Exam 3 seinor year Flashcards
intentional physical abuse or neglect, emotional abuse or neglect or sexual abuse of children, usually done by adults
abuse/child maltreatment
who is at higher risk of death of children
younger parents (inadequate knowledge)
failure to provide for kids basic needs
neglect
deliberate attempt to destroy or significantly impair a child’s self esteem or competence
emotional abuse
deliberate infliction of physical injury on a child, usually by the child’s caregiver
physical abuse
inappropriate touching of child’s breast or genitalia
sexual abuse
signs and symptoms of child abuse
fearful behavior, bed wetting, UTI’s abdominal pain, extreme sexual behavior
characteristics of the typical child abuser
male, knows victim, any social level
illness that one person fabricates or induces in another person
Munchausen syndrome by proxy
infant can suffer trauma resulting from an intentional or non accidental head injury by caregiver
shaken baby syndrome
Signs and symptoms of shaken baby syndrome
increase ICP decrease LOC resp compromise vomiting seizures coma death
when is the babies brain synapses being produced
first 3 years
cranio-cerebral patho of infant
heads disproportionably larger, weak cervico-spinal muscles, larger subarachnoid spaces
violent shaking of a baby causes
soft tissue of the brain to bounce around inside the skull
who is the least likely to be the perpetrator of the child during abuse
mother
injuries due to shaken baby syndrome (SBS)
increase ICP
retinal hemorrhage and or detachment
skeletal fractures
who is responsible for mandatory reporting of suspected child abuse
healthcare professionals, including nurses
when is a child diagnosed with failure to thrive
child’s weight for age is below 3rd or 5th percentile or falls more than 2 major percentile lines (ex. 75-25)
organic failure to thrive
cardiac, neurological, renal, GI, endocrine
Ex. cleft lip or palate, GERD, celiac, DM, hyperthyroidism
non organic failure to thrive
poverty, health beliefs, knowledge deficit, family stress
what are characteristics of failure to thrive
growth failure, failure to maintain growth patterns, developmental delays, flattened occiput, apathy, avoid eye contact, poor hygiene, feeding disorders
how do you Tx a child with failure to thrive
reverse malnutrition & provide sufficient calories to support “catch up” growth (150%), don’t overstimulate (cause baby to use more calories than needed)
what do you need to obtain during initial assessment
growth, diet hx, elimination pattern, medical hx, family hx, social hx (socioeconomic status of family)
overweight
85-95 percentile
obese
over 95 percentile
health risks due to obesity
DM, HTN, sleep apnea, cancer, obesity as adult
what is the #1 cause of obesity
inactivity
BMI
Ht (inches) 2 (squared)
treatment for obesity
exercise
5, 2, 1, almost none
(5 fruits/veggies, 2 hours of TV, 1 hour of activity, almost no sweets/sodas)
goal for obesity
maintain and allow for growth (plate method)
puberty
transition btwn childhood and sexual maturity
menarche
first menstruation
menstruation
periodic uterine bleeding
avg blood loss is 20-80 ml
14 days after ovulation
female hormones during menstrual cycle
F-follicle stimulating hormone E-estrogen L-leutinizing hormone O-ovulation P-progesterone
corpus luteum
provides progesterone, helps with gestation of fetus
if the corpus luteum is not fertilized what will happen to it
shrink and degenerate (go away)
bleeding occurs when?
decrease of estrogen and progesterone
what does the fertilized egg secrets and what does it do
HCG, keeps corpus luteum “alive” which produces progesterone that keeps the fetus alive
effects of estrogen
endometrial growth, uterine change, liquidity and elasticity of cervical mucus, dilation of cervical os
effects of progesterone
relaxation of uterus, ripens uterine lining, prepares uterus for implantation, changes in cervical mucus, breast tissue preparation
what phase is estrogen seen the greatest
proliferative phase
what phase is progesterone seen the greatest
secretory phase (luteal)
phase 1 is
menstrual phase (shedding of endometrium)
phase 2 is
proliferative phase (rapid endometrial growth)
phase 3 is
luteal phase, increase of progesterone from corpus luteum matures endometrial lining
phase 4 is
ischemic phase (if egg is not fertilized, corpus luteum reaches end of life cycle,
unable to achieve conception after one year of unprotected intercourse
infertility
less than 6 months is over age of 35
absolute factor preventing reproduction
sterility
both partners have reduced fertility
subfertility
couple has never had a child
primary infertility
couple previously conceived, now unable to conceive
secondary infertility
factors that contribute to infertility
weight, smoking, stress, chemical exposure, age, reproduction organ issues
uterine fibroids
benign growths on uterine wall that interfere with embryonic and fetal development
what is the most common cause of tubal issues
PID
what is the most important determinant of infertility
age
male factors that are associated with infertility
substances, infections, heat exposure, pelvic radiation
varicocele
vein in testicle has inadequate valves causing blood to back up, results in poor sperm quality
retrograde ejaculation
ejaculate enters bladder instead of exiting penis
when can a sperm analysis be done
2-3 days after abstinence, deliver within one hour of collection, maintain body temperature
BBT
determines approx. time of ovulation
take temperature before rising our of bed, record for 3-4 months, ovulation temp will increase 0.4- degrees for 3 days
cervical mucus does what during ovulation
thins for sperm to be able to move easier
ferning capacity
shows lined channels that favor sperm migration (lok like road ways, look like a maze when ovulation is not occurring)
what must the cervical mucus be like for the sperm
thin, clear, watery, profuse, alkaline, acelluar
hysterosalpingography
checks tubal patency and uterine abnormalities, cause cramps
diagnostic laparascopy
general anesthesia, pump CO2 into pelvis for visualization, have post op neck and back pain
what is the first line therapy for females in infertility
clomid, simulates follicle growth, take po for 5 days, can have hot flashes, blurred vision, HA
when with polycystic ovarian disease may be given what
hypoglycemic, help to induce ovulation
homologous
husbands sperm used
heterologous
donors sperm used
gamete intra fallopian tube transfer (GIFT)
eggs retrieved and placed directly in fallopian tube with sperm before fertilization
IVF
women’s egg collected and fertilized in lab then placed in uterus
gene
basic unit of heredity
chromosomes
total of 46 (1 pair of sex chromosomes, 22 other pairs)
is the sex chromosomes is X and Y then the baby is
male
phenotype
outward appearance of gene
genotype
actual genetic composition
genome
complete set of genes present
homozygous
two like genes for a trait
heterozygous
unlike genes for a trait
dominate
dominant in their action over others
autosomal dominance
person with dominant gene for a disease which is Heterozygous
autosomal recessive
most genetic disorders are inherited as recessive traits
X linked dominant
some genes for disorders are located on and transmitted only by female sex chromosome
X linked recessive
female-normal gene also present blocks expression of the disease, only male children will have the disease (mother is carrier, father is normal)
chromosomal abnormalities
mutation of chromosomes, usually lethal or cause profound disabilities
meiosis
2 stage reduction, daughter cells, cell division
what happens if you have 45 chromosomes or less
death
a part of the chromosome breaks during cell division causing a normal number of chromosomes plus or minus an extra portion of a chromosome
deletion abnormalities
child gains an additional chromosome through another route, one or more chromosomes are released or jumped to another one, still have the correct # of chromosomes
translocation abnormalities
late division error, nondisjunction disorder occurs after fertilization of ovum as the structure begins mitotic division
mosaicism
consanguineous couple
closely related
visual presentation of a persons chromosome pattern
karyotyping, done by scraping of cells from buccal membrane
Barr body
determine the sex of a child, scrape cells from buccal cavity, stain, magnify, dye will appear black.
chorionic villi sampling
retrieve and analyze chorionic villi for chromosome analysis (10-12 weeks gestation)
cant detect neural tube defects
amniocentesis
15-20 weeks gestation, 15-20 ml of amniotic fluid is aspirated , cant detect neural tube defects
percutaneous umbilical blood sampling
cordocentesis, direct fetal blood sample from cord
fertilization occurs where
outer 1/3 of the fallopian tube
the highest estrogen production is during ovulation because
increases contractibility of FT, helps move ovum, thins cervical mucus, facilitates penetration of sperm
what enzyme is used for the sperm penetration of ovum
hyaluronidase
female pronucleus
once the ovum is penetrated the ovum completes maturation
when do chromosomal abnormalities happen
moment of fertilization
when does implantation occur
7-10 days after fertilization
decidua
prevents menstrual sloughing, protects and nourishes embryo, after birth it becomes lochia
purpose of amnion
protect and support the embryo as it grows and develops, contains amniotic fluid
chorion
thick outer membrane, has villi on surface until month 4
allantois
out pouching of yolk sac, forms basis of umbilical cord
placenta
begins to shrink after 8 months, exchanges nutrients and waste products, functions as lungs
umbilical cord has how many arteries and veins
2 arteries, one vein
name the three primary germ layers
ectoderm (outer)
mesoderm (middle)
endoderm (inner)
the primary germ layers eventually develop into what
all organ systems, organs and tissues
pre embryonic stage
from zygote to implantation (about 2 weeks)
embryonic period
15 days-8 weeks, all internal organs begin to form here, most vulnerable period
fetal period
8-9 weeks to birth, 1st half growth and development, 2nd half weight increases
first lunar month
1-4 weeks, germ layers develop, arm & leg buds, heart has 2 chambers, brain is visable
second lunar month
5–8 weeks, all organs present, fetal circulation has begun, largest organ is brain
3rd lunar month
9-12 weeks, end of 1st trimester, head is 1/3-1/2 of size of entire fetus, eye lids fuse together, FHT are heard with Doppler, kidney secretion by week 10 now responsible for amniotic fluid production, intestines now have bile
4th lunar month
13-16 weeks, lanugo on head, Quickening, meconium present, sucking motions, swallow (this allows for swallowing of amniotic fluid which causes meconium to form)
5th lunar month
17-20 weeks, prominent lanugo, sub Q fat, vernix, regular habits (sleep, suck, kick)
6th lunar month
21-24 weeks, end of 2nd trimester, substantial weight gain, fetal respiratory movements (as breathe take in amniotic fluid into lungs),onsidered viable at the end of lunar month
7th lunar month
25-28 weeks, surfactant production (allows aveoli opening, crucial part of getting the lungs to inflate, life depends on it), eyelids reopen, testes descend, respiratory and circulatory system sufficiently developed
8th lunar month
29-32 weeks, mineral storage in bones, can be conditioned to respond to sounds outside of mothers body
9th lunar month
33-36 weeks, increase of fat deposits, lanugo disappears
10th lunar month
37-40 weeks, considered full term, fills uterus completely, acquires antibodies from mother
Fetal nervous system
first to appear last to mature, full brain potential will occur after birth
fetal respiratory system is fully developed at
age 8
fetal urinary system
secretions begin at 9 weeks, urine present in bladder 16 weeks, prior not stored at all
fetal GI system
umbilical hernia until week 10, bowels empty after birth, fetus begins swallowing amniotic fluid @ 4 months
fetal musculoskeletal system
muscles contract week 7, calcium formation at 9 weeks
what is the most common site for ectopic pregnancy
fallopian tube, increase of risk with surgeries, and use of intrauterine devices
endometriosis
uterine tissue outside of uterus
symptoms of ectopic pregnancy
N/V, breast tenderness, amenorrhea
prior to rupture of ectopic pregnancy s/sx
abd pain, tenderness, delayed menses, spotting
after rupture of ectopic pregnancy s/sx
severe pain, referred shoulder pain (phrenic nerve is irritated) shock, faint/dizzy
gestational trophoblastic disease
trophoblastic cells on outer layer of blastocyte, grow abnormally fast, nonviable pregnancy
under 15, over 45, Asian/Latin American
choriocarcinoma
cancer found in placenta during pregnancy, bloody brown discharge all the time
10th lunar month
37-40 weeks, considered full term, fills uterus completely, acquires antibodies from mother
Fetal nervous system
first to appear last to mature, full brain potential will occur after birth
fetal respiratory system is fully developed at
age 8
fetal urinary system
secretions begin at 9 weeks, urine present in bladder 16 weeks, prior not stored at all
fetal GI system
umbilical hernia until week 10, bowels empty after birth, fetus begins swallowing amniotic fluid @ 4 months
fetal musculoskeletal system
muscles contract week 7, calcium formation at 9 weeks
what is the most common site for ectopic pregnancy
fallopian tube, increase of risk with surgeries, and use of intrauterine devices
endometriosis
uterine tissue outside of uterus
symptoms of ectopic pregnancy
N/V, breast tenderness, amenorrhea
prior to rupture of ectopic pregnancy s/sx
abd pain, tenderness, delayed menses, spotting
oral hypoglycemic
cause facial deformities, be alert for newborn hypoglycemia
gestational trophoblastic disease
trophoblastic cells on outer layer of blastocyte, grow abnormally fast, nonviable pregnancy
under 15, over 45, Asian/latin american
why is smoking bad for pregnancy
decreases fetal blood flow, decreases O2 to fetus
abortion
termination of a pregnancy before 20 weeks
spontaneous abortion
miscarriage, early in pregnancy
threatened abortion
days of unexplained bleeding/cramping, cervix is closed, risk of expulsion
blighted ovum
fertilized ovum stops developing in 1st 12 weeks, no gestational sac or fetal heart beat
elective abortion
prior to 12 weeks gestation any women can get it, from 12-20 weeks state regulated, over 20 weeks is prohibited except to save moms life
RU486, methotrexate
abortion pills
substance that adversely affect the normal fetal growth and development
teratogens
most birth defects happen bc of what
exposure happens before know they are pregnant
accutane
increase risk of spontaneous abortion and congenital anomalies
mycins
odotoxic, have damage to inner ear
oral hypoglycemics
cause facial deformities, be alert for newborn hypoglycemia
how much caffeine is considered safe
300 mg of caffeine is considered safe (3 cups)
why is smoking bad for pregancy
decreases fetal blood flow, decreases O2 to fetus
preterm delivery is at what week
26 6/7 weeks
what is the most common teratogen and leading cause of intellectual disability
alcohol use
umbrella term that includes all categories of prenatal alcohol exposure
fetal alcohol syndrome
facial characteristics of FAS
strabismus, ptosis, eyes wide set, short, upturned nose, broad nasal bridge, thin upper lip, smooth phitrum, flattened cheeks
neonatal abstinence syndrome
set of behaviors that results from fetal exposure to substance abuse in utero
the closer to deliver a mom takes the drug the ____ the delay in onset of withdrawal
greater, usually within 72 hours
do you use narcan on NAS babies
No, can cause automatic withdrawal, cause seizures
signs of neonatal withdrawal
hypertonia, seizures, excess crying, yawning/sneezing than 3 consecutive yawns/sneezes, vomiting, por swallowing, fever, sweating, apnea/tachypnea, rash
abstinence scoring system
used to objectively measure withdrawal symptoms, done within 2 hours of birth, Q4 hours after that
assessment of NAS
urine and meconium toxicology screen (on 1st voids only), give higher cal meals
mifepristone
stops pregnancy that is less than 49 days in duration, stops progesterone, 2 doses
birth control
contains estrogen and progesterone, stops ovaries from releasing egg
depo
prevents ovaries from releasing eggs, increases the mucus thickness
diaphragm, cervical cap, leas shield
barrier method
implonon
implant into arm, progesterone, increases cervix mucus
sterilization (essure, tubal ligation)
tubes placed in FT (scar tissue forms)
tubes tied
standard days method
calendar method, need to abstain btwn 8-19 days
symptothermal
temperature, abstained 2 days prior and after ovulation
lactational amenorrhea
moms who have child less than 6 months and are amenorrheic and are fully breast feeding
plan b
taken as soon as after unprotected sex
ovulation method
tracking changes in cervical mucous for BBT daily to determine fertility
Ductus arteriosis
Opening in circulatory system that allