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Nur 404 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

first breath of infant causes __________

A

decreased pulmonary artery pressure

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2
Q

decreased pulmonary artery pressure causes (3)

A

-increased P O2
-closure of ductus venosus and umbilical arteries and vein due decreased flow
-closure of foramen ovale (pressure in left side of heart greater than right side

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3
Q

increased P O2 leads to

A

closure of ductus arteriosus

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4
Q

immediate care of newborn (6)

A

-skin to skin
-dry the infant
-APGAR score
-encourage breast feeding
-head to toe assessment
-admin newborn meds (2)

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5
Q

newborn meds immediately given at birth

A

-erythromycin
-vitamin K

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6
Q

heat loss in newborn (4)

A

-convection
-radiation
-conduction
-evaporation

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7
Q

APGAR stands for

A

Activity
Pulse
Grimace
Appearance
Respiration

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8
Q

APGAR activity scoring

A

0: absent
1: flexed arms and legs
2: active

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9
Q

APGAR pulse scoring

A

0: absent
1: below 100 bpm
2: over 100 bpm

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10
Q

APGAR scoring grimmace

A

0: floppy
1: minimal response to stimulation
2: prompt response to stimulation

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11
Q

APGAR appearance score

A

0: pale, blue
1: pink body, blue extremities
2: pink

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12
Q

APGAR respiration scoring

A

0: absent
1: slow and irregular
2: vigorous

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13
Q

components of complete newborn assessment (4)

A

-perinatal hx
-physical exam
-gestational age assessment
-behavioral assessment

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14
Q

when newborn assessments scheduled

A

-birth
-within 1-4 hrs of birth
-within 24 hrs before discharge

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15
Q

newborn v/s taken

A

-temp
-pulse 120-140
-respiration 30-60
-b/p

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16
Q

general assessment components

A

-general appearance (symmetry? fontanelles?)
-head circumference
-chest circumference
-length (inches)
-weight (2500 g to 4000 g); lose weight at first, breast fed back to birth weight in 7 days

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17
Q

head assessment

A

-fontanelles
-molding
-cephalohematoma

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18
Q

cephalohematoma

A

burst blood vessels; won’t cross sutures

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19
Q

caput succedaneum

A

will cross sutures

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20
Q

face assessment

A

-eyes
-ears
-nose
-mouth
-tongue

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21
Q

ears

A

-lower set ears could indicate genetic abnormality
-hearing test

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22
Q

nose

A

-patent nostrils
-discharge
-milia (little white heads) normal

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23
Q

mouth

A

-suck reflex
-epstein’s pearls (little white cysts on hard palate)
-

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24
Q

chest

A

-clavicles intact, not broken
-lungs: normal breathing pattern and sounds; watch for signs of respiratory distress
-heart: rate, rhythm (can listen for 15 seconds and multiply to get rate
-retractions are abnormal

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25
Q

hemangiomas

A

birth mark, example: port wine stain, stork bite

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26
Q

Mongolian spots aka congenita

A

will disappear on own

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27
Q

erythema toxicum

A

-reaction to external reaction to unfamilair stimuli

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28
Q

reflexes of newborn (7)

A

-rooting
-swallow
-sucking
-palmar grasp
-plantar grasp
-moro (startle)
-babinski (toes fan when outer edge of foot stroked)

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29
Q

Babinski reflex should end by about

A

1 year old

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30
Q

high risk pregnancy general types of causes (2)

A

can be from pregnancy or preexisting conditions

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31
Q

preexisting high risk pregnancy conditions

A

-pregestational diabetes (pregestational 1-2%)
-gestational diabetes 6-10%

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32
Q

pregestational Diabetes Type I or II subtypes

A

-subtype A without vascular damage
-subtype B with vascular damage

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33
Q

diabetes mellitus course in pregnancy

A

-early pregnancy: blood sugar demands lower, tend to be hypoglycemic
-later pregnancy: inulin needs increase

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34
Q

Diabetes subtype slide missing

A
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35
Q

pregestational (pre-existing diabetes counseling need

A

preconception counseling

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36
Q

risk of pregestational diabetes for pregnant person

A

-can cause excess amniotic fluid
-HTN
-hypo/hyperglycemia
-preeclampsia
-infections
-PPH
-increased risk of mortality

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37
Q

risk of pregestational diabetes (pre-existing) to fetus

A

-macrosomia
-hypoglycemia at birth
-congenital anomolies (cardiac if HgA1C is high at conception)
-respiratory distress syndrome
-stillbirth
-IUGR (?

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38
Q

tx goals for diabetes during pregnancy

A

-normal glucose (65-120)
-ID and treat complications of diabetes
-routine screening (HGA1C, blood glucose monitoring, ???

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39
Q

antepartum period

A

-diet
-exercise
-insulin/ blood glucose monitoring (-fasting <95
-postprandial 1 hr <140
-postprandial 2 hr < 120)
-urinalysis
-frequent prenatal visits
-fetal surveillance
-determine delivery date/route (no later than 39 weeks, before if complications)

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40
Q

intrapartum pregestational diabetes

A

-monitor fluid status
-BG 90-110
-continuous fetal monitoring
-possible c-section

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41
Q

postpartum pregestational diabetes care

A

-glucose monitoring
-monitoring for postpartum complications (PPH, preeclampsia/ eclampsia)
-encourage breastfeeding to decrease glucose

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42
Q

Hormone given off by placenta in pregnancy that reduces insulin need

A

HPL

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43
Q

gestational diabetes

A

-79-87% of diabetes
-2nd half of pregnancy

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44
Q

gestational diabetes risk

A

??

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45
Q

Associated risk of gestational diabetes pregnant person

A

-HTN/preeclampsia
-infections

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46
Q

associated risks of gestational diabetes for baby

A

????

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47
Q

Gestational diabetes screening & diagnosis

A

-50g glucose drink given
-checked later by blood draw (130 or higher is positive)
-if positive, not diagnostic, more testing needed
-diagnostic test with 100g glucose; positive if 2 of the following: (fasting over 95, 1 hr 180, 2 hr over 155, 3 hr over 140)

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48
Q

gestational diabetes care antepartum period

A

-diet
-exercise
-bg <95 fasting, <140 1 hr postprandial, <120 2 hr postprandial
-pharmacological tx
-fetal surveillance (growth every 3-4 weeks, ?)

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49
Q

gestational diabetes intrapartum care

A

-bg 70-110
-regualr insulin infusion
-possible c-section

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50
Q

postpartum gestational diabetes care

A

-levels will return to normal
-meds d/c
-perform 2 hr Glucose Tolerance Test 6 weeks postpartum

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51
Q

HIV in pregnancy

A

-19.2 million women in 2019
-48% of new cases
-anout 5000 HIV positive women give birth per year

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52
Q

vertical transmission

A

-risk is 15-45% with no tx
-1-2% with tx
-higher risk if high viral load, prolonged ROM, chorioamnionitis, poor antiretroviral tx adherence
???

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53
Q

Care f client with HIV antepartum

A

-nutrition
-optimize immune fx
-monitor for infection
-test and treat STDs, pap smear
-provide emotional support
-refer as appropriate

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54
Q

intrapartum and post partum HIV care

A

-no fetal scalp electrode
-zidovudine
-newborn bath
-no breastfeeding

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55
Q

common pregnancy complications first trimester

A

miscarriage
ectopic pregnancy

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56
Q

common pregnancy complications 2nd trimester

A

-gestational trophoblastic disease
-???

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57
Q

common pregnancy complications 3rd trimester

A

???

