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Mother-Baby > Birth Trauma & Newborn Disorders > Flashcards

Birth Trauma & Newborn Disorders Flashcards

1
Q

What is Caput

A

Edema that crosses suture lines, soft, resolves in a few days

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2
Q

What is cephalohematoma?

A

Blood between skull & periostem
Does not cross suture lines, firm and defined
Resolves over 2-3 weeks
Hemolysis of RBCs = increased risk of hyperbilirubinemia

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3
Q

Linear skull birth trauma

A

Most common, not unusual with cephalohematoma, no treatment

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4
Q

Depressed skull birth trauma

A

“Ping pong ball” indention
CT to evaluate for underlying trauma to brain

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5
Q

Clavicle birth trauma

A

Most common birth fracture
Increased risk with macrosomia, breech delivery
Signs: limited arm (unilateral) movement and absense of moro reflex on affected side, crepitus over clavicle
No treatment- comfort measures

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6
Q

Facial birth trauma of peripheral nervous system

A

Increased risk with forceps delivery or prolonged 2nd stage
Typically self-limiting, resolves within hours or days
Protect cornea, assist with feeding

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7
Q

Brachial plexus trauma

A

Most common birth related paralysis- mechanical trama to spinal nerve roots at c5-T1
Presentation: arm hangs at side, shoulder adducted and internally rotated, wrist and fingers flexed, grasp reflex typically present, absent moro reflex on affect side
Treatment: immobilization and ROM, resolves in most infants, surgery rarely indicated

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8
Q

Intracranial hemorrhage: subdural

A

Risk factors: difficult or precipitous delivery, assisted birth, LGA

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9
Q

Intracranial hemorrhage: subarachnoid

A

Risk factors:
full term: trauma
preterm: hypoxia

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10
Q

Infants of diabetic mothers: macrosomia

A

Increased birth trauma
Increased hypoglycemia
Increased hypocalcemia
Increased hyperviscosity
Increased hyperbilirubinemia

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11
Q

Infants of diabetic mothers: respiratory distress

A

Increased risk if born <38 weeks
Increased maternal hyperglycemia = decreased fetal lung maturity
-impaired surfactant synthesis: increased fetal glucose, increased fetal insulin

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12
Q

Infants of diabetic mothers: hypoglycemia causes

A

increased maternal glucose = increased fetal insulin production
After birth decreased available circulating glucose but still increased fetal insulin = hypoglycemia

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13
Q

Infant hypoglycemia S/S

A

Jittery
Weak cry
Apnea or tachypnea
Hypotonic, decreased activity
If severe could lead to seizures

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14
Q

Infant hypoglycemia management

A

Prevent with early frequent feeds - most common in 1st 1-6 hours
monitor blood sugars - ideally >40-45
IV dextrose if unable to feed or symptomatic or blood sugar <25
Keep warm

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15
Q

Infants of diabetic mothers: hyperbilirubinemia patho

A

Increased insulin –>
Increased metabolic rate –>
Increased ox demand –>
Increased RBC production =
Polycythemia =
Increased hemolysis

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16
Q

Hyperbilirubinemia management

A

Early frequent feeds: feed in first 1-2 hours then 8-12 times/24 hrs, lactation consultation early if feeding difficulties
Assess for jaundice every 8-12 hrs
If jaundice <24 hrs check transcutaneous or serum bili and follow nomogram
Otherwise predischarge screening
Phototherapy prn

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17
Q

Neonatal sepsis classifications

A

Congenital
Early onset
Late onset

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18
Q

Neonatal sepsis S/S

A

Irritable, lethargic
Poor feeding
Temperature instability
Respiratory distress, apnea, cyanosis
Jaundice
Seizures
Abnormal bleeding

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19
Q

Neonatal sepsis treatment/prevention

A

Best intervention is prevention: antenatal maternal screening, eye prophylaxis, sterile/aseptic procedures, hand hygiene, avoid sick contacts
Collect specimen- blood, urine, stool
IV fluids
Oxygen
IV antibiotics/antifungals/antivirals - possible isolation
Comfort

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20
Q

Infection: Group B Streptococcus (GBS)

A

Prenatal assessment and prevention is key
-all women screened at 36 0/7-37 6/7 weeks
–>if positive treat with intrapartum antibiotic prophylaxis: PCN or ampicillin
-if presents in labor before GBS screening or no prenatal care follow algorithm

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21
Q

Gonorrhea

A

Eye prophylaxis with erythromycin ointment to prevent opthalmia neonatorium

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22
Q

Syphilis

A

Congenital syphilis rate increaseing- associated with SAB/stillbirth, early infant death if no maternal treatment
Mother should be treated with PCN G to prevent placental transmission

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23
Q

HIV

A

Rare to be symptomatic at birth
25% chance of transmission if mom untreated
All infants born to seropositive moms presumed positive
Bathe ASAP
Prompt antiretroviral administration within 12 hours of birth to slow the progression
Breastfeeding is contraindicated

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24
Q

Intrauterine risk of tobacco

A

SAB
Placental abruption and placenta previa
SGA, LBW infant, preterm birth

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25
Q

Extrauterine risks of tobacco

A

Ear infections
Chronic respiratory infections
SIDS

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26
Q

Patient teaching of tobacco

A

Smoking cessation
No smoking around infant

27
Q

Fetal Alcohol Syndrome

A
  1. Dysmorphic facial features: small eyelids fissures, thin upper lip, missing vertical groove in median portion of upper lip
  2. Growth deficiency: pre & postnatal, IUGR, LBW, short birth length, <10th percentile
  3. CNS abnormalities (structural, developmental & functional): microcephaly, low cognitive functioning, attention or hyperactivity, poor social & language skills
28
Q

Opioids/Neonatal Abstinence Syndrome (NAS) Manifestations

A
  1. CNS Dysfunction
    - tremors
    -generalized seizures
    -hyperactive reflexes
    -irritability
    -hypertonic muscle tone, constant movement
    -shrill, high-pitched cry
    -disturbed sleep patterns
  2. Metabolic, Vasomotor, and Respiratory Disturbances
    -fever
    -frequent yawning
    -mottling of the skin
    -sweating
    -nasal stuffiness
    -temperature instability
    -frequent sneezing
  3. Gastrointestinal dysfunction
    -poor feeding
    -frantic sucking or rooting
    -uncoordinated sucking
    -poor weight gain
    -loose or watery stools
    -regurgitation or projectile vomiting
29
Q

RH incompatibility

A

Rh - mom and Rh + fetus
Sensitization: fetal RBCs with Rh antigens pass through placenta to maternal circulation causing maternal antibody production
Affect on fetus = relative number of antibodies produced, increased antibodies increased destruction of fetal RBCs –> anemia/hyperbilirubinemia
Most cases mild resulting in little to no anemia or hyperbilirubinemia

30
Q

Prenatal RH incompatibility

A

Indirect Coombs test on mom
If + check antibodies q 2-4 weeks

31
Q

At birth Rh incompatibility

A

Direct Coombs on fetal cord blood
If + follow H&H and bilirubin more closely, ensure early and frequent feeds, avoid stressors

32
Q

Treatment of Rh incompatibility

A

phototherapy for hyperbilirubinemia, if severe exchange transfusion

33
Q

Severe Rh incompatibility

A

Erythroblastosis fetalis- excessive fetal RBC (hemolysis) and fetal hyperbilirubinemia
Hydrops fetalis- severe hemolytic anemia with fetal cardiac decompensation, hepatomegaly, edema

34
Q

ABO incompatibility

A

Most common cause of hemolytic dz in the newborn: pathologic hyperbilirubinemia
Fetal blood type A, B, AB and mom O
Maternal anti- A and anti- B antibodies are transferred across placenta from mom to baby
Anemia: mild if occurs
Hyperbilirubinemia: typically resolved with phototherapy, exchange transfusion is rare

35
Q

Cardiac congenital anomalies

A

Most common congenital anomaly
Often associated with anomalies of other systems or chromosomal abnormalities

36
Q

S/S of cardiac congenital anomalies

A

Central cyanosis, pallor at birth
Cyanosis or pallor with crying or feeding
Lethargy
Irregular HR
Murmur
Bonding pulses, decreased capillary refill, >20mmHG difference in BP between upper and lower extremities
Tachypnea

37
Q

Nursing actions cardiac congenital anomalies

A

Modify feeds to reduce energy expenditure
Elevate head and shoulders to reduce cardiac workload
Knee-chest if respiratory distress

38
Q

Newborn CCHD Screening

A

24-48 hrs of life
Pulse ox
Preductal (r. hand)
Postductal (L or R. foot)
Pass: SpO2 > or = 95% in hand OR foot AND hand-foot difference < or = 3%

39
Q

Nursing actions of meningocele & myelomeningcele CNS congenital anomalies

A

Prone positioning
Sterile dressing and plastic to prevent drying of exposed defects
Reduce infection risk- diaper care
Head circumference
NO LATEX

40
Q

Choanal Atresia

A

Blockage of posterior nares
Infants are obligate nose breathers first 4-6 weeks of life
Respiratory distress, decreased SaO2, cyanosis at rest, feeding, or pacifier use
With cry, color, SaO2 improve and distress resolves

