Class 10: Acquired & Congenital Problems Flashcards
define: acquired or congenital problems
- conditions or circumstances superimposed on normal course of events associated w birth & adjustment to extrauterine existence
what are examples of acquired & congenital problems (4)
- birth trauma
- maternal substance use
- infection
- congenital anomalies
define: birth trauma
- physical injury sustained during L&D
a small percentage of signif birth injuries are….
- unavoidable depsite skilled & competent obstetrical care
what are examples of causes of unavoidable birth trauma (2)
- difficult or prolonged labor
- infant in abnormal presentation
some birth injuries cannot be anticipated until…
- the circumstances are encountered during birth
what are risk factors for birth trauma (3)
- macrosomic infant
- shoulder dystocia
- births requiring assistive devices
what are common fractures that can occur w birth trauma (4)
- clavicular
- skull (linear or depressed)
- humerus
- femur
what types of injuries can occur w birth trauma (5)
- fractures
- peripheral nervous system injuries
- facial nerve injuries
- neuro injuries
- spinal cord injuries
what are signs of birth trauma (6)
- asymmetry in limb mvmts, flaccid
- abnormalities & crepitus on inspection
- asymmetrical chest mvmts, unequal breath sounds
- asymmetry in facial mvmts
- signs of neuro injury
- unilateral edema
what are some signs of neuro injury (6)
- poor tone
- asymmetry in mvmts
- apnea
- seizures
- trouble w feeding
- bulging fontanelles
what is a sign of damage to the phrenic nerve
- unequal chest mvmts
what is a sign of damage to the facial nerve
- unequal facial mvmts
what are risks for sepsis (9)
- prolonged ROM
- intrapartum fever in birther
- prolonged labor
- chorioamnionitis
- prematurity
- low socioeconomic status
- poor prenatal care
- poor nutrition
- substance use
what are neonatal factors for sepsis (2)
- low birth weight
- prematurity
what is considered early onset neonatal infection? late onset?
- early onset: 24-48 hrs
- late onset: 7-30 days
early onset of a neonatal infection is passed from?
- the birth
what is a common cause of early neonatal infections
- group B strep
what causes late neonatal infection?
- hospital acquired = nosocomial infection
what are nonspecific early signs of sepsis (4)
- lethargy
- poor feeding
- poor weight gain
- irritability
what are other signs of sepsis (6)
- apnea
- bradycardia
- tachypnea
- signs of resp distress
- hypo or hyperthermia
- jaundice
what is the most common infection in the neonate
- pneumonia
bacterial meningitis is higher risk in…
- preterm infants
gasteroeneteritis is..
- sporadic
what is considered fever in a newborn
- anything above 37.5
what is included in neonatal care for neonatal infections (7)
- temp during labor
- review antenatal record
- vigilant assessment
- prevention
- note PROM, prolonged labor
- more freq monitoring VS
- monitor feeding & hydration (risk of dehydration)
the earliest clinical signs of neonatal sepsis are characterized by…
- lack of specificity
diagnostics for neonatal infections include (8)
- CBC
- blood & urine cultures
- lumbar puncture
- CRP
- viral cultures
- CXR
- liver function & enzymes
- fungal cultures
neonatal infections may require..
- invasive support
what is the TORCH complex
- group of perinatal infections likely to cause fetal anomalies
what does TORCH stand for
Toxoplasmosis
Other (HBV, HIV, west nile virus)
Rubella
Cytomegalovirus
Herpes simplex virus
what are examples of maternal infections that can impact the newborn (9)
- TORCH complex
- HIV
- chlamydia
- gonorrhea
- HBV
- syphilis
- GBS
- candidasis
- thrush
what can chlamydia cause in the infant? (2)
- conjuctivitis
- pneumonia
what is given for eye prophylaxis r/t chlamydia
- give erythromycin drops
if conjunctivitis is noted in the newborn, what should be done?
- check for pneumonia
what kind of prophylaxis is provided w gonorrhea
- eye prophylaxis
NBs can be infected w a maternal infection of HBV in what ways?
- can be infected during birth
- or in first few days (present in breastmilk)
if the mother has HBV, what should be given to the infant?
- HBV vaccine should be given to the infant
- HBIG may also be given
when is syphilis screened for? (2)
- in pregnancy
- at delivery
when can syphilis be transmitted? (2)
- during pregnancy
- during birth
GBS can cause what kind of infection in the newborn? (2)
- early onset infection
- late onset also possible
how is GBS infection in the newborn treated?
- antibiotics –> penicillin G
what can GBS cause in the newborn (3)
- sepsis
- meningitis
- pneumonia
where can thrush be developed in the infant? whats it’s treatment?