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58
Q

1st trimester bleeding: miscarriage

A

-spontaneous (before 20 weeks)
-threatened (vaginal bleeding early in pregnancy)
-inevitable (vaginal bleeding and cervical dilation early in pregnancy)
-complete (passage of all products of conception)
-incomplete (not all products of conception passed
-missed (loss of pregnancy with no s/s)

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59
Q

implantation bleeding diagnosis

A

exam
ultrasound

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60
Q

implantation bleeding tx

A

-expectant management (let body pass on own)
-meds (misoprostol)
-dilation and curettage (D&C): uterus cleaned out with tools; (RhoGAM needed within 72 hrs of bleeding beginning if RH-)

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61
Q

ectopic pregnancy causes

A

-anything that compromises tubes
-STI (can cause scarring in tube)
-IUD

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62
Q

ectopic pregnancy sx

A

-unilateral pelvic exam
-spotting
-shoulder pain (possible ruptured ectopic)
-can be asymptomatic

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63
Q

ectopic pregnancy diagnosis

A

-ultrasound
-bHCG labs

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64
Q

ectopic pregnancy tx

A

-methotrexate
-surgery

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65
Q

second trimester: molar pregnancy risk factors

A

-prior molar pregnancy
-early teens or >40

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66
Q

second trimester: molar pregnancy symptoms

A

-excessive nausea and vomiting
-rapid uterine growth
-dark brown bleeding
-no fetal HR
-snowstorm appearance on ultrasound

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67
Q

second trimester: molar pregnancy diagnosis

A

-ultrasound
-bHCG high (over 100,000 early)

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68
Q

second trimester: molar pregnancy tx

A

-dilation and curettage
-close monitoring of bHCG (elevated is sign of cancer)
-RhoGAM if RH-

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69
Q

second trimester: premature cervical dilation risk

A

-prior preterm delivery
-prior procedure to cervix

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70
Q

second trimester: molar pregnancy sx

A

-usually asymptomatic
-light pink discharge
-increased pelvic pressure

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71
Q

second trimester: molar pregnancy tx

A

-cerclage
-pessary

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72
Q

third trimester bleeding: placenta previa

A

-marginal (low lying)
-incomplete (partial)
-complete (total)

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73
Q

third trimester bleeding: placenta previa risk factors

A

-previous placenta previa
-uterine scarring
-age > 35
-smoking

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74
Q

third trimester bleeding: placenta previa sx

A

-painless bleeding
-nontender uterus

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75
Q

third trimester bleeding: placenta previa diagnosis

A

-ultrasound
-no vaginal exams

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76
Q

third trimester bleeding: placenta previa tx

A

-monitor
-pelvic rest
-possible c-section
-RhoGAM if RH-

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77
Q

third trimester bleeding: placental abruption

A

premature separation of placenta from uterus

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78
Q

third trimester bleeding: placental abruption risk

A

-HTN
-abdominal trauma
-cocaine
-prior abruption
-smoking
-premature rupture of membranes
-multiple gestation

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79
Q

third trimester bleeding: placental abruption sx

A

-painful bleeding
-uterine tenderness
-firm tender rigid abdomen

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80
Q

third trimester bleeding: placental abruption dx

A

-exam
-ultrasound

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81
Q

third trimester bleeding: placental abruption tx

A

-monitor
-labs (CBC, PT/PTT/fibrinogen, kleihaur betke (KB) (tells how much RhoGAM needed), type and screen
-blood products
-delivery
-RhoGAM if RH-

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82
Q

third trimester bleeding: preterm labor (20-37 weeks) risk

A

-infection
-polyhydraminos
-smoking
-substance abuse
-HTN
-DM
-hx of preterm labor

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83
Q

third trimester bleeding: preterm labor (20-37 weeks) sx

A

-backache
-cramp
-pelvic pressure
-vaginal discharge
-urinary freq

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84
Q

third trimester bleeding: preterm labor (20-37 weeks) diagnosis

A

-vaginal exam
-fetal fibronectin

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85
Q

third trimester bleeding: preterm labor (20-37 weeks) tx

A

-tocolytics (MGSO4, nifedipine, indomethacin)
-betamethasone
-antibiotics (for group beta strep)
-monitor client and fetus wellbeing

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86
Q

when to try to stop labor if preterm

A

before 34 weeks

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87
Q

tocolytics purpose

A

stop labor

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88
Q

preterm premature rupture of membrane risk

A

-infection
-prior pre-term birth

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89
Q

preterm premature rupture of membrane sx

A

-gush or trickle of fluid

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90
Q

preterm premature rupture of membrane dx

A

-sterile speculum exam (fern, dye (could be false positive), pool)

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91
Q

preterm premature rupture of membrane tx

A

-monitor fetal wellbeing
-antibiotics
-betamethasone
-monitor for infection (frequent temp, daily CBC)

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92
Q

chorioamnionitis description

A

-bacterial infection of amniotic cavity from premature rupture od membrane, vaginitis, amniocentesis, intrauterine procedures

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93
Q

chorioamnionitis assessment

A

-uterine tenderness
-contractions
-elevated temp
-pregnant person and or fetal tachycardia
-?

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94
Q

chorioamnionitis tx

A

??

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95
Q

Gestational HTN

A

-after 20 weeks of pregnancy w/o lab abnormalities, sx, or protein in urine

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96
Q

pre-eclampsia

A

-pre-eclampsia w or w/o severe features

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97
Q

eclampsia

A

-new onset tonic clonic seizures w/out other cause wuth HTN

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98
Q

HELLP syndrome

A

-hemolysis, elevated?????

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99
Q

pre-eclampsia w/out severe features

A

-SBP > 140 and or BBP > 90 with-
-significant proteinuria 300 mg in 24 hr urine

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100
Q

pre-eclampsia with severe features

A

-SBP >160 and/or DBP >110 with
-significant proteinuria OR
-SBP > 140 or DBP > 90 WITH
-headache unresponive to meds
-vision changes
-epigastric pain unresponsive to meds
-platelets < 100k
-LFTs twice normal
-Cr > 1.1 or twice baseline
-pulmonary edema

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101
Q

vascular effects of vasospasm

A

-vascular effects
-vasoconstriction
-poor organ perfusion
-increased BP

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102
Q

kidney effects of vasospasm

A

???

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103
Q

pre-eclampsia risk factors include

A

-client <19 or >40
???

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104
Q

pre-eclampsia physical exam

A

-brisk reflexes
-decreased breath sounds
-facial edema
-lower extremity edema
-clonus
Labs (AST, ALT, LDH urine protein, creatinine, CBC (HCT, PLT))

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105
Q

preeclampsia tx

A

-antihypertensive meds
-magnesium sulfate
-betamethasone
-delivery

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106
Q

preclampsia nursing care

A

-client fetal monitoring
-monitor for signs magnesium toxicity
-client ed (NPO, bedrest, calm, quiet room, what to expect with magnesium)

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107
Q

Magnesium toxicity sx

A

-hypotension
-areflexia
-respiratory depression
-oliguria
-shortness of breath
-chest pain
-slurred speech
-confusion

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108
Q

magnesium toxicity intervention

A

-stop magnesium
-give calcium gluconate
-draw magnesium level

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109
Q

HELLP syndrome assessment

A

-epigastric pain/right upper quadrant
-severe edema
-sx of preeclampsia
-n/v
-general malaise

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110
Q

HELLP syndrome labs

A

-hemolysis of RBCs: LDH>600
-thrombocytopenia :platelets <100 k
-elevated liver enzymes: alanine amniotransferase and serum aspartate 2x normal

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111
Q

HELLP syndrome management

A

-ICU
-Magnesium sulfate to reduce BP and prevent seizures
-reverse thr???

