Exam 3 Flashcards
(451 cards)
1
Q
first breath of infant causes __________
A
decreased pulmonary artery pressure
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
3
Q
increased P O2 leads to
A
closure of ductus arteriosus
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)
5
Q
newborn meds immediately given at birth
A
-erythromycin
-vitamin K
6
Q
heat loss in newborn (4)
A
-convection
-radiation
-conduction
-evaporation
7
Q
APGAR stands for
A
Activity
Pulse
Grimace
Appearance
Respiration
8
Q
APGAR activity scoring
A
0: absent
1: flexed arms and legs
2: active
9
Q
APGAR pulse scoring
A
0: absent
1: below 100 bpm
2: over 100 bpm
10
Q
APGAR scoring grimmace
A
0: floppy
1: minimal response to stimulation
2: prompt response to stimulation
11
Q
APGAR appearance score
A
0: pale, blue
1: pink body, blue extremities
2: pink
12
Q
APGAR respiration scoring
A
0: absent
1: slow and irregular
2: vigorous
13
Q
components of complete newborn assessment (4)
A
-perinatal hx
-physical exam
-gestational age assessment
-behavioral assessment
14
Q
when newborn assessments scheduled
A
-birth
-within 1-4 hrs of birth
-within 24 hrs before discharge
15
Q
newborn v/s taken
A
-temp
-pulse 120-140
-respiration 30-60
-b/p
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
17
Q
head assessment
A
-fontanelles
-molding
-cephalohematoma
18
Q
cephalohematoma
A
burst blood vessels; won’t cross sutures
19
Q
caput succedaneum
A
will cross sutures
20
Q
face assessment
A
-eyes
-ears
-nose
-mouth
-tongue
21
Q
ears
A
-lower set ears could indicate genetic abnormality
-hearing test
22
Q
nose
A
-patent nostrils
-discharge
-milia (little white heads) normal
23
Q
mouth
A
-suck reflex
-epstein’s pearls (little white cysts on hard palate)
-
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
25
hemangiomas
birth mark, example: port wine stain, stork bite
26
Mongolian spots aka congenita
will disappear on own
27
erythema toxicum
-reaction to external reaction to unfamilair stimuli
28
reflexes of newborn (7)
-rooting
-swallow
-sucking
-palmar grasp
-plantar grasp
-moro (startle)
-babinski (toes fan when outer edge of foot stroked)
29
Babinski reflex should end by about
1 year old
30
high risk pregnancy general types of causes (2)
can be from pregnancy or preexisting conditions
31
preexisting high risk pregnancy conditions
-pregestational diabetes (pregestational 1-2%)
-gestational diabetes 6-10%
32
pregestational Diabetes Type I or II subtypes
-subtype A without vascular damage
-subtype B with vascular damage
33
diabetes mellitus course in pregnancy
-early pregnancy: blood sugar demands lower, tend to be hypoglycemic
-later pregnancy: inulin needs increase
34
Diabetes subtype slide missing
35
pregestational (pre-existing diabetes counseling need
preconception counseling
36
risk of pregestational diabetes for pregnant person
-can cause excess amniotic fluid
-HTN
-hypo/hyperglycemia
-preeclampsia
-infections
-PPH
-increased risk of mortality
37
risk of pregestational diabetes (pre-existing) to fetus
-macrosomia
-hypoglycemia at birth
-congenital anomolies (cardiac if HgA1C is high at conception)
-respiratory distress syndrome
-stillbirth
-IUGR (?
38
tx goals for diabetes during pregnancy
-normal glucose (65-120)
-ID and treat complications of diabetes
-routine screening (HGA1C, blood glucose monitoring, ???
39
antepartum period
-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)
40
intrapartum pregestational diabetes
-monitor fluid status
-BG 90-110
-continuous fetal monitoring
-possible c-section
41
postpartum pregestational diabetes care
-glucose monitoring
-monitoring for postpartum complications (PPH, preeclampsia/ eclampsia)
-encourage breastfeeding to decrease glucose
42
Hormone given off by placenta in pregnancy that reduces insulin need
HPL
43
gestational diabetes
-79-87% of diabetes
-2nd half of pregnancy
44
gestational diabetes risk
??
45
Associated risk of gestational diabetes pregnant person
-HTN/preeclampsia
-infections
46
associated risks of gestational diabetes for baby
????
47
Gestational diabetes screening & diagnosis
-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)
48
gestational diabetes care antepartum period
-diet
-exercise
-bg <95 fasting, <140 1 hr postprandial, <120 2 hr postprandial
-pharmacological tx
-fetal surveillance (growth every 3-4 weeks, ?)
49
gestational diabetes intrapartum care
-bg 70-110
-regualr insulin infusion
-possible c-section
50
postpartum gestational diabetes care
-levels will return to normal
-meds d/c
-perform 2 hr Glucose Tolerance Test 6 weeks postpartum
51
HIV in pregnancy
-19.2 million women in 2019
-48% of new cases
-anout 5000 HIV positive women give birth per year
52
vertical transmission
-risk is 15-45% with no tx
-1-2% with tx
-higher risk if high viral load, prolonged ROM, chorioamnionitis, poor antiretroviral tx adherence
???
53
Care f client with HIV antepartum
-nutrition
-optimize immune fx
-monitor for infection
-test and treat STDs, pap smear
-provide emotional support
-refer as appropriate
54
intrapartum and post partum HIV care
-no fetal scalp electrode
-zidovudine
-newborn bath
-no breastfeeding
55
common pregnancy complications first trimester
miscarriage
ectopic pregnancy
56
common pregnancy complications 2nd trimester
-gestational trophoblastic disease
-???
