEN
PHRENIC NERVE PARALYSIS
95
PHRENIC NERVE PARALYSIS IS MOST LIKELY TO DEVELOP
PNEUMONIA AND ATELECTASIS
96
Nursing Care Management: Phrenic Nerve Paralysis
- Requires the nursing care of an infant with respiratory failure
- Meet emotional needs of family by giving explanations of the cause and treatment
- Emphasize follow-up care because of extended length of recovery