41
Q

Congenital diaphragmatic hernia

A

Often diagnosed with prenatal ultrasound
Commonly associated with chromosomal abnormalities or defects of cardiac and MSK systems, male > female
Severity of symptoms depends on size of defect
-large defects associated with significant respiratory distress at birth, cyanosis, mottling, pulmonary hypertension

42
Q

Cleft Lip/Palate

A

Genetic and environmental
Mild to severe
Cosmetic and functional
Risk for compromised airway, feeding, speech development

43
Q

Omphalocele

A

Covered herniation of abdominal contents into base of umbilical cord

44
Q

Gastroschisis

A

Herniation of abdominal contents through defect in abdominal wall with no covering membrane

45
Q

Nursing care of omphalocele/gastroschisis

A

Sterile moist dressing over defect, polyethylene bag over torso
Side lying
Replogle gastric tube for decompression
Thermoregulation, fluid balance, infection risk reduction

46
Q

Esophageal atresia & Tracheoesophageal fistula

A

Esophagus with a blind pouch (dead end) and/or fistula to trachea
Infants with excessive oral secretions, drooling, respiratory distress and feeding intolerance are suspicious for TEF
-do not feed orally and notify provider
Raise HOB, replogle to LIS, anti-reflex/antacid meds
Surgical intervention

47
Q

Four components of congenital clubfoot

A
  1. inversion and adduction of the forefoot
  2. inversion of heel and hindfoot
  3. limitation of extension of the ankle
  4. internal rotation of the leg
48
Q

Ponseti method for clubfoot

A

Stretching and casting
Move infant’s foot into a correct position and then place it in a cast to hold it there
Reposition and recast the infant’s foot once a week for several months
Possibly a minor surgical procedure to lengthen the Achilles tendon toward the end of this process

49
Q

Congenital hip dysplasia

A

Hip joint laxity
Demonstrated with Barlow and Ortolani maneuvers during newborn assessment but most reliable at 2-3 months

50
Q

Hip dysplasia treatments

A

Infants are usually treated with a soft brace, such as a Pavlik harness, that holds the ball portion of the joint firmly in its socket for several months. This helps the socket mold to the shape of the ball
Double diapering is no longer recommended as interferes with proper hip development

51
Q

Hypospadias

A

Abnormally located urinary meatus on the underside of the penis
Increased severity results in urinary and infertility problems
Surgery at approx 6 months

52
Q

Epispadias

A

Urethra opening at the top or side of the penis
Often occurs with exstrophy of the bladder

53
Q

Bladder exstrophy

A

Prevent infection (cover)
Preserve renal fxn
Maintain skin integrity

54
Q

Ambiguous genitalia

A

Discrepancy between the chromosomal sex and external genitalia
External genitalia anatomy is unclear
Karyotyping
Counseling

55
Q

Phenylkeonuria (PKU)

A

Genetic disorder caused by a deficiency of the liver enzyme, phenylalanine hydroxylase
Results in increased levels of amino acid phenylalanine leads to CNS damage which leads to intellectual disability

56
Q

Symptoms of PKU

A

Vomiting
Poor feeding
FTT
Overactivity
Irritability
Musty-smelling urine

57
Q

Treatment of PKU

A

Lifelong low protein diet- special infant formula without phenylalanine
Breastfeeding only in conjunction with phenylalanine free formula

58
Q

Galactosemia

A

Genetic disorder resulting in deficiency of enzyme that convert galactose to glucose

59
Q

Early symptoms of galactosemia

A

Vomiting, poor weight gain
Hypoglycemia
Liver damage, hyperbilirubinemia
Frequent infections
CaTaracts

60
Q

Treatment of galactosemia

A

Lifelong galactose free diet and calcium supplementation
Breastfeeding is contraindicated due to presence of. lactose

61
Q

Congenital hypothyroidism

A

Multiple causes: defects with thyroid gland and/or thyroid hormone –> decreased levels of T4 & elevated levels of TSH
Ideally screen at 3 days of life and repeat at 2 weeks of age

62
Q

Symptoms of congenital hypothyroidism

A

Large protruding tongue, distended abdomen, constipation, poor feeding
Slow reflexes
Large, open posterior fontanelle
Hypothermia
Hoarse cry
Dry skin, coarse hair
Goiter, jaundice

63
Q

Treatment of congenital hypothyroidism

A

Untreated: irreversible cognitive & motor impairment
Treatment: lifelong thyroid replacement hormone

Mother-Baby (3 decks)

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