57
common pregnancy complications 3rd trimester
???
58
1st trimester bleeding: miscarriage
-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)
59
implantation bleeding diagnosis
exam
ultrasound
60
implantation bleeding tx
-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-)
61
ectopic pregnancy causes
-anything that compromises tubes
-STI (can cause scarring in tube)
-IUD
62
ectopic pregnancy sx
-unilateral pelvic exam
-spotting
-shoulder pain (possible ruptured ectopic)
-can be asymptomatic
63
ectopic pregnancy diagnosis
-ultrasound
-bHCG labs
64
ectopic pregnancy tx
-methotrexate
-surgery
65
second trimester: molar pregnancy risk factors
-prior molar pregnancy
-early teens or >40
66
second trimester: molar pregnancy symptoms
-excessive nausea and vomiting
-rapid uterine growth
-dark brown bleeding
-no fetal HR
-snowstorm appearance on ultrasound
67
second trimester: molar pregnancy diagnosis
-ultrasound
-bHCG high (over 100,000 early)
68
second trimester: molar pregnancy tx
-dilation and curettage
-close monitoring of bHCG (elevated is sign of cancer)
-RhoGAM if RH-
69
second trimester: premature cervical dilation risk
-prior preterm delivery
-prior procedure to cervix
70
second trimester: molar pregnancy sx
-usually asymptomatic
-light pink discharge
-increased pelvic pressure
71
second trimester: molar pregnancy tx
-cerclage
-pessary
72
third trimester bleeding: placenta previa
-marginal (low lying)
-incomplete (partial)
-complete (total)
73
third trimester bleeding: placenta previa risk factors
-previous placenta previa
-uterine scarring
-age > 35
-smoking
74
third trimester bleeding: placenta previa sx
-painless bleeding
-nontender uterus
75
third trimester bleeding: placenta previa diagnosis
-ultrasound
-no vaginal exams
76
third trimester bleeding: placenta previa tx
-monitor
-pelvic rest
-possible c-section
-RhoGAM if RH-
77
third trimester bleeding: placental abruption
premature separation of placenta from uterus
78
third trimester bleeding: placental abruption risk
-HTN
-abdominal trauma
-cocaine
-prior abruption
-smoking
-premature rupture of membranes
-multiple gestation
79
third trimester bleeding: placental abruption sx
-painful bleeding
-uterine tenderness
-firm tender rigid abdomen
80
third trimester bleeding: placental abruption dx
-exam
-ultrasound
81
third trimester bleeding: placental abruption tx
-monitor
-labs (CBC, PT/PTT/fibrinogen, kleihaur betke (KB) (tells how much RhoGAM needed), type and screen
-blood products
-delivery
-RhoGAM if RH-
82
third trimester bleeding: preterm labor (20-37 weeks) risk
-infection
-polyhydraminos
-smoking
-substance abuse
-HTN
-DM
-hx of preterm labor
83
third trimester bleeding: preterm labor (20-37 weeks) sx
-backache
-cramp
-pelvic pressure
-vaginal discharge
-urinary freq
84
third trimester bleeding: preterm labor (20-37 weeks) diagnosis
-vaginal exam
-fetal fibronectin
85
third trimester bleeding: preterm labor (20-37 weeks) tx
-tocolytics (MGSO4, nifedipine, indomethacin)
-betamethasone
-antibiotics (for group beta strep)
-monitor client and fetus wellbeing
86
when to try to stop labor if preterm
before 34 weeks
87
tocolytics purpose
stop labor
88
preterm premature rupture of membrane risk
-infection
-prior pre-term birth
89
preterm premature rupture of membrane sx
-gush or trickle of fluid
90
preterm premature rupture of membrane dx
-sterile speculum exam (fern, dye (could be false positive), pool)
91
preterm premature rupture of membrane tx
-monitor fetal wellbeing
-antibiotics
-betamethasone
-monitor for infection (frequent temp, daily CBC)
92
chorioamnionitis description
-bacterial infection of amniotic cavity from premature rupture od membrane, vaginitis, amniocentesis, intrauterine procedures
93
chorioamnionitis assessment
-uterine tenderness
-contractions
-elevated temp
-pregnant person and or fetal tachycardia
-?
94
chorioamnionitis tx
??
95
Gestational HTN
-after 20 weeks of pregnancy w/o lab abnormalities, sx, or protein in urine
96
pre-eclampsia
-pre-eclampsia w or w/o severe features
97
eclampsia
-new onset tonic clonic seizures w/out other cause wuth HTN
98
HELLP syndrome
-hemolysis, elevated?????
99
pre-eclampsia w/out severe features
-SBP > 140 and or BBP > 90 with-
-significant proteinuria 300 mg in 24 hr urine
100
pre-eclampsia with severe features
-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
101
vascular effects of vasospasm
-vascular effects
-vasoconstriction
-poor organ perfusion
-increased BP
102
kidney effects of vasospasm
???
103
pre-eclampsia risk factors include
-client <19 or >40
???