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112
Q

hyramnios: oligohydrmnios

A

not enough amniotic fluid, lungs may not develop properly, small baby

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113
Q

hydramnios: polyhydramnios

A

-too much amniotic fluid; more likely for breech, cord prolapse, larger uterus

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114
Q

fetal demise assessment

A

-decreased fetal movement
-absence of fetal heart tones
-lack of fetal growth
-decrease in fundal height

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115
Q

fetal demise nursing

A

-supportive care
-assist with delivery
-support naming baby/holding after delivery
-chaplain

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116
Q

postterm pregnancy (after 42 weeks)

A

-monitor for placental insufficiency
-increased risk of macrosomia
-stillbirths
meconium aspiration risk

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117
Q

when can you start giving fruit juice to children?

A

at least 6 months old, preferably older

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118
Q

how to determine if infant adequately hydrated in first week of life

A

should have as many we t diapers as they are days old

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119
Q

after first week how many wet diapers per day indicate adequate hydration

A

6-8

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120
Q

preschool age

A

3-5

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121
Q

IgE

A

allergic/hypersensitivity

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122
Q

antigens include (3)

A

pathogens
food proteins
pollens

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123
Q

responsible for humoral immunity

A

B lymphocytes

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124
Q

produce antibodies (immunoglobins (Ig) that bind to and destroy specific )

A

B lymphocytes

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125
Q

autoimmunity result from

A

inability to distinguish self from non-self, so immune response is directed at normal cells

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126
Q

autoimmune disease risk factors

A

genetics
gender

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127
Q

Different Igs ????

A
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128
Q

monogenetic inherited Primary Immunodeficiency can be ________ or __________ based

A

humoral or T-lymphocyte

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129
Q

secondary (acquired) immunodeficiency causes (7)

A

-cancer
-radiation
-systemic infection
-stress
-malnutrition
-monoclonal antibody tx
-aging

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130
Q

anaphylaxis characteristics (2)

A

-extreme vasodilation
-bronchoconstriction

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131
Q

tx for covid in children

A

-high flow O2
-dexamethasone
-CANNOT have convalescent plasma

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132
Q

Rheumatic fever caused by

A

reaction to a group A hemolytic strep infection

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133
Q

if pt. has had rheumatic fever, must

A

always be followed by cardiologist

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134
Q

rheumatic fever causes

A

inflammation of heart, blood vessels, brain, joints
-can gradually damage left heart valves

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135
Q

immediate nurse care for suspected rheumatic fever (sx 10 days after strep) (2)

A

-throat culture
-blood work

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136
Q

rheumatic fever tx

A

-penicillin for full 10 day course
-pt. may eventually need valve replacement or surgical intervention

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137
Q

asthma

A

-chronic inflammatory disorder of respiratory system

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138
Q

asthma typically presents before age ______

A

5

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139
Q

asthma triggers

A

-environmental factors
-immune response
-genetics

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140
Q

asthma assessment (4)

A

-wheezing
-breathlessness
-chest tight
-coughing

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141
Q

asthma cellular process

A

-allergen invades mast cells, releases histamine and leukotrienes

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142
Q

asthma tx

A

continuous nebulization of inhaled Beta2 agonist and IV corticosteroids to reduce inflammation; may also take PO corticosteroids

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143
Q

severe asthma case tx

A

endotracheal tube and mechanical ventilation

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144
Q

anemia is a disorder of_______ and can be classified as a reduction in the # of __________

A

RBCs
erythrocytes

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145
Q

kinds of anemia in children

A

-acute blood loss anemia
-anemia of a cute infection
-aplastic anemia, hypoplastic anemia from suppression of the hemopoietic activity (can be congenital or acquired)
-macrocytic anemias occur from folic acid defidiency
-pernicious anemia occurs from vitamin B 12 deficiency

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146
Q

causes of iron deficiency anemia

A

-poor diet
-blood loss
-colitis
-adolescent menses

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147
Q

lab results for iron deficiency anemia

A

Hgb<11g/100mL of blood
Hct<33%
RBCs are macrocytic & hypochromic with irregular shape (called polkilocyte)

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148
Q

nursing care for anemia

A

-supportive
-packed RBCs
-diet mod (high iron and vitamin C)
-iron supplement

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149
Q

iron supplement admin

A

-give 1 hour before or 2 hrs after milk
-use straw (teeth staining)
-typically 4-6 weeks (or more)
-teach family diet, med admin, preventing constipation, dental care, blood

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150
Q

iron dextran admin

A

-IM
-Z trach method

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151
Q

hemophilia cause

A

inherited, sex linked recessive trait

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152
Q

Factor VIII

A

intrinsic factor of coagulation (thromboplastin)

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153
Q

will child with hemophilia is bleeding, will it clot

A

yes, eventually

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154
Q

Hemophilia A

A

-bleeding and bruising may not appear til child walks, plays
-GI bleeding, nosebleeds, peritoneal cavity
-joint pain and soft tissue bleeding may occur

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155
Q

hemophilia A lab work:

A

-normal platelet
-normal PT
whole blood time may be normal or prolonged
-thromboplastic generator test is abnormal
-abnormal PTT

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156
Q

tx for hemophilia A

A

Factor VIII via whole blood, fresh or frozen plasma, or concentrate of Factor VII

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157
Q

concentrate of Factor VII for hemophilia A

A

-powder that is reconstituted at home

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158
Q

other hemophilia

A

-Von Willibrand Disease: platelets cannot aggregate, prolonged bleeding time, hemorrhages of mucous membranes

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159
Q

Christmas disease (aka hemophilia B/Factor IX deficiency (a sex linked trait)) tx

A

factor IX

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160
Q

hemophilia C/Factor X deficiency (autosomal recessive trait)

A

-mild sx
-plasma thromboplastin antecedent deficiency

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161
Q

hemophilia C/Factor X deficiency (autosomal recessive trait) bleeding episode tx

A

-desmopressin (DDAVP)
-fresh blood
-plasma

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162
Q

needed for school readiness (3)

A

-immunizations
-vision & hearing
-dental

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163
Q

UTI material ???

A
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164
Q

Celiac disease ????????

A
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165
Q

Cerebral Palsy caused by

A

nonprogressive disorders of upper motor neuron impairment

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166
Q

cerebral palsy sx

A

-motor
-ocular
-seizures
-cognitive d/o
-hyperactivity

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167
Q

CP physiological cause

A

-abnormal brain development
-damage to developing brain leading to cell destruction of motor tracts

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168
Q

CP caused by

A

-maternal infections (cytomegalovirus, toxoplasmosis)
-birth injury

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169
Q

other causes that can leadto CP like sx

A

-head injury from child maltreatment or automobile accidents
-infections (like meningitis or encephalitis)

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170
Q

CP types (4)

A

-pyramidal (spastic)
-extrapyramidal (dyskinetic)
-ataxic
-mixed

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171
Q

preterm gestational age

A

delivered before 37 0/7 weeks

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172
Q

late preterm gestational age

A

34 0/7 to 36 6/7 weeks

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173
Q

early term gestational age

A

37 0/7 to 38 6/7 weeks

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174
Q

term gestational age

A

39 0/7 to 40 6/7 weeks

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175
Q

late term gestational age

A

41 0/7 to 41 6/7 weeks

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176
Q

post term

A

42 0/7 weeks +

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177
Q

Newborn meds

A

-vitamin K for clotting
-Erythromycin eye ointment
-Hepatitis B vaccine

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178
Q

vitamin K admin in neonates

A

IM in vastus lateralus

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179
Q

Hepatitis B admin

A

-within first 12 hours of birth
-needs parental consent
-given IM in vastus lateralus on other side from vitamin K
-hepatitis Ig also given if mother has Hepatitis B

