Exam 3 - book - incomplete Flashcards

1
Q

security - code pink

A

Tags (usually attached to babies) that alarm when taken past a point to prevent abduction; locks down hospital and nearby streets

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2
Q

circumcision

A

removal of prepuce, insufficient data to recommend by major bodies

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3
Q

circumcision pain relief

A

EMLAs, nerve blocks, acetaminophen
nonpharm = pacifiers, oral sucrose, music, low lights, intrauterine sounds, talking softly to infant

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4
Q

circumcision care

A
  • Consent
  • infant is stable and already had vit K
  • withhold feeding for 2-4 hours
  • note first urination after surgery or 6-8 hours if hasnt by discharge by mother
  • yellow crust normal
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5
Q

Infant characteristics that lead to increased heat loss

A
  • thin skin
  • low white fat
  • 3x more SA and 4x more heat loss
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6
Q

infant thermogenesis

A

by nonshivering thermogenesis using brown fat (in back, chest, neck, front). starts by thermoreceptor stim releasing norepi initiating casade.

PT infants dont have enough brown fat

hypoxia, hypogly, and acidosis limit thermogenesis

uses up glucose, RF jaundice

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7
Q

newborn care tasks

A

Admin vitamin K and erythromycin

removing secretions

bathing and cord care

assisting with feedings

positioning, protecting, and IDing the infant

preventing abduction

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8
Q

Admin of vitamin K and erythromycin

A

K: clotting factor, within the first hour bc the baby cant make it on its own

Erythromycin: prophylactically to prevent ophthalmia neonatorum if mother has gonorrhea

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9
Q

removing secretions

A

turn head to side and using a bulb suction out secretions to help the baby breath better

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10
Q

bathing, cleaning diaper area and cord care

A

bath: given to remove birth stuff, bath in 38*C or 100.4*F water, this is a good time to include teaching

diaper area: water or soap, or detergen/EtOH free wipes

Cord care: checked for bleeding or oozing, purulent drainage = infection, becomes brownish black within 2-3 days and falls off in 10-14 days

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11
Q

Positioning, protecting and IDing the infant

A

Positioning: on back not belly, firm sleep surface, tummy time

Protection: baby to the right parent, precautions for abductions, preventing or recognizing signs of infection

IDing: ID bands or cord blood in case

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12
Q

Infant discharge requirements and follow-up care

A

Discharge requirements: normal VS, 2x successful feedings, passed urine and stool, no excess bleeding, testing complete, or follow up care scheduled

Follow-up care:

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13
Q

preventing abduction

A

have everyone wear an photo ID, teach parents to prevent kidnapping, be suspicious, never leave infant alone, always match infant to parent when they take an infant

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14
Q

SS of hypoglycemia in infants

A

diaphoresis (normally uncommon in infants), jitteriness or tremors, rapid respirations, low temp, poor muscle tone

complication: RDS

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15
Q

Ix for IDM (infants of DM mothers)

A

feed early or immediately when BG <45 mg/gl (IDMs are poor feeders), IV glucose if needed, support mother, aware of RDS

consider hypocalcemia if BG normal

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16
Q

RDS pathology

A

insufficient surfactant usually in PT infants that begins production at 34-36 weeks. Surfactant decreases surface tension so the alveoli stay open each breath making lungs noncomplient (stiff)

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17
Q

RDS SS

A

TP, nasal flaring, retractions, cyanosis, grunting, decreased breath sounds

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18
Q

RDS Tx

A

surfactant replacement therapy

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19
Q

RDS RN considerations

A

be aware for at birth and early hours of life, abn in lab ABGs or acid-base

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20
Q

PT appearance

A

frail and weak, large head, thin translucent skin, (undecended testes/ labia minora > majora

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21
Q

PT behavior

A

low energy

22
Q

PT respiratory problems

A

RF RDS, apneic spells (lack of breathing lasting >20 sec)

23
Q

PT respiratory Ix

A

humidified O2, CPAP

place in side-lying or prone (until can breathing with proper drainage and without regurgitation)

Suctioning (5-10 sec each), proper hydration

24
Q

PT thermoregulation problems

A

thin skin, low brown fat, less flexion (extended arms)