104
pre-eclampsia physical exam
-brisk reflexes
-decreased breath sounds
-facial edema
-lower extremity edema
-clonus
Labs (AST, ALT, LDH urine protein, creatinine, CBC (HCT, PLT))
105
preeclampsia tx
-antihypertensive meds
-magnesium sulfate
-betamethasone
-delivery
106
preclampsia nursing care
-client fetal monitoring
-monitor for signs magnesium toxicity
-client ed (NPO, bedrest, calm, quiet room, what to expect with magnesium)
107
Magnesium toxicity sx
-hypotension
-areflexia
-respiratory depression
-oliguria
-shortness of breath
-chest pain
-slurred speech
-confusion
108
magnesium toxicity intervention
-stop magnesium
-give calcium gluconate
-draw magnesium level
109
HELLP syndrome assessment
-epigastric pain/right upper quadrant
-severe edema
-sx of preeclampsia
-n/v
-general malaise
110
HELLP syndrome labs
-hemolysis of RBCs: LDH>600
-thrombocytopenia :platelets <100 k
-elevated liver enzymes: alanine amniotransferase and serum aspartate 2x normal
111
HELLP syndrome management
-ICU
-Magnesium sulfate to reduce BP and prevent seizures
-reverse thr???
112
hyramnios: oligohydrmnios
not enough amniotic fluid, lungs may not develop properly, small baby
113
hydramnios: polyhydramnios
-too much amniotic fluid; more likely for breech, cord prolapse, larger uterus
114
fetal demise assessment
-decreased fetal movement
-absence of fetal heart tones
-lack of fetal growth
-decrease in fundal height
115
fetal demise nursing
-supportive care
-assist with delivery
-support naming baby/holding after delivery
-chaplain
116
postterm pregnancy (after 42 weeks)
-monitor for placental insufficiency
-increased risk of macrosomia
-stillbirths
meconium aspiration risk
117
when can you start giving fruit juice to children?
at least 6 months old, preferably older
118
how to determine if infant adequately hydrated in first week of life
should have as many we t diapers as they are days old
119
after first week how many wet diapers per day indicate adequate hydration
6-8
120
preschool age
3-5
121
IgE
allergic/hypersensitivity
122
antigens include (3)
pathogens
food proteins
pollens
123
responsible for humoral immunity
B lymphocytes
124
produce antibodies (immunoglobins (Ig) that bind to and destroy specific )
B lymphocytes
125
autoimmunity result from
inability to distinguish self from non-self, so immune response is directed at normal cells
126
autoimmune disease risk factors
genetics
gender
127
Different Igs ????
128
monogenetic inherited Primary Immunodeficiency can be ________ or __________ based
humoral or T-lymphocyte
129
secondary (acquired) immunodeficiency causes (7)
-cancer
-radiation
-systemic infection
-stress
-malnutrition
-monoclonal antibody tx
-aging
130
anaphylaxis characteristics (2)
-extreme vasodilation
-bronchoconstriction
131
tx for covid in children
-high flow O2
-dexamethasone
-CANNOT have convalescent plasma
132
Rheumatic fever caused by
reaction to a group A hemolytic strep infection
133
if pt. has had rheumatic fever, must
always be followed by cardiologist
134
rheumatic fever causes
inflammation of heart, blood vessels, brain, joints
-can gradually damage left heart valves
135
immediate nurse care for suspected rheumatic fever (sx 10 days after strep) (2)
-throat culture
-blood work
136
rheumatic fever tx
-penicillin for full 10 day course
-pt. may eventually need valve replacement or surgical intervention
137
asthma
-chronic inflammatory disorder of respiratory system
138
asthma typically presents before age ______
5
139
asthma triggers
-environmental factors
-immune response
-genetics
140
asthma assessment (4)
-wheezing
-breathlessness
-chest tight
-coughing
141
asthma cellular process
-allergen invades mast cells, releases histamine and leukotrienes
142
asthma tx
continuous nebulization of inhaled Beta2 agonist and IV corticosteroids to reduce inflammation; may also take PO corticosteroids
143
severe asthma case tx
endotracheal tube and mechanical ventilation
144
anemia is a disorder of_______ and can be classified as a reduction in the # of __________
RBCs
erythrocytes
145
kinds of anemia in children
-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
146
causes of iron deficiency anemia
-poor diet
-blood loss
-colitis
-adolescent menses
147
lab results for iron deficiency anemia
Hgb<11g/100mL of blood
Hct<33%
RBCs are macrocytic & hypochromic with irregular shape (called polkilocyte)
148
nursing care for anemia
-supportive
-packed RBCs
-diet mod (high iron and vitamin C)
-iron supplement
149
iron supplement admin
-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
150
iron dextran admin
-IM
-Z trach method
151
hemophilia cause
inherited, sex linked recessive trait
152
Factor VIII
intrinsic factor of coagulation (thromboplastin)
153
will child with hemophilia is bleeding, will it clot
yes, eventually
154
Hemophilia A
-bleeding and bruising may not appear til child walks, plays
-GI bleeding, nosebleeds, peritoneal cavity
-joint pain and soft tissue bleeding may occur
155
hemophilia A lab work:
-normal platelet
-normal PT
whole blood time may be normal or prolonged
-thromboplastic generator test is abnormal
-abnormal PTT
156
tx for hemophilia A
Factor VIII via whole blood, fresh or frozen plasma, or concentrate of Factor VII
157
concentrate of Factor VII for hemophilia A
-powder that is reconstituted at home
158
other hemophilia
-Von Willibrand Disease: platelets cannot aggregate, prolonged bleeding time, hemorrhages of mucous membranes
159
Christmas disease (aka hemophilia B/Factor IX deficiency (a sex linked trait)) tx
factor IX
160
hemophilia C/Factor X deficiency (autosomal recessive trait)
-mild sx
-plasma thromboplastin antecedent deficiency
161
hemophilia C/Factor X deficiency (autosomal recessive trait) bleeding episode tx
-desmopressin (DDAVP)
-fresh blood
-plasma
162
needed for school readiness (3)
-immunizations
-vision & hearing
-dental
163
UTI material ???