- can be developed on gums & mouth of infant
- treat w oral anti-fungal
what is included in nursing care for infants w infectious diseases (6)
- identify causative organism
- watch for signs of infection in the newborn
- routine precautions
- pregnant healthcare provider precautions
- specimen collection
- assist family w coping
what are the signs of infection in the NB (10)
- lethargy
- poor feeding
- irritability
- poor weight gain
- apnea
- bradycardia
- tachypnea
- temp >37.5
- temp <36.5
- signs of resp distress
what is included in drug exposed infants (3)
- drug use
- smoking
- alcohol use
what is the difference between addicted vs drug-exposed newborn terms
- use drug exposed
- do not refer to ass addicted, cannot drug seek
define: neonatal abstinence syndrome
- the physiological response of infants who are withdrawing from addictive drugs or substances they were exposed to in utero
what should be done if there is risk for NAS based on history for birther of substance use
- initiate observation of clinical signs & symptoms
what is the onset of neonatal withdrawl
- 12-72 hrs after birth (may be longer)
what are signs of neonatal withdrawal (14)
- irritability
- seizures
- crying
- difficult to console
- poor feeding
- diarrhea
- vomiting
- fever
- nasal stuffiness
- disrupted sleep
- tachycardia
- tachypnea
- temp instability
- tremors
what scale is used to assess for withdrawl in drug exposed infants
- finnegan neonatal abstience scale
when is the finnegan neonatal abstinence scale used
- at 2 hrs of age
who should be referred with drug exposed infants
- social work
what categories does the Finnegan neonatal abstinence scale assess (6)
- muscle tone (increased)
- tremors
- RR>60/min, with or without retractions
- sweating
- excessive sucking
- crying/consolable in 5 min and % of time spent crying (,50% versus >50%)
the Finnegan Neonatal Abstinence scale scire ranges from?
0-16
what scores on the Finnegan Neonatal Abstinence scale indicate the need to call NICU and admit infant
- if scores 8 or more on 3 consecutive scores
- or 12 or higher on 2 scores
the following drugs if used within the 72 hrs prior to birth can cause NAS (6)
- narcotics **
- alcohol
- barbituates
- benzos
- inhalants
- SSRIs
what are examples of narcotics that can cause NAS (4)
- methadone
- morphine
- heroin
- fentanyl
what are substances that can cause neurological symptoms but not withdrawal (7)
- caffeine
- cocaine
- meth
- marijuana
- hashish
- nitrous oxide
- nictotine (large quantities)
what are key factors in nursing care for drug exposed infants
- early identification and treatment
what is included in mngmt for drug exposed infants (4)
- calm, quiet enviro
- skin to skin care
- decrease sensory stimuli
- swaddle (safely)
if the Finnegan Neonatal Abstinence scale score is high , what should be skipped for now
- bathing
what is included in nursing care for drug exposed infants (5)
- social & legal factors
- support & encourage breast feeding (if not contraindicated)
- degree of withdrawal
- neonatal abstinence scoring system of Finnegan tool
- pharmacological treatment
in what situation might breastfeeding be a problem with drug exposed infants (2)
- if ongoing drug use
- HIV
what is included in pharmacological treatment for drug exposed infants (2)
- treat w morphine for withdrawal or narcotics
- treat w phenobarbital if alcohol or benzos
what is a common parental concern with drug exposed infants
- that they will have their infant taken away
describe the use of naloxone for drug exposed infants
- contraindicated in infants born to women addicted to narcotics or on methadone therapy bc it may exacerbate neonatal abstinence syndrome (NAS) and cause seizures
what are the most common major congenital anomalies that cause serious problems in neonates (7)
- congenital heart disease
- abdominal wall defects
- imperforate anus
- neural tube defects
- cleft lip or palate
- clubfoot
- developmental dysplasia of the hip
describe imperforate anus (4)
- improperly placed anus
- hole too small
- anal opening weird
- may be fistula
what are signs of neural tube defects in the infant
- assess back for dimple or sinus
- tuft of hair at gluteal cleft
clefts may require? (2)
- assistance w feeding
- surgical repair
what is club foot?
- deformity of ankle & foot
club foot may be associated with? (3)
- spina bifida
- other chromosomal abnormalities
- or independent of other issues
what is a sign of hip dysplacia
- hip clicks
what is included in newborn screening for congenital anomalies (4)
- phenylketonuria
- galactosemia
- hypothyroidism
- congenital heart disease
what is included in nursing care for congenital abnormalities
- newborn care
- parents & family info, guidance, and support
how is congenital heart disease first screened? what indicates further investigations
- with O2 sats
- if less than 90, investigate further
