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4500 Gender & reproductive health > class 10 newborn complications > Flashcards

class 10 newborn complications Flashcards

1
Q

What is jaundice?

A

elevated serum unconjugated bilirubin levels

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2
Q

What are the 2 types of jaundice?

A

physiologic
pathologic

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3
Q

which jaundice do MOST newborns experience?

A

physiologic jaundice

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4
Q

What causes increased unconjugated bilirubin levels?

A

RBC break down = unconjugated bilirubin
liver process it so = immature liver

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5
Q

Why is unbound bilirubin a bad thing?

A

it can leave the blood stream and go into tissues
can cross the blood brain barrier

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6
Q

what are the 5 reasons a newborn could have normal physiological jaundice?

A
  1. too many RBC at birth so they break down
  2. RBC don’t live as long - 60-90 days
  3. Newborn liver can’t make bilirubin water soluble in first few days of life
  4. not enough albumin to carry the bilirubin to the liver
  5. enterohepatic circulation is in overdrive so too much bilirubin is being absorbed - not filtered out well
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7
Q

What is the BEST method to help prevent jaundice?

A

Early
frequent
breast/chest feeding

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8
Q

what is a normal % of weight loss for newborns?

A

5-7% over first 3 days
regain within 10-14 days of life

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9
Q

what gestational age babies are at risk for jaundice?

A

35-38 weeks GA

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10
Q

How do we know if a newborn has neurotoxicity - acute bilirubin encephalopathy?

A
  • lose startle reflex
  • lethargic - not eating well
  • high pitched cry
  • irritable
  • seizure
  • coma
  • death
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11
Q

what are the results of chronic bilirubin encephalopathy (kernicterus) ?

A
  • long term brain damage
  • hearing loss
  • CP
  • gaze abnormalities
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12
Q

What is the main difference between physiologic and pathologic jaundice ?

A

physiologic = AFTER 24 hours it appears - usually resolves without treatment in 2 weeks
- not due to underlying condition

pathologic = UNDER 24 hours it appears
- TBS increases more than 100 mcmol/L in 24 hours
TSB >256mcmol/L
- underlying condition

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13
Q

what is HDN (hemolytic disease of the newborn)?

A

erythoblastosis fetalis
- RBC broken down or destroyed tooo quickly
= anemia = increased bilirubin

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14
Q

What blood type is the newborn with risk for hemolytic disease (HDN)?

A

RH+ newborn
RH- birther

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15
Q

What are the 2 causes of HDN (hemolytic disease of newborn)?

A
  1. ABO incompatibility - blood/antibody issue in the newborn - coombs test (DAT) for antibodies
  2. Rh Isoimmunization - baby is Rh+ and mom is Rh- blood mixed and baby didn’t like it
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16
Q

How does WinRHO help the birther ?

A

it masks leftover fetal RBCs in maternal circulation so that 2nd fetus is protected regardless of Rh status

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17
Q

Which HDN is more severe, Rh Isoimmunization or ABO incompatibility?

A

Rh Isoimmunization

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18
Q

sometimes jaundice is neither pathological nor physiological. What is the other cause of jaundice?

A

Chest/breast feeding

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19
Q

When does chest/breast feeding jaundice occur and why?

A

(early)
days 2-5
insufficient feeding/stooling

(late)
days 5-10
good feeding/weight gain
compound in milk that inhibits the glucuronyl transferase so it can’t become water soluble and excreted

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20
Q

what do we do for early chest/breast jaundice?

A

suppliment feeding
support breast feeding better so baby gets more milk

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21
Q

As part of the newborn jaundice assessment what are 3 things nurses do as part of this assessment?

A
  1. routine inspection
  2. routine TcB - transutaneous bilirubin monitor (like a forehead thermometer)
  3. TSB - total serum bilirubin - IF
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21
Q

According to WRHA policy how often do newborns get screened for jaundice and when?

A

between 24-30 hours
q morning until discharge

22
Q

Which is the first test that is done for jaundice, TcB or TSB?

A

TcB - think little c = less concerned

23
Q

Where is the prefered place for TcB reading?

A

infant’s forehead

24
Q

Where is a second place we can check jaundice with TcB if bruising or sun exposure is present?

A

sternum

25
Q

What is the measurment range for TcB?

A

0-340 umol/L

26
Q

If the TcB reading is >340 umol/L what type of jaundice is it probably?

A

pathological

27
Q

At 24 hours what is an abnormal TcB reading and what do we do?

A

> 100 umol/L

send serum bilirubin to get exact level

28
Q

What is the order of events if an infant is jaundiced <24 hours of age?

A
  1. TcB meter
  2. plot the TcB on the nomogram
  3. tell the infants doc the result
  4. Get order for TSB and DAT/coombs test
29
Q

Which chart is more important, the Phototherapy implimentation threshold graph or the nomogram for evaluation screening?

A

Phototherapy implimentation threshold graph

30
Q

What test determines level of risk for jaundice infant?

A

Phototherapy implimentation threshold graph

31
Q

What 6 things do we want to continue to assess in jaundice babies?

A
  1. weight loss
  2. milk intake
  3. assessment of breat/chest feeding
  4. number of stools
  5. number of voids
  6. bilirubin levels- ongoing
32
Q

how do we check neuro in newborns?

A

reflexes

33
Q

once initiated, when do we stop phototherapy?

A

until the TSB decreases

34
Q

how often do we check healthy infants Temp, RR, and HR receiving phototherapy?

A

Temp Q2 h
RR Q4 hr
HR Q4 hr

35
Q

If phototherapy is not effective, what can be done?

A

exchange transfusion

36
Q

what are the signs of encephalopathy?

A

decreased Moro reflex
hyperreflexia
hypotonia
lethargy
sleepy
poor feeding
vomiting

37
Q

What are the 3 things that exchange transfusion does?

A
  1. takes out antibody coded RBCs
  2. takes out partially hemolyzed RBCs
  3. replaces blood with uncoated donor RBCs
38
Q

what percentile is considered small for gestational age?

A

<10th percentile

39
Q

what percentile is IUGR usually?

A

<3rd percentile

40
Q

What percentile is considered large for gestational age?

A

> 90th percentile

41
Q

how do we figure out weight loss?

A

birth weight minus current weight divided by birth weight times 100.

41
Q

Does gestational age include birth weight?

A

No it does not
It is the completed weeks of birth since day one of the LMP of birther

42
Q

how many weeks is late preterm?

A

34-36+6

43
Q

How many weeks is term?

A

37-40 weeks

44
Q

how many weeks is postterm?

A

> 42 weeks

45
Q

if a baby has apnea >20 sec how do we intervene?

A

rub the back (stimulation)

46
Q

What does an APGAR of <7 mean?

A

They had to work harder to transition

47
Q

when do we care about infant blood glucose?

A

<2.6

48
Q

what antihypertensive can affect hypoglycemia in baby?

A

labatolol

49
Q

what is the glucose goal for baby?

A

> 2.6 mmol/L pre-feed

50
Q

what is the most common infection in neonates?

A

PN

51
Q

what are the 5 things we do if baby isn’t feeding well?

A

1.Check VS (if not already completed)
2.Blood glucose check
3.Review when the last feed occurred
4.Review when last void & bowel movement occurred
5.Perform a head to toe exam on the NB

4500 Gender & reproductive health (11 decks)

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