Abd temp: 96.8* - 97.7*

Axillary temp: 97.3* - 98.4*

25
Q

poor thermoregulation SS

A

poor feeding

hypoglycemia

lethargy, irritability

poor muscle tone

RDS

26
Q

PT thermoregulation Ix

A

maintain neutral thermal environment

wean to open crib once 1500g

27
Q

SGA characteristics

A

thin/wasted, dry loose skin, thigh creases, sunken abd, elderly appearance

28
Q

SGA Tx

A

good prenatal care, determination if need to deliver early bc common complications of asphyxia, meconium, temp instab, hypoglycemia, polycythemia

29
Q

SGA RN considerations

A

observe for common problems, hypoglycemia, thermoregulation, polycythemia (RF jaundice)

30
Q

SGA infants have …

A

higher mortality, low APGARS, meconium, polycythemia, hypoglycemia, poor themoregulation

31
Q

LGA infants can have …

A

longer labors, c-s, fractures, CHD

32
Q

LGA Tx

A

ID by fundal height or US, problems lead to assisted delivery

33
Q

LGA RN considerations

A

carefully assess for injuries, hypoglycemia

34
Q

Sepsis neonatorum affects infants more bc

A

infants have less mature immune system, more so PT infants, and those with unusual labor times

35
Q

sepsis can be what kind of onsets

A

early when acquired at birth, onset is in the first 72 hr - 7 days

late when acquired after the first week of life

36
Q

Infant Sepsis Dx

A

increased IgM

eleveated C-reactive protein

positive culture

37
Q

Infant sepsis SS

A

Depends on infection but general changes are:

Temperature instability

respiratory problems

feeding changes

(TP or TC)

(V/D)

(crying)

38
Q

is unconjugated bilirubin fat soluble

A

yes

39
Q

unconjugated bilirubin binds to … and causes …

A

fat in and accumulated in the brain

bilirubin encephalopathy

40
Q

Chronic bilirubin encephalopathy causes …

A

kernicterus

41
Q

unconjugted bilirubin binds … in blood and is … in the … and excreated as …

A

albumin

conjuctated

liver

bile

42
Q

RF for elevaed bilirubin

A

excess production

abn RBC life cycle

abn albumin binding sites

liver immaturity

gestation

feeding, intestinal problems

trauma

43
Q

physiologic jaundice

A

normal, transient

bilirubin is 5-6

appears after day 2 and lasts ~7 days

44
Q

nonphysiologic jaundice

A

occurs w/in 24 hr

from high RBC death or bilirubin processing abn

45
Q

breastfeeding associated jaundice /

early onset jaundice

A

bilirubin > 12

caused by insufficient intake of colostrum

glucose water doesnt help and should be avoided

46
Q

true breast milk jaundice

A

onset on day 3-5 lasts 2w- 3 months

unknown cause

phototherapy

47
Q

Chorionic Villus Sampling

what/purpose

when

adv

disadv

give what

A

tests chorionic (proto-placental villi) for chromosomal or metabolic abn but not those that require amniotic fluid. Sample aspirated

Performed at 10-13 weeks

can be done earlier than amniocentesis

may cause spont. abortion, physical abn, infeciton

give RhoGam

48
Q

Amniocentesis

what

when

adv

disadv

A

aspiration of amniotic fluid

15-20 weeks

safe, fast

long testing time

49
Q

Amniocentesis purpose in 2nd trimester

A

for chromosomal or biochemical abn, Rh, AFAFP

>35 yr old, genetic Hx, pregnancy after multiple spont. abortions

50
Q

Amniocentesis purpose in 3rd trimester

A

Determine lung maturity when nonemergency delivery is considered before 38 wks. lecithin:sphingomyelin ratio > 2:1 is good

tests for fetal hemolytic disease (bilirubin concentration if mother is Rh- and sensatived )

51
Q

Amniocentesis procedure

A

pt supine with towel under buttock

US finds baby and 3-4 in 20-21 g need is used to extract 20 ml

woman should avoid strenuous activities for 24 hrs, report bleed or leakage

52
Q

Spontaneous abortion types

A

threatened

inevitable

incomplete