Exam 3 - book - incomplete Flashcards
security - code pink
Tags (usually attached to babies) that alarm when taken past a point to prevent abduction; locks down hospital and nearby streets
circumcision
removal of prepuce, insufficient data to recommend by major bodies
circumcision pain relief
EMLAs, nerve blocks, acetaminophen
nonpharm = pacifiers, oral sucrose, music, low lights, intrauterine sounds, talking softly to infant
circumcision care
- 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
Infant characteristics that lead to increased heat loss
- thin skin
- low white fat
- 3x more SA and 4x more heat loss
infant thermogenesis
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
newborn care tasks
Admin vitamin K and erythromycin
removing secretions
bathing and cord care
assisting with feedings
positioning, protecting, and IDing the infant
preventing abduction
Admin of vitamin K and erythromycin
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
removing secretions
turn head to side and using a bulb suction out secretions to help the baby breath better
bathing, cleaning diaper area and cord care
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
Positioning, protecting and IDing the infant
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
Infant discharge requirements and follow-up care
Discharge requirements: normal VS, 2x successful feedings, passed urine and stool, no excess bleeding, testing complete, or follow up care scheduled
Follow-up care:
preventing abduction
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
SS of hypoglycemia in infants
diaphoresis (normally uncommon in infants), jitteriness or tremors, rapid respirations, low temp, poor muscle tone
complication: RDS
Ix for IDM (infants of DM mothers)
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
RDS pathology
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)
RDS SS
TP, nasal flaring, retractions, cyanosis, grunting, decreased breath sounds
RDS Tx
surfactant replacement therapy
RDS RN considerations
be aware for at birth and early hours of life, abn in lab ABGs or acid-base
PT appearance
frail and weak, large head, thin translucent skin, (undecended testes/ labia minora > majora
PT behavior
low energy
PT respiratory problems
RF RDS, apneic spells (lack of breathing lasting >20 sec)
PT respiratory Ix
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
PT thermoregulation problems
thin skin, low brown fat, less flexion (extended arms)
Abd temp: 96.8* - 97.7*
Axillary temp: 97.3* - 98.4*
poor thermoregulation SS
poor feeding
hypoglycemia
lethargy, irritability
poor muscle tone
RDS
PT thermoregulation Ix
maintain neutral thermal environment
wean to open crib once 1500g
SGA characteristics
thin/wasted, dry loose skin, thigh creases, sunken abd, elderly appearance
SGA Tx
good prenatal care, determination if need to deliver early bc common complications of asphyxia, meconium, temp instab, hypoglycemia, polycythemia
SGA RN considerations
observe for common problems, hypoglycemia, thermoregulation, polycythemia (RF jaundice)
SGA infants have …
higher mortality, low APGARS, meconium, polycythemia, hypoglycemia, poor themoregulation
LGA infants can have …
longer labors, c-s, fractures, CHD
LGA Tx
ID by fundal height or US, problems lead to assisted delivery
LGA RN considerations
carefully assess for injuries, hypoglycemia
Sepsis neonatorum affects infants more bc
infants have less mature immune system, more so PT infants, and those with unusual labor times
sepsis can be what kind of onsets
early when acquired at birth, onset is in the first 72 hr - 7 days
late when acquired after the first week of life
Infant Sepsis Dx
increased IgM
eleveated C-reactive protein
positive culture
Infant sepsis SS
Depends on infection but general changes are:
Temperature instability
respiratory problems
feeding changes
(TP or TC)
(V/D)
(crying)
is unconjugated bilirubin fat soluble
yes
unconjugated bilirubin binds to … and causes …
fat in and accumulated in the brain
bilirubin encephalopathy
Chronic bilirubin encephalopathy causes …
kernicterus
unconjugted bilirubin binds … in blood and is … in the … and excreated as …
albumin
conjuctated
liver
bile
RF for elevaed bilirubin
excess production
abn RBC life cycle
abn albumin binding sites
liver immaturity
gestation
feeding, intestinal problems
trauma
physiologic jaundice
normal, transient
bilirubin is 5-6
appears after day 2 and lasts ~7 days
nonphysiologic jaundice
occurs w/in 24 hr
from high RBC death or bilirubin processing abn
breastfeeding associated jaundice /
early onset jaundice
bilirubin > 12
caused by insufficient intake of colostrum
glucose water doesnt help and should be avoided
true breast milk jaundice
onset on day 3-5 lasts 2w- 3 months
unknown cause
phototherapy
Chorionic Villus Sampling
what/purpose
when
adv
disadv
give what
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
Amniocentesis
what
when
adv
disadv
aspiration of amniotic fluid
15-20 weeks
safe, fast
long testing time
Amniocentesis purpose in 2nd trimester
for chromosomal or biochemical abn, Rh, AFAFP
>35 yr old, genetic Hx, pregnancy after multiple spont. abortions
Amniocentesis purpose in 3rd trimester
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 )
Amniocentesis procedure
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
Spontaneous abortion types
threatened
inevitable
incomplete