164
Celiac disease ????????
165
Cerebral Palsy caused by
nonprogressive disorders of upper motor neuron impairment
166
cerebral palsy sx
-motor
-ocular
-seizures
-cognitive d/o
-hyperactivity
167
CP physiological cause
-abnormal brain development
-damage to developing brain leading to cell destruction of motor tracts
168
CP caused by
-maternal infections (cytomegalovirus, toxoplasmosis)
-birth injury
169
other causes that can leadto CP like sx
-head injury from child maltreatment or automobile accidents
-infections (like meningitis or encephalitis)
170
CP types (4)
-pyramidal (spastic)
-extrapyramidal (dyskinetic)
-ataxic
-mixed
171
preterm gestational age
delivered before 37 0/7 weeks
172
late preterm gestational age
34 0/7 to 36 6/7 weeks
173
early term gestational age
37 0/7 to 38 6/7 weeks
174
term gestational age
39 0/7 to 40 6/7 weeks
175
late term gestational age
41 0/7 to 41 6/7 weeks
176
post term
42 0/7 weeks +
177
Newborn meds
-vitamin K for clotting
-Erythromycin eye ointment
-Hepatitis B vaccine
178
vitamin K admin in neonates
IM in vastus lateralus
179
Hepatitis B admin
-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
180
Newborn screenings
-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
181
betamethasone
-given to rapidly mature fetal lungs
-given to pregnant person IM q 24 hrs x2
182
physiologic jaundice
-after 24 hours since birth
-disappears in 1-2 weeks
-from immature liver
183
pathologic jaundice
-occurs before 24 hrs since birth
-blood compatibility
-kernicterus: neurological irreversible damage from high bilirubin levels
184
other screenings
-sickle cell
-PKU (protein metabolism defect)
-cystic fibrosis
-thalassemia (alpha and beta)
185
lab tests
-BG
-blood type
186
newborn care
-ID bands
-birth registration
-breastfeeding support
-newborn bath
-circumcision care
-education
187
newborn care parent education
-bulb suction
-feeding cues
-car seat safety
-umbilical cord care
-SIDs prevention
188
when should first feeding occur?
within first 30 minutes after birth
189
what symptom of infection is different for newborns compared to adults
subnormal temperature is a sign of infection in newborns
190
why are newborns given vitamin K
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
indicators of adequate fluid intake in infants
-wetting diaper 6-8 times per day
-sleeping between feedings
-no excessive crying
-gaining weight
192
Newborn stool progression
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
infant stool after transitional stool if breast fed
loose, watery, mustard-colored stool
194
infant stool after transitional stool if formula fed
soft, more formed pale yellow to yellowish brown to light brown or brownish green stool
195
Breast fed babies in first 5 days of life typically poop _____ times a day
as many times as they are days old
196
who has more extracellular fluid, infants or adults, and what are the implications?
infants are more prone to dehydration because they have less ECF
197
source of infant calcium
milk/formula
198
iron source for newborns
born with 3-month store, enough to last until hemoglobin is fully developed to produce iron
199
vitamin supplement recommended for newborns
vitamin D
200
formula fed babies poop _____ times/day
3 - 4
201
newborns lose _____% of their weight initially
10
202
newborns should regain lost weight by
day 10-14 of life
203
initial thin yellow watery breast milk
colostrum
204
colostrum contents (7)
sugar
fat
water
vitamins
minerals
protein
maternal antibodies
205
how long colostrum lasts
3-4 days
206
next milk after colostrum
transition milk
207
when transition milk ends
10 to 15 days after birth
208
third stage of breast milk
true milk
209
advantages of breastfeeding for parent
-releases oxytocin, which contracts/involutes uterus, protects against cancer
-helps with weight loss
-cheaper than formula
-oxytocin enhances bond between mother and baby
210
school aged is ages:
6-12
211
expected growth curve
gradual increase/stable
212
biggest problem for school-aged kids
cavities
213
age brain growth complete
10
214
fine motor coordination in school age
becomes refined
215
school-aged vision
globe reaches final shape, adult vision achieved
216
eruption of permanent teeth and growth of jaw not being correlated cn cause
malocclusion with teeth misalignment
217
dental development in school age
deciduous teeth lost, permanent teeth erupt
218
number of teeth gained on average during school age
28
219
____________ (part of brain) that transmits enzyme to the __________ (part of brain) to begin production of gonadotropic horrmones, initiating changes in genitals (puberty)
hypothalamus
anterior pituitary gland
220
Tanner stages track _________
puberty/sexual development
221
typical secondary sex characteristics 9-11 y.o. males
prepubertal weight gain
222
typical secondary sex characteristics 9-11 y.o. females
-breasts: elevation of papilla with breast bud formation; areolar diameter enlarges
223
typical secondary sex characteristics 11-12 y.o. males
-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
typical secondary sex characteristics 11-12 y.o. female
-straight hair along the labia
-vaginal epithelium becomes cornified
-pH of vaginal secretions becomes acidic; slight mucous vaginal discharge present
-dramatic growth spurt
225
typical secondary sex characteristics 12-13 y.o. male
-pubic hair present across pubis
-penis lengthens
-dramatic linear growth spurts
-breast enlargement may occur
226
typical secondary sex characteristics 12-13 y.o. females
-pubic hair grows darker, spreads over entire pubis
-breasts enlarge, still no protrusion of nipples
-axillary hair present
-menarche
227
Physical development age 6
-constant motion
-skipping is new skill
-first molars
228
Physical development age 7
-central incisors erupt
-awareness of learned gender roles seen in play
-spends time in quiet play
229
Physical development age 8
-coordination definitely improved
-eyesight fully develops
-playing with friends becomes important
230
Physical development age 9
all activities done with friends
231
Physical development age 10
coordination improves
232
Physical development age 11
active, but awkward and ungainly
233
Physical development age 12
coordination improves
234
psychosocial and cognitive development age 6
-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
psychosocial and cognitive development age 7
-quiet year; striving for perfection leads to this year being called an eraser year
-learns conservation
-can tell time
-can make simple change ($)
236
psychosocial and cognitive development age 8
-best friends
-whispering, giggling
-can write in cursive or print
-understands past, present, future
237
psychosocial and cognitive development age 9
-friend or club age
-clubs are all boy or girl, form and disband quickly
238
psychosocial and cognitive development age 10
-ready for camp away from home
-collecting age
-like rules
-ready for competitive games
239
psychosocial and cognitive development age 11
-insecure with peers of genders to which they feel attraction
-repeats off-color jokes
240
psychosocial and cognitive development age 12
-sense of humor is present
-social and cooperative
241
school age developmental task
industry vs. inferiority (how to do things well)
242
not achieving task of industry can cause
difficulty tackling new situations
243
school age cognitive development
transition from preoperational thought stage to concrete operational thought stage
244
moral/spiritual development in school age children
-begin to mature in terms of moral development as they enter preconventional reasoning
-focused on following rules and following authorities
245
health promotion / safety for school aged- children: motor vehicles
-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
health promotion / safety for school aged- children: bicycles
-teach bicycle safety, including wearing a helmet and not giving "passengers" rides
247
health promotion / safety for school aged- children: tech
-safe and supervised use
-phone/gaming/internet
248
health promotion / safety for school aged- children: community
-teach children to avoid unsafe areas (train yards, grain silos, back alleys)
-stress that children should not go with strangers
249
health promotion / safety for school aged- children: sexual safety
-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
health promotion / safety for school aged- children: motor vehicles burns
-teach safety with candles, matches, campfires
-teach safety around cooking
-teach to wear sunblock
-teach not to climb electric poles
251
health promotion / safety for school aged- children: falls
-teach that some activities are hazardous
-teach skateboard, scooter, and skating safety (helmets)
252
health promotion / safety for school aged- children: sports injuries
-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
health promotion / safety for school aged- children: drugs
-teach the child to avoid tobacco, alcohol, drugs
-teach to take prescription meds as directed
254
health promotion / safety for school aged- children: firearms
-teach safety
-keep firearms locked in cabinets with bullets separate from gun
255
immunizations for school aged
???
256
school health screens (7)
-height
-weight
-BMI
-hearing
-vision
-posture (scoliosis)
-esper (for substance abuse/mental health)
257
school aged nutrition
-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
school aged activities
-reading
-games
-peer time
-sports
-bike riding
259
sleep
-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
how do school aged children do with rules
thrive
261
anaphylaxis
-acute type 1 sensitivity reaction
-leads to vascular collapse
-give epipen asap
-transport to hospital after epipen
262
rheumatic fever caused by
strep
263
rheumatic fever affects what organ?
primarily heart; will need to be followed by cardiologist for life after rheumatic fever
264
asthma
-triggered by allergies
-treated by beta 2 agonist?
-sx don't include fever (look for pneumonia if fever)
265
iron deficient anemia
-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
hemophilia
-sx: bleeding profusely from circumcision
-may not know that they have hemophilia
267
celiac disease diagnosed by
endoscopy
268
benefits of breast feeding for baby
-maternal antibodies
-protects against GI and respiratory infections
-reduces allergies
-decrease risk of obesity later in life
-may reduce SIDS
269
after placenta delivered, how are hormones affected
-estrogen drops rapidly
-progesterone increases
270
progesterone stimulates what hormone
prolactin
271
what are prolactin's effects
body stimulated to make breast milk
272
sucking from infant on nipple stimulates
the hypothalamus, which signals the posterior pituitary gland to release oxytocin, which causes mammary glands to contract and widen
273
let down reflex
anterior pituitary releases prolactin to stimulate breast milk production
274
4 steps to good latch
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
best way to know infant is getting enough milk
-infant has wet diapers
-infant seems content between feedings
276
possible causes for infant not sucking well
-possibly from analgesic from labor
-mother may be trying to feed when infant is not hungry
-infant exhausted by crying from hunger
277
tx if breastfeeding mother reports engorgement
-encourage baby to suck
-apply warm packs to breast or have mother take warm shower before feeding to soften breast tissue
278
pt. ed for breastfeeding (3)
-provide immediate support if problems arise
-provide info regarding techniques for burping breastfed baby
-support for a mother who is breastfeeding multiple babies
279
how to encourage effective breastfeeding (4)
-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
nursing care for sore nipples
-prevent or relieve engorgement (regular feeding)
-promote healing of sore nipples
281
freshly expressed/pumped breastmilk storage ed
-counter for 4 hours
-refrigerator 4 days
-freezer 6-12 months
282
previously frozen breastmilk storage
-counter for 1-2 hours
-refrigerator for 1 day
-never refreeze
283
unfinished bottle of breast milk lasts
2 hrs
284
how to know formula adequate
-same as breast milk
-hunger cues (smacking lips, putting fist in mouth
285
how often to feed formula fed baby
every 3-4 hours
286
how often to feed breast fed baby
every 2-3 hrs
287
if infant sucks bottle, but then stops and cries
check bottle to make sure it isn't clogged or too fast (should drop at 1 drop per second
288
infant does not burp well after feeding
-check that infant needs to burp
-check that parents are effectively burping infant
289
parent reports baby is constipated
-examine stool
-assure parent and explain that formula fed babies have more formed stool and that straining is normal
290
formula feeding time limits (from start of feeding and from time prepared) if unrefrigerated
-within 1 hr of start of feeding
-within 2hrs. of preparation
291
if prepared formula won't be used within 2 hrs, then _________
refrigerate for up to 24 hrs
292
once feeding has started, what should be done with leftovers in the bottle
throw out because bacteria can grow because formula mixes with saliva
293
Discharge planning to do list
-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
CLAMS acronym for sutures and fontanelles of newborn
Coronal Suture
Lambdoid suture
Anterior fontanelle
Metopic suture
Sagittal suture
295
coronal suture
296
Lambdoid suture
297
Anterior fontanelle
298
Metopic suture
299
Sagittal suture
300
cephalohematoma
a bruise from birth on the head that does not cross the suture line caused by bleeding below the periosteum
301
cephalohematoma is more common in births assisted by ________ or __________
vacuum or forceps
302
infants with cephalohematomas are at increased risk for ________ because __________
-jaundice
-because of the breakdown of hemoglobin as the bruise resolves
303
swelling that crosses the suture line caused by fluid accumulation above periosteum caused by force of delivery
caput succedaneum
304
extensive swelling across suture lines due to rupture of emissary veins
subgaleal hemorrhage
305
congenital anomoly in which the scalp has not formed properly
cutis aplasia
306
implication of cutis aplasia
look for other atypical features (may be part of a syndrome)
307
implications of ear formation issues
-may be normal
-minor variants may be associated with genetic conditions, hearing loss, or kidney anomalies
308
preschool Erickson
initiative vs. guilt/shame
309
preschool Piaget stage
preoperational
310
preschool vaccines
Varicella
DTao
Influenza
MMR
311
best predictor of child's ability to fight infection
absolute neutrophil count (ANC)
312
Tx environment for status asthmaticus
ICU usually
313
rescue med for asthma
beta2 adrenergic agonist like albuterol
314
new asthma pt. teahing
avoid triggers (allergens, cigarette smoke)
315
BUN range
5-20
316
creatinine range
0.6-1.2
317
most important urology/kidney labs
BUN
creatinine
318
glomerulonephritis
glomeruli are damaged and inflamed
319
sx of glomerulonephritis
-blood in urine (hematuria)
-protein in urine
320
difference between nephrotic syndrome and acute glomerulonephritis
glomerulonephritis: HTN and high levels of hematuria
321
early improvement in glomerulonephritis
increased urine output
322
priority nursing in pt. with glomerulonephritis
weight (to track fluid balance)
323
newborn priorities (8)
-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
initiating/maintaining newborn respirations (5)
-resuscitation
-airway
-lung expansion
-ventilation maintenance
-drug therapy (narcan if opioids present)
325
extrauterine circulation for newborn
chest compression if no HR or HR<60 bpm
326
newborn fluid and electrolyte balance (2)
check for
-hypoglycemia
-dehydration
327
newborn temperature regulation
-radiant heat sources
-incubators
-skin-to-skin care
328
nutrition (2)
-IV
-tube feedings
329
risk factors for respiratory difficulty in newborns (13)
-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
respiratory distress assessment scale
0 no distress
1-3 mild distress
4-6 moderate distress
7-10 severe distress
331
preterm infant defined
born prior to 37 0/7 weeks
332
early preterm gestation age
24 - 33 6/7 weeks
333
late preterm gestational age
34 -36 6/7 weeks
334
risk factors for preterm birth
-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
preterm assessment
-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
interventions for preterm infant
-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
complications of preterm birth: anemia
-effective production of RBCs begins after 32 weeks
-frequent blood draws
-delayed cord clamping may help...IF ABLE
338
complications of preterm birth: acute bilirubin encephalopathy
kernicterus: destruction of brain cells from indirect or unconjugated bilirubin
339
complications of preterm birth: persistent patent ductus arteriosus
-from decreased surfactant
-more difficult to move blood from the pulmonary artery to the lungs
-can't close the ductus arteriosus
340
complications of preterm birth: periventricular / intraventricular hemorrhage
caused by fragile capillaries and immature cerebral vascular development
341
complications of preterm birth: other
-respiratory distress syndrome
-apnea
-retinopathy of prematurity
342
Preterm nutrition: feeding schedule
small feeds (1-2 mL) every 2-3 hrs
343
complications of preterm birth: nutrition: gavage feeding
-babies having difficulty coordinating suck and swallow before 32 weeks (no gag reflex)
344
complications of preterm birth: nutrition: formula
22 cal.oz.
345
complications of preterm birth: nutrition: breast milk
increases immune defenses
346
infants who are small for gestational age (SGA): define
-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
due to intrauterine growth restriction (IUGR)
-adequate nutrition in pregnancy
-higher in adolescents
-placental issues
-smoking
-drug use
348
small for gestational age infant: prenatal assessment
-fundal height
-ultrasound
349
small for gestational age infant: appearance
-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
small for gestational age infant: lab findings
-elevated Hct, increased RBCs (jaundice risk)
-hypoglycemia (BG<45 mg/dL)
351
large for gestational age (LGA) infant: define
birth weight above 90th percentile
352
large for gestational age (LGA) infant: cause
exposure to an overproduction of nutrients and growth hormones in utero
353
large for gestational age (LGA) infant risk factors
-maternal obesity
-maternal diabetes
354
large for gestational age (LGA) infant prenatal assessment (2)
-fundal height
-ultrasound
355
large for gestational age (LGA) infant: appearance
-"normal", but may be immature
-may have bruising
-may have caput, cephalohematoma, or molding
356
large for gestational age (LGA) infant concerns
-birth trauma/injury
-respiratory distress
-hypoglycemia
-cardiovascular dysfunction from increased risk for transposition of the great vessels and/or polycythemia (jaundice)
357
large for gestational age (LGA) infant skin assessment
-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
large for gestational age (LGA) infant assessment of upper extremities
-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
large for gestational age (LGA) infant assessment of anterior chest for asymmetry or unilateral lack of movement
-can be caused by edema of the phrenic nerve
-cervical nerve may be stretched by birth of wide shoulders
360
large for gestational age (LGA) infant eye assessment
-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
large for gestational age (LGA) infant assess for seizure
-jitteriness
-lethargy
-uncoordinated eye movements
-likely caused by intracranial pressure
362
postterm newborn define
born after 42 weeks
363
postterm appearance
-dry cracked skin
-absence of vernix
-long fingernails
-meconium staining on skin, nails, umbilical cord
-lack of subcutaneous fat
364
postterm concerns
-difficulty establishing respirations
-polycythemia
-hypoglycemia
-difficulty with temperature regulation
365
respiratory distress syndrome causes
-meconium syndrome
-sepsis
-slow transition to extrauterine life
-pneumonia
366
respiratory distress sx
-tachypnea
-nasal flaring
-expiratory grunting
-intercostal, subxiphoid, and subcostal retractions
-decreased breath sounds
-apnea
-pallor and cyanosis
-hypothermia
-poor muscle tone
367
respiratory distress syndrome tx
-surfactant replacement
-o2 admin
-ventilation
-nitric oxide
-extracorporeal membrane oxygenation (ECMO) (rare)
-supportive care
368
surfactant replacement for respiratory distress syndrome
-synthetic surfactant sprayed into an ET tube with a syringe or catheter
-infant tipped in an upright position
-avoid suctioning
369
o2 admin for respiratory distress syndrome
-CPAP
-PEEP
370
nitric oxide for respiratory distress syndrome
-potent vasodilator
-reduces pulmonary resistance
-increases o2
371
newborn illness: transient tachypnea
-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
newborn illness: meconium aspiration syndrome
-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
newborn illness: apnea
cessation of repirations for more than 20 seconds
374
SIDS
-contributing factors:?
-should sleep on back
375
newborn illness: apparent life-threatening event
infant w/noticeable color change, some degree of apnea and decreased tone
376
hyperbilirubinemia types
-physiologic
-pathologic
377
hyperbilirubinemia: pathologic
-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
hyperbilirubinemia assessment
-jaundice (report signs in first 24 hrs to provider)
-elevated serum bilirubin levels
-poor muscle tone
-poor sucking reflex
-enlarged liver
-lethargy
379
hyperbilirubinemia management
-monitor bilirubin level
-early feedings
-maintain hydration
-phototherapy
-exchange transfusion (RARE)
380
hyperbilirubinemia phototherapy
-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
newborn illeness: twin to twin transfusion
-monochorionic twins
-more blood shunts to one twin over the other
382
newborn illness: necrotizing enterocolitis
-premature newborns at greatest risk
-necrotic patches develop on bowel
383
retinopathy of prematurity
-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
newborn at risk due to maternal infections: beta-hemolytic group b streptococcal
-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
ophthalmia neonatorum
-eye infection due to either Neisseria Gonorrhoeae or Chlamydia Trachomatis
-erythromycin eye ointment
386
newborn at risk due to maternal infections: hepatitis B
-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
newborn at risk due to maternal infections Herpes simplex virus
-suppression started at 36 weeks if birthing parent with hx of HSV
-thorough exam on admission for labor
-c-section if lesions present
388
newborn at risk due to maternal infections: infant of diabetic birthing parent
-macrosomia
-cardiac anomalies
389
newborn at risk due to maternal infections: complications
-respiratory distress syndrome
-neonatal hypoglycemia (jitteriness, hypothermia, poor muscle tone, lethargy, apnea, cyanosis)
390
newborn at risk due to maternal infections infant of diabetic: tx management
-feed early
-avoid bolus of glucose to prevent rebound hypoglycemia
-maintain body temperature
391
newborn at risk due to maternal infections infant of mom w/HIV: transmission
-across placental barrier
-during labor and delivery
-via breast milk
392
newborn at risk due to maternal infections infant of mom w/HIV: risk reduction
-early identifiction in pregnancy
-antiretroviral meds
-monitoring of maternal labs
-avoid invasive procedures in labor
393
newborn at risk due to maternal infections infant of mom w/HIV: interventions
-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
neonatal abstinence syndrome sx
-irritable
-frequent sneezing
-disturbed sleep
-shrill, high-pitched cry
-constant movemnet
-tachypnea
-tremors
-vomiting
-diarrhea
-hyperreflexia, clonus
395
Scoring Newborn Respiratory Distress
-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
Neonatal abstinence syndrome: non pharm management
-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
neonatal abstinence syndrome pharmacological management
-morphine
-phenobarbital
-methadone
398
newborn with Fetal Alcohol Syndrome general info
-causes placenta to deteriorate
-IUGR
-Cognitive challenges
-Cerebral palsy
399
FAS assessment
-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
cutis aplasia
congenital anomaly in which the scalp has not formed properly
401
minor variations of ears, including helix formation, crus formation, pits, or skin tags may be associated with _________ (3)
-genetic conditions
-hearing loss
-kidney anomalies
402
eye shape assessment
-do palpebral fissures line up horizontally, are they upslanting (outside higher then inside), or are they downslanting?
-spacing between eyes
403
asymetric red reflex may indicate (2)
-congenital cataract
-retinblastoma
404
coloboma def.
missing pieces of tissue in the eye's structure
405
what to do if coloboma found
refer to ophthalmology and medical genetics for further testing
406
what to do if asymetrical red reflex found
refer to ophthalmology and medical genetics for further testing
407
newborn nose assessment
-nasal patency (respiratory distress when feeding or crying?)
408
choanal atresia
back of nasal passage malformed so that it is occluded
409
choanal stenosis
back of nasal passage malformed so that it is abnormally narrow
410
how to prove nasal patency
pass small french catheter through each nares
411
transient edema at back of nasal passage in newborn can be caused by _______
suctioning after birth
412
syndrome related to choanal atresia
CHARGE
413
CHARGE syndrome anagram
Coloboma of eye
Heart abnormality
Atresia of the Choanae
Retardation of growth or development
Genitourinary abnormalities
Ear abnormalities
414
what to do if Choanal atresia
refer to ENT specialist and medical geneticist
415
newborn mouth assessment
-gloved finger: feel suck reflex, hard poalate, soft palate
-assess tongue (able to lift tongue, push it past lower gums (ankyloglossia))
416
what to do if cleft palate or cleft lip
refer to ENT specialist and may need special help with feeding
417
ankyloglossia
-aka tongue tied
-not a sign of genetic condition
-could impair ability to breast feed (frenotomy)
418
newborn neck assessment
-neck webbing (Turner syndrome)
-redundant skin (Noonan syndrome)
419
chest
-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
newborn HR range
120-160; listen for whole minute
421
heart murmurs in newborn
should be further evaluated if do not improve within days
422
investigation of newborn heart murmur (3)
-pre- and post-ductal O2 sats
-4 extremity BPs
-EKG
423
periodic breathing
infants normally take short pauses in their breathing or breath at a slightly irregular rate
424
newborn RR range
30-60
425
what to do if umbilical hernia
-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
palpate abdomen
-should not feel masses/liver
-
427
newborn groin assessment
-femoral pulse: if unable to find or very weak on one side, possible aortic coarctation
-check for inguinal hernia
-check genitals
428
how to further investigate if suspected aortic coarctation
-measure pre-and post-ductal O2 sats and 4 extremity BPs
429
newborn female genitalia assessment
-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
newborn male genital assessment
-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
assessment of anus
-assess patency by using one hand to hold the legs and the other to gently spread apart the gluteal cleft
432
minor hand anomaly like one palmar crease w/out other factors
not for genetics referral
433
major hand or foot anomalies (not 10 digits)
further investigation required;
434
blue/gray macules on back that fade over time that fade over time
common; not problematic
435
HTN existing before 20 weeks pregnant
chronic/preexisting HTN
436
HTN beginning after 20 weeks of pregnancy
gestational HTN
437
if HTN found after 20 weeks pregnancy does not resolve within 12 weeks of giving birth
likely undetected preexisting HTN
438
preeclampsia
-HTN after 20 weeks of pregnancy
-protein in urine
-other form of organ damage
439
eclampsia
woman with preeclampsia develops seizures
440
etiology of preeclampsia
-probably caused by abnormal development of placental blood vessels early in the pregnancy
441
magnesium toxicity signs
-feel warm/flushing
-RR <12
-UOP (urinary output <30 cc/hr
-very diminished or absent DTR
-EKG changes
442
magnesium antidote
calcium gluconate
443
tx in preeclampsia if hyperreflexia
magnesium
444
position for pt. w/preeclampsia
bed rest on left side w/fetal monitoring
445
reasons pt. w/preeclampsia should be lying on left side (3)
-prevent aspiration
-opens airway
-helps blood flow to placenta
446
nursing role for pt. w/ preeclampsia
-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)
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signs of high fever risk in pt. w/ preeclampsia (2)
-hyperreflexia
- + ankle clonus (3 beats or more)
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diet for preeclampsia
-high protein
-low salt
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HELLP Syndrome
-Hemolysis (ruptured RBCs)
-Elevated
Liver enzymes (ALT, AST)
-Low
Platelets
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meds for preeclampsia
-magnesium (antidote calcium gluconate)
-antihypertensives (like labetalol, hydralazine) (used with caution because low BP could compromise blood flow to fetus)
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