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180
Q

Newborn screenings

A

-hearing before discharge
-critical congenital heart disease (CCHD) (pulse ox on right hand and either foot, both should be above 95 with less than 3 % difference; failure leads to more screenings)
-bilirubin
-metabolic screen
-laboratory tests

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181
Q

betamethasone

A

-given to rapidly mature fetal lungs
-given to pregnant person IM q 24 hrs x2

182
Q

physiologic jaundice

A

-after 24 hours since birth
-disappears in 1-2 weeks
-from immature liver

183
Q

pathologic jaundice

A

-occurs before 24 hrs since birth
-blood compatibility
-kernicterus: neurological irreversible damage from high bilirubin levels

184
Q

other screenings

A

-sickle cell
-PKU (protein metabolism defect)
-cystic fibrosis
-thalassemia (alpha and beta)

185
Q

lab tests

A

-BG
-blood type

186
Q

newborn care

A

-ID bands
-birth registration
-breastfeeding support
-newborn bath
-circumcision care
-education

187
Q

newborn care parent education

A

-bulb suction
-feeding cues
-car seat safety
-umbilical cord care
-SIDs prevention

188
Q

when should first feeding occur?

A

within first 30 minutes after birth

189
Q

what symptom of infection is different for newborns compared to adults

A

subnormal temperature is a sign of infection in newborns

190
Q

why are newborns given vitamin K

A

to enable their blood to clot since they don’t yet have the bacteria in their guts that makes vitamin K in older people

191
Q

indicators of adequate fluid intake in infants

A

-wetting diaper 6-8 times per day
-sleeping between feedings
-no excessive crying
-gaining weight

192
Q

Newborn stool progression

A

1) meconium (dark, tarry, thick)
2) transitional after first 24 hrs. (dark green to yellow, maybe seedy texture)
3) 3-4 days of transitional stool
4) color and consistency of stool determined by diet of infant

193
Q

infant stool after transitional stool if breast fed

A

loose, watery, mustard-colored stool

194
Q

infant stool after transitional stool if formula fed

A

soft, more formed pale yellow to yellowish brown to light brown or brownish green stool

195
Q

Breast fed babies in first 5 days of life typically poop _____ times a day

A

as many times as they are days old

196
Q

who has more extracellular fluid, infants or adults, and what are the implications?

A

infants are more prone to dehydration because they have less ECF

197
Q

source of infant calcium

A

milk/formula

198
Q

iron source for newborns

A

born with 3-month store, enough to last until hemoglobin is fully developed to produce iron

199
Q

vitamin supplement recommended for newborns

A

vitamin D

200
Q

formula fed babies poop _____ times/day

A

3 - 4

201
Q

newborns lose _____% of their weight initially

A

10

202
Q

newborns should regain lost weight by

A

day 10-14 of life

203
Q

initial thin yellow watery breast milk

A

colostrum

204
Q

colostrum contents (7)

A

sugar
fat
water
vitamins
minerals
protein
maternal antibodies

205
Q

how long colostrum lasts

A

3-4 days

206
Q

next milk after colostrum

A

transition milk

207
Q

when transition milk ends

A

10 to 15 days after birth

208
Q

third stage of breast milk

A

true milk

209
Q

advantages of breastfeeding for parent

A

-releases oxytocin, which contracts/involutes uterus, protects against cancer
-helps with weight loss
-cheaper than formula
-oxytocin enhances bond between mother and baby

210
Q

school aged is ages:

A

6-12

211
Q

expected growth curve

A

gradual increase/stable

212
Q

biggest problem for school-aged kids

A

cavities

213
Q

age brain growth complete

A

10

214
Q

fine motor coordination in school age

A

becomes refined

215
Q

school-aged vision

A

globe reaches final shape, adult vision achieved

216
Q

eruption of permanent teeth and growth of jaw not being correlated cn cause

A

malocclusion with teeth misalignment

217
Q

dental development in school age

A

deciduous teeth lost, permanent teeth erupt

218
Q

number of teeth gained on average during school age

A

28

219
Q

____________ (part of brain) that transmits enzyme to the __________ (part of brain) to begin production of gonadotropic horrmones, initiating changes in genitals (puberty)

A

hypothalamus
anterior pituitary gland

220
Q

Tanner stages track _________

A

puberty/sexual development

221
Q

typical secondary sex characteristics 9-11 y.o. males

A

prepubertal weight gain

222
Q

typical secondary sex characteristics 9-11 y.o. females

A

-breasts: elevation of papilla with breast bud formation; areolar diameter enlarges

223
Q

typical secondary sex characteristics 11-12 y.o. males

A

-sparse growth of straight, downy, slightly pigmented hair at base of penis
-scrotum becomes textured, growth of penis and testes begins
-sebaceous gland secretion increases
-perspiration increases

224
Q

typical secondary sex characteristics 11-12 y.o. female

A

-straight hair along the labia
-vaginal epithelium becomes cornified
-pH of vaginal secretions becomes acidic; slight mucous vaginal discharge present
-dramatic growth spurt

225
Q

typical secondary sex characteristics 12-13 y.o. male

A

-pubic hair present across pubis
-penis lengthens
-dramatic linear growth spurts
-breast enlargement may occur

226
Q

typical secondary sex characteristics 12-13 y.o. females

A

-pubic hair grows darker, spreads over entire pubis
-breasts enlarge, still no protrusion of nipples
-axillary hair present
-menarche

227
Q

Physical development age 6

A

-constant motion
-skipping is new skill
-first molars

228
Q

Physical development age 7

A

-central incisors erupt
-awareness of learned gender roles seen in play
-spends time in quiet play

229
Q

Physical development age 8

A

-coordination definitely improved
-eyesight fully develops
-playing with friends becomes important

230
Q

Physical development age 9

A

all activities done with friends

231
Q

Physical development age 10

A

coordination improves

232
Q

Physical development age 11

A

active, but awkward and ungainly

233
Q

Physical development age 12

A

coordination improves

234
Q

psychosocial and cognitive development age 6

A

-1st grade teacher becomes authority figure
-adjustment to all-day school, lead to nervousness (leading to fingernail biting, etc.)
-defines word by their use

235
Q

psychosocial and cognitive development age 7

A

-quiet year; striving for perfection leads to this year being called an eraser year
-learns conservation
-can tell time
-can make simple change ($)

236
Q

psychosocial and cognitive development age 8

A

-best friends
-whispering, giggling
-can write in cursive or print
-understands past, present, future

237
Q

psychosocial and cognitive development age 9

A

-friend or club age
-clubs are all boy or girl, form and disband quickly

238
Q

psychosocial and cognitive development age 10

A

-ready for camp away from home
-collecting age
-like rules
-ready for competitive games

239
Q

psychosocial and cognitive development age 11

A

-insecure with peers of genders to which they feel attraction
-repeats off-color jokes

240
Q

psychosocial and cognitive development age 12

A

-sense of humor is present
-social and cooperative

241
Q

school age developmental task

A

industry vs. inferiority (how to do things well)

242
Q

not achieving task of industry can cause

A

difficulty tackling new situations

243
Q

school age cognitive development

A

transition from preoperational thought stage to concrete operational thought stage

244
Q

moral/spiritual development in school age children

A

-begin to mature in terms of moral development as they enter preconventional reasoning
-focused on following rules and following authorities

245
Q

health promotion / safety for school aged- children: motor vehicles

A

-encourage children to use seat belts and a booster seat if needed; model seat belt use
-teach street-crossing safety; stress that streets are no place for roughhousing, pushing, shoving
-teach parking lot and school bus safety

246
Q

health promotion / safety for school aged- children: bicycles

A

-teach bicycle safety, including wearing a helmet and not giving “passengers” rides

247
Q

health promotion / safety for school aged- children: tech

A

-safe and supervised use
-phone/gaming/internet

248
Q

health promotion / safety for school aged- children: community

A

-teach children to avoid unsafe areas (train yards, grain silos, back alleys)
-stress that children should not go with strangers

249
Q

health promotion / safety for school aged- children: sexual safety

A

-teach to say no to people who touch genitals or anywhere they do not want
-do not meet with people from internet
-for older school-aged kids, teach safe sex

250
Q

health promotion / safety for school aged- children: motor vehicles burns

A

-teach safety with candles, matches, campfires
-teach safety around cooking
-teach to wear sunblock
-teach not to climb electric poles

251
Q

health promotion / safety for school aged- children: falls

A

-teach that some activities are hazardous
-teach skateboard, scooter, and skating safety (helmets)

252
Q

health promotion / safety for school aged- children: sports injuries

A

-teach the importance of wearing appropriate equipment for sports
-teach that child should not play to the point of exhaustion or in a sport beyond physical capability
-trampoline use should be supervised by adult
-don’t swim beyond limits of capabilities

253
Q

health promotion / safety for school aged- children: drugs

A

-teach the child to avoid tobacco, alcohol, drugs
-teach to take prescription meds as directed

254
Q

health promotion / safety for school aged- children: firearms

A

-teach safety
-keep firearms locked in cabinets with bullets separate from gun

255
Q

immunizations for school aged

A

???

256
Q

school health screens (7)

A

-height
-weight
-BMI
-hearing
-vision
-posture (scoliosis)
-esper (for substance abuse/mental health)

257
Q

school aged nutrition

A

-variety of food
-ensure enough food (free lunches, breakfast, food pantries, summer/vacation outreach)
-let children prep food and if able have a choice in meal selection

258
Q

school aged activities

A

-reading
-games
-peer time
-sports
-bike riding

259
Q

sleep

A

-needs vary among individual children
-younger school aged children typically require 10-12
-older school aged children require 10-12
-most 6-year-olds need quiet time after school
-may have more night terrors as school begins

260
Q

how do school aged children do with rules

A

thrive

261
Q

anaphylaxis

A

-acute type 1 sensitivity reaction
-leads to vascular collapse
-give epipen asap
-transport to hospital after epipen

262
Q

rheumatic fever caused by

A

strep

263
Q

rheumatic fever affects what organ?

A

primarily heart; will need to be followed by cardiologist for life after rheumatic fever

264
Q

asthma

A

-triggered by allergies
-treated by beta 2 agonist?
-sx don’t include fever (look for pneumonia if fever)

265
Q

iron deficient anemia

A

-sx hypoxia leading to lethargy
–excessive milk with not enough food can cause anemia after 6 months
-iron supplement through straw if PO, Z-trach if IM

266
Q

hemophilia

A

-sx: bleeding profusely from circumcision
-may not know that they have hemophilia

267
Q

celiac disease diagnosed by

A

endoscopy

268
Q

benefits of breast feeding for baby

A

-maternal antibodies
-protects against GI and respiratory infections
-reduces allergies
-decrease risk of obesity later in life
-may reduce SIDS

269
Q

after placenta delivered, how are hormones affected

A

-estrogen drops rapidly
-progesterone increases

270
Q

progesterone stimulates what hormone

A

prolactin

271
Q

what are prolactin’s effects

A

body stimulated to make breast milk

272
Q

sucking from infant on nipple stimulates

A

the hypothalamus, which signals the posterior pituitary gland to release oxytocin, which causes mammary glands to contract and widen

273
Q

let down reflex

A

anterior pituitary releases prolactin to stimulate breast milk production

274
Q

4 steps to good latch

A

1) nose on target with nipple
2) tickle lower lip with nipple
3) wait for wide mouth to latch
4) lips flanged (turned out) and chin tucked

275
Q

best way to know infant is getting enough milk

A

-infant has wet diapers
-infant seems content between feedings

276
Q

possible causes for infant not sucking well

A

-possibly from analgesic from labor
-mother may be trying to feed when infant is not hungry
-infant exhausted by crying from hunger

277
Q

tx if breastfeeding mother reports engorgement

A

-encourage baby to suck
-apply warm packs to breast or have mother take warm shower before feeding to soften breast tissue

278
Q

pt. ed for breastfeeding (3)

A

-provide immediate support if problems arise
-provide info regarding techniques for burping breastfed baby
-support for a mother who is breastfeeding multiple babies

279
Q

how to encourage effective breastfeeding (4)

A

-anticipate potential problems and suggest methods for resolving
-provide info on supplemental feedings
-provide info for a mother who works outside home
provide info on weaning

280
Q

nursing care for sore nipples

A

-prevent or relieve engorgement (regular feeding)
-promote healing of sore nipples

281
Q

freshly expressed/pumped breastmilk storage ed

A

-counter for 4 hours
-refrigerator 4 days
-freezer 6-12 months

282
Q

previously frozen breastmilk storage

A

-counter for 1-2 hours
-refrigerator for 1 day
-never refreeze

283
Q

unfinished bottle of breast milk lasts

A

2 hrs

284
Q

how to know formula adequate

A

-same as breast milk
-hunger cues (smacking lips, putting fist in mouth

285
Q

how often to feed formula fed baby

A

every 3-4 hours

286
Q

how often to feed breast fed baby

A

every 2-3 hrs

287
Q

if infant sucks bottle, but then stops and cries

A

check bottle to make sure it isn’t clogged or too fast (should drop at 1 drop per second

288
Q

infant does not burp well after feeding

A

-check that infant needs to burp
-check that parents are effectively burping infant

289
Q

parent reports baby is constipated

A

-examine stool
-assure parent and explain that formula fed babies have more formed stool and that straining is normal

290
Q

formula feeding time limits (from start of feeding and from time prepared) if unrefrigerated

A

-within 1 hr of start of feeding
-within 2hrs. of preparation

291
Q

if prepared formula won’t be used within 2 hrs, then _________

A

refrigerate for up to 24 hrs

292
Q

once feeding has started, what should be done with leftovers in the bottle

A

throw out because bacteria can grow because formula mixes with saliva

293
Q

Discharge planning to do list

A

-review feeding plan (answer questions)
-check to see if home care referral or visit has been scheduled
-ensure mother has phone #s to get questions answered before visit
-review adequate fluid criteria
-supply phone # of local support groups
-ensure mother has appt. with baby’s PCP or a phone # to make the appt.

294
Q

CLAMS acronym for sutures and fontanelles of newborn

A

Coronal Suture
Lambdoid suture
Anterior fontanelle
Metopic suture
Sagittal suture

295
Q

coronal suture

A
296
Q

Lambdoid suture

A
297
Q

Anterior fontanelle

A
298
Q

Metopic suture

A
299
Q

Sagittal suture

A
300
Q

cephalohematoma

A

a bruise from birth on the head that does not cross the suture line caused by bleeding below the periosteum

301
Q

cephalohematoma is more common in births assisted by ________ or __________

A

vacuum or forceps

302
Q

infants with cephalohematomas are at increased risk for ________ because __________

A

-jaundice
-because of the breakdown of hemoglobin as the bruise resolves

303
Q

swelling that crosses the suture line caused by fluid accumulation above periosteum caused by force of delivery

A

caput succedaneum

304
Q

extensive swelling across suture lines due to rupture of emissary veins

A

subgaleal hemorrhage

305
Q

congenital anomoly in which the scalp has not formed properly

A

cutis aplasia

306
Q

implication of cutis aplasia

A

look for other atypical features (may be part of a syndrome)

307
Q

implications of ear formation issues

A

-may be normal
-minor variants may be associated with genetic conditions, hearing loss, or kidney anomalies

308
Q

preschool Erickson

A

initiative vs. guilt/shame

309
Q

preschool Piaget stage

A

preoperational

310
Q

preschool vaccines

A

Varicella
DTao
Influenza
MMR

311
Q

best predictor of child’s ability to fight infection

A

absolute neutrophil count (ANC)

312
Q

Tx environment for status asthmaticus

A

ICU usually

313
Q

rescue med for asthma

A

beta2 adrenergic agonist like albuterol

314
Q

new asthma pt. teahing

A

avoid triggers (allergens, cigarette smoke)

315
Q

BUN range

A

5-20

316
Q

creatinine range

A

0.6-1.2

317
Q

most important urology/kidney labs

A

BUN
creatinine

318
Q

glomerulonephritis

A

glomeruli are damaged and inflamed

319
Q

sx of glomerulonephritis

A

-blood in urine (hematuria)
-protein in urine

320
Q

difference between nephrotic syndrome and acute glomerulonephritis

A

glomerulonephritis: HTN and high levels of hematuria

321
Q

early improvement in glomerulonephritis

A

increased urine output

322
Q

priority nursing in pt. with glomerulonephritis

A

weight (to track fluid balance)

323
Q

newborn priorities (8)

A

-initiating and maintaining respirations
-establishing extrauterine circulation
-maintaining electrolyte & fluid balance
-regulating temperature
-adequate nutritional intake
-establishing waste elimination
-preventing infection
-establishing parental-infant bond

324
Q

initiating/maintaining newborn respirations (5)

A

-resuscitation
-airway
-lung expansion
-ventilation maintenance
-drug therapy (narcan if opioids present)

325
Q

extrauterine circulation for newborn

A

chest compression if no HR or HR<60 bpm

326
Q

newborn fluid and electrolyte balance (2)

A

check for
-hypoglycemia
-dehydration

327
Q

newborn temperature regulation

A

-radiant heat sources
-incubators
-skin-to-skin care

328
Q

nutrition (2)

A

-IV
-tube feedings

329
Q

risk factors for respiratory difficulty in newborns (13)

A

-low birth weight
-maternal history of diabetes
-premature rupture of membranes
-maternal use of barbiturates or narcotics close to birth
-meconium staining
-irregularities detected by fetal heart monitor during labor
-low Apgar score (<7 at 1 or 5 minutes)
-post term
-small for gestational age
-breech birth
-multiple birth
-chest, heart, or respiratory tract anomalies

330
Q

respiratory distress assessment scale

A

0 no distress
1-3 mild distress
4-6 moderate distress
7-10 severe distress

331
Q

preterm infant defined

A

born prior to 37 0/7 weeks

332
Q

early preterm gestation age

A

24 - 33 6/7 weeks

333
Q

late preterm gestational age

A

34 -36 6/7 weeks

334
Q

risk factors for preterm birth

A

-low socioeconomic status
-poor nutrition
-lack of prenatal care
-multiple pregnancies
-previous early birth
-race (people of color are more likely)
-tobacco use
-age of parents (esp. younger than 20)
-order of birth (more likely in first pregnancies or beyond the 4th pregnancies
-closely spaced pregnancies
-abnormalities of birthing parent’s reproductive system, such as intrauterine septum
-infections (esp. UTI)
-pregnancy complications (premature rupture of membranes or premature separation of placenta)
-early induction of labor
-elective c-section

335
Q

preterm assessment

A

-respirations irregular w/ apnea
-does not frequently cry, or weak and high pitched
-body temp below normal
-poor suck and swallow reflexes
-diminished bowel sounds
-head disproportionately larger than chest circumference
-ruddy, possibly transparent skin
-vernix present if born after 28 weeks, lacking if before
-lanugo extensive in late preterm, scant if prior
-small fontanelles
-neuro system difficult to evaluate due to immutarity

336
Q

interventions for preterm infant

A

-monitor v/s every 2-4 hrs
-maintain cardiopulmonary fx
-maintain airway, oxygen as prescribed
-monitor intake, output, electrolyte balance, daily weight
-maintain body temperature
-provide appropriate stimulation, touch, cuddling

337
Q

complications of preterm birth: anemia

A

-effective production of RBCs begins after 32 weeks
-frequent blood draws
-delayed cord clamping may help…IF ABLE

338
Q

complications of preterm birth: acute bilirubin encephalopathy

A

kernicterus: destruction of brain cells from indirect or unconjugated bilirubin

339
Q

complications of preterm birth: persistent patent ductus arteriosus

A

-from decreased surfactant
-more difficult to move blood from the pulmonary artery to the lungs
-can’t close the ductus arteriosus

340
Q

complications of preterm birth: periventricular / intraventricular hemorrhage

A

caused by fragile capillaries and immature cerebral vascular development

341
Q

complications of preterm birth: other

A

-respiratory distress syndrome
-apnea
-retinopathy of prematurity

342
Q

Preterm nutrition: feeding schedule

A

small feeds (1-2 mL) every 2-3 hrs

343
Q

complications of preterm birth: nutrition: gavage feeding

A

-babies having difficulty coordinating suck and swallow before 32 weeks (no gag reflex)

344
Q

complications of preterm birth: nutrition: formula

A

22 cal.oz.

345
Q

complications of preterm birth: nutrition: breast milk

A

increases immune defenses

346
Q

infants who are small for gestational age (SGA): define

A

-birth weight below 10th percentile for gestational age
-low birth weight (<2500 grams at birth)
-very low birth weight (<1500 grams at birth)
-extremely low birth weight (<1000 grams at birth)
-can be preterm, term, or post term

347
Q

due to intrauterine growth restriction (IUGR)

A

-adequate nutrition in pregnancy
-higher in adolescents
-placental issues
-smoking
-drug use

348
Q

small for gestational age infant: prenatal assessment

A

-fundal height
-ultrasound

349
Q

small for gestational age infant: appearance

A

-overall wasted appearance
-lack subcutaneous fat
-poor skin turgor
-proportionally large head
-dull hair
-sunken abdomen
-umbilical cord may be dry and appear yellow
-prolonged acrocyanosis
-monitor for respiratory distress, temperature instability

350
Q

small for gestational age infant: lab findings

A

-elevated Hct, increased RBCs (jaundice risk)
-hypoglycemia (BG<45 mg/dL)

351
Q

large for gestational age (LGA) infant: define

A

birth weight above 90th percentile

352
Q

large for gestational age (LGA) infant: cause

A

exposure to an overproduction of nutrients and growth hormones in utero

353
Q

large for gestational age (LGA) infant risk factors

A

-maternal obesity
-maternal diabetes

354
Q

large for gestational age (LGA) infant prenatal assessment (2)

A

-fundal height
-ultrasound

355
Q

large for gestational age (LGA) infant: appearance

A

-“normal”, but may be immature
-may have bruising
-may have caput, cephalohematoma, or molding

356
Q

large for gestational age (LGA) infant concerns

A

-birth trauma/injury
-respiratory distress
-hypoglycemia
-cardiovascular dysfunction from increased risk for transposition of the great vessels and/or polycythemia (jaundice)

357
Q

large for gestational age (LGA) infant skin assessment

A

-for jaundice, ecchymosis, erythema
-rationale: bruising from birth from large size; polycythemia can cause ruddiness; ecchymosis important to document because jaundice may occur from breakdown of ecchymotic collections of blood

358
Q

large for gestational age (LGA) infant assessment of upper extremities

A

-lack of Moro reflex may be caused by broken clavicle (may find crepitus or swelling)
-Erb palsy from edema of the cervical nerve plexus

359
Q

large for gestational age (LGA) infant assessment of anterior chest for asymmetry or unilateral lack of movement

A

-can be caused by edema of the phrenic nerve
-cervical nerve may be stretched by birth of wide shoulders

360
Q

large for gestational age (LGA) infant eye assessment

A

-unresponsive or dilated pupils
-assess for vomiting, bulging fontanelles, high-pitched cry suggestive of increased intracranial pressure
-caused by pressure on head during birth

361
Q

large for gestational age (LGA) infant assess for seizure

A

-jitteriness
-lethargy
-uncoordinated eye movements
-likely caused by intracranial pressure

362
Q

postterm newborn define

A

born after 42 weeks

363
Q

postterm appearance

A

-dry cracked skin
-absence of vernix
-long fingernails
-meconium staining on skin, nails, umbilical cord
-lack of subcutaneous fat

364
Q

postterm concerns

A

-difficulty establishing respirations
-polycythemia
-hypoglycemia
-difficulty with temperature regulation

365
Q

respiratory distress syndrome causes

A

-meconium syndrome
-sepsis
-slow transition to extrauterine life
-pneumonia

366
Q

respiratory distress sx

A

-tachypnea
-nasal flaring
-expiratory grunting
-intercostal, subxiphoid, and subcostal retractions
-decreased breath sounds
-apnea
-pallor and cyanosis
-hypothermia
-poor muscle tone

367
Q

respiratory distress syndrome tx

A

-surfactant replacement
-o2 admin
-ventilation
-nitric oxide
-extracorporeal membrane oxygenation (ECMO) (rare)
-supportive care

368
Q

surfactant replacement for respiratory distress syndrome

A

-synthetic surfactant sprayed into an ET tube with a syringe or catheter
-infant tipped in an upright position
-avoid suctioning

369
Q

o2 admin for respiratory distress syndrome

A

-CPAP
-PEEP

370
Q

nitric oxide for respiratory distress syndrome

A

-potent vasodilator
-reduces pulmonary resistance
-increases o2

371
Q

newborn illness: transient tachypnea

A

-due to delayed absorption of alveolar fluid in lungs
-tachypnea, mild retractions, nasal flaring
-onset at 2 hrs of life, peaks at 36 hours and resolves by 72 hours

372
Q

newborn illness: meconium aspiration syndrome

A

-aspiration of meconium in utero or at first breath
-may have difficulty establishing respirations at birth, severe respiratory distress (tachypnea, retractions, cyanosis)
-management: amnioinfusion for thick meconium; may need O2 and ventilation

373
Q

newborn illness: apnea

A

cessation of repirations for more than 20 seconds

374
Q

SIDS

A

-contributing factors:?
-should sleep on back

375
Q

newborn illness: apparent life-threatening event

A

infant w/noticeable color change, some degree of apnea and decreased tone

376
Q

hyperbilirubinemia types

A

-physiologic
-pathologic

377
Q

hyperbilirubinemia: pathologic

A

-Rh incompatibility: affects next pregnancy; Rho immune globulin (RhoGAM)
-ABO incompatibility: hemolysis occurs at birth if parent type O and fetus type A/B

378
Q

hyperbilirubinemia assessment

A

-jaundice (report signs in first 24 hrs to provider)
-elevated serum bilirubin levels
-poor muscle tone
-poor sucking reflex
-enlarged liver
-lethargy

379
Q

hyperbilirubinemia management

A

-monitor bilirubin level
-early feedings
-maintain hydration
-phototherapy
-exchange transfusion (RARE)

380
Q

hyperbilirubinemia phototherapy

A

-expose as much skin as possible
-shield eyes
-remove eye shields and probes at least once per shift
-monitor temperature frequently
-increase fluids as prescribed
-monitor input and output (bright green stools are normal, monitor skin for breakdown)
-reposition Q2H

381
Q

newborn illeness: twin to twin transfusion

A

-monochorionic twins
-more blood shunts to one twin over the other

382
Q

newborn illness: necrotizing enterocolitis

A

-premature newborns at greatest risk
-necrotic patches develop on bowel

383
Q

retinopathy of prematurity

A

-ocular disease that results in partial or total blindness
-due to vasoconstriction of immature retinal blood vessels
-due to high concentrations of O2 (keep below 70%)

384
Q

newborn at risk due to maternal infections: beta-hemolytic group b streptococcal

A

-universal screening between 36 0/7 - 37 6/7 weeks
-if birthing parent is positive, then antibiotics in labor
-monitor for s/s of sepsis after birth (pallor, tachypnea, tachycardia, poor feeding, temperature instability)

385
Q

ophthalmia neonatorum

A

-eye infection due to either Neisseria Gonorrhoeae or Chlamydia Trachomatis
-erythromycin eye ointment

386
Q

newborn at risk due to maternal infections: hepatitis B

A

-can be transmitted during delivery
-if birthing parent is positive the newborn should be bathed as soon as possible to remove infected secretions
-newborn receives serum Hepatitis B immune globulin (HBIG) in addition to hepatitis B vaccine
-can breastfeed after HBIG given

387
Q

newborn at risk due to maternal infections Herpes simplex virus

A

-suppression started at 36 weeks if birthing parent with hx of HSV
-thorough exam on admission for labor
-c-section if lesions present

388
Q

newborn at risk due to maternal infections: infant of diabetic birthing parent

A

-macrosomia
-cardiac anomalies

389
Q

newborn at risk due to maternal infections: complications

A

-respiratory distress syndrome
-neonatal hypoglycemia (jitteriness, hypothermia, poor muscle tone, lethargy, apnea, cyanosis)

390
Q

newborn at risk due to maternal infections infant of diabetic: tx management

A

-feed early
-avoid bolus of glucose to prevent rebound hypoglycemia
-maintain body temperature

391
Q

newborn at risk due to maternal infections infant of mom w/HIV: transmission

A

-across placental barrier
-during labor and delivery
-via breast milk

392
Q

newborn at risk due to maternal infections infant of mom w/HIV: risk reduction

A

-early identifiction in pregnancy
-antiretroviral meds
-monitoring of maternal labs
-avoid invasive procedures in labor

393
Q

newborn at risk due to maternal infections infant of mom w/HIV: interventions

A

-cleanse newborn’s skin before invasive procedures
-administer zidovudine to newborn
-repeated HIV culture (may be asymptomatic for several years…monitor for early signs of immunodeficiency

394
Q

neonatal abstinence syndrome sx

A

-irritable
-frequent sneezing
-disturbed sleep
-shrill, high-pitched cry
-constant movemnet
-tachypnea
-tremors
-vomiting
-diarrhea
-hyperreflexia, clonus

395
Q

Scoring Newborn Respiratory Distress

A

-Chest movements (0= synchronized respirations; 1= lag on respirations; 2= seesaw respirations)
-Intercostal retractions (0= none; 1= just visible; 2= marked)
-Xiphoid retractions (0=none; 1=just visible; 2= marked)
-Nares dilation (0= none; 1= minimal; 2= marked)
-Expiratory grunt (0= none; 1= audible by stethoscope; 2= audible by unaided ear)

396
Q

Neonatal abstinence syndrome: non pharm management

A

-quiet dark environment
-ESC:
Eat: poor eating from NS?
Sleep: sleep for <1hr after feeding
Console: does NAS cause infant to not be able to be consoled

397
Q

neonatal abstinence syndrome pharmacological management

A

-morphine
-phenobarbital
-methadone

398
Q

newborn with Fetal Alcohol Syndrome general info

A

-causes placenta to deteriorate
-IUGR
-Cognitive challenges
-Cerebral palsy

399
Q

FAS assessment

A

-facial changes
-abnormal palmar creases
-congenital heart defects
-respiratory distress
-irritability & hypersensitivity to stimuli
-poor feeding/week suck reflex
-tremors
-seizures
-sleep disturbances
-microcephaly

400
Q

cutis aplasia

A

congenital anomaly in which the scalp has not formed properly

401
Q

minor variations of ears, including helix formation, crus formation, pits, or skin tags may be associated with _________ (3)

A

-genetic conditions
-hearing loss
-kidney anomalies

402
Q

eye shape assessment

A

-do palpebral fissures line up horizontally, are they upslanting (outside higher then inside), or are they downslanting?
-spacing between eyes

403
Q

asymetric red reflex may indicate (2)

A

-congenital cataract
-retinblastoma

404
Q

coloboma def.

A

missing pieces of tissue in the eye’s structure

405
Q

what to do if coloboma found

A

refer to ophthalmology and medical genetics for further testing

406
Q

what to do if asymetrical red reflex found

A

refer to ophthalmology and medical genetics for further testing

407
Q

newborn nose assessment

A

-nasal patency (respiratory distress when feeding or crying?)

408
Q

choanal atresia

A

back of nasal passage malformed so that it is occluded

409
Q

choanal stenosis

A

back of nasal passage malformed so that it is abnormally narrow

410
Q

how to prove nasal patency

A

pass small french catheter through each nares

411
Q

transient edema at back of nasal passage in newborn can be caused by _______

A

suctioning after birth

412
Q

syndrome related to choanal atresia

A

CHARGE

413
Q

CHARGE syndrome anagram

A

Coloboma of eye

Heart abnormality

Atresia of the Choanae

Retardation of growth or development

Genitourinary abnormalities

Ear abnormalities

414
Q

what to do if Choanal atresia

A

refer to ENT specialist and medical geneticist

415
Q

newborn mouth assessment

A

-gloved finger: feel suck reflex, hard poalate, soft palate
-assess tongue (able to lift tongue, push it past lower gums (ankyloglossia))

416
Q

what to do if cleft palate or cleft lip

A

refer to ENT specialist and may need special help with feeding

417
Q

ankyloglossia

A

-aka tongue tied
-not a sign of genetic condition
-could impair ability to breast feed (frenotomy)

418
Q

newborn neck assessment

A

-neck webbing (Turner syndrome)
-redundant skin (Noonan syndrome)

419
Q

chest

A

-flat
-concave (pectus excavatum)
-convex (pectus carinatum)
-pectus excavatum or carinatum are more common in connective tissue and cardiac d/o like Marfan syndrome, but isolated pectus abnormality not a cause for genetics referral

420
Q

newborn HR range

A

120-160; listen for whole minute

421
Q

heart murmurs in newborn

A

should be further evaluated if do not improve within days

422
Q

investigation of newborn heart murmur (3)

A

-pre- and post-ductal O2 sats
-4 extremity BPs
-EKG

423
Q

periodic breathing

A

infants normally take short pauses in their breathing or breath at a slightly irregular rate

424
Q

newborn RR range

A

30-60

425
Q

what to do if umbilical hernia

A

-try to push back in gently
-if firm hernia or hernia that is stuck in place, may be incarcerated and should be referred to surgical specialist to be evaluated

426
Q

palpate abdomen

A
427
Q

newborn groin assessment

A

-femoral pulse: if unable to find or very weak on one side, possible aortic coarctation
-check for inguinal hernia
-check genitals

428
Q

how to further investigate if suspected aortic coarctation

A

-measure pre-and post-ductal O2 sats and 4 extremity BPs

429
Q

newborn female genitalia assessment

A

-labia and clitoris may appear engorged from maternal hormones
-some newborns may have small amount of vaginal discharge or bleeding
-common: vaginal skin tags on posterior fourchette

430
Q

newborn male genital assessment

A

-testicles descended?
-hydrocele: enlargement of scrotum caused by fluid around testes that will resolve spontaneously
-penis: abnormal curvatures? foreskin should cover glans (hooded foreskin often indicative of hypospadias: ventral displacement of urethral meatus)

431
Q

assessment of anus

A

-assess patency by using one hand to hold the legs and the other to gently spread apart the gluteal cleft

432
Q

minor hand anomaly like one palmar crease w/out other factors

A

not for genetics referral

433
Q

major hand or foot anomalies (not 10 digits)

A

further investigation required;

434
Q

blue/gray macules on back that fade over time that fade over time

A

common; not problematic

435
Q

HTN existing before 20 weeks pregnant

A

chronic/preexisting HTN

436
Q

HTN beginning after 20 weeks of pregnancy

A

gestational HTN

437
Q

if HTN found after 20 weeks pregnancy does not resolve within 12 weeks of giving birth

A

likely undetected preexisting HTN

438
Q

preeclampsia

A

-HTN after 20 weeks of pregnancy
-protein in urine
-other form of organ damage

439
Q

eclampsia

A

woman with preeclampsia develops seizures

440
Q

etiology of preeclampsia

A

-probably caused by abnormal development of placental blood vessels early in the pregnancy

441
Q

magnesium toxicity signs

A

-feel warm/flushing
-RR <12
-UOP (urinary output <30 cc/hr
-very diminished or absent DTR
-EKG changes

442
Q

magnesium antidote

A

calcium gluconate

443
Q

tx in preeclampsia if hyperreflexia

A

magnesium

444
Q

position for pt. w/preeclampsia

A

bed rest on left side w/fetal monitoring

445
Q

reasons pt. w/preeclampsia should be lying on left side (3)

A

-prevent aspiration
-opens airway
-helps blood flow to placenta

446
Q

nursing role for pt. w/ preeclampsia

A

-monitor for seizure (high risk before and up to 48 hours after labor); if seizure, stay with, do not restrain, time seizure, note characteristics of seizure
-have pt. lie on her left side
-O2 @ 8-10 L
-monitor baby
-I/O (especially urine want >30 cc/hr)

447
Q

signs of high fever risk in pt. w/ preeclampsia (2)

A

-hyperreflexia
- + ankle clonus (3 beats or more)

448
Q

diet for preeclampsia

A

-high protein
-low salt

449
Q

HELLP Syndrome

A

-Hemolysis (ruptured RBCs)
-Elevated
Liver enzymes (ALT, AST)
-Low
Platelets

450
Q

meds for preeclampsia

A

-magnesium (antidote calcium gluconate)
-antihypertensives (like labetalol, hydralazine) (used with caution because low BP could compromise blood flow to fetus)

451
Q
A

Nur 404 (5 decks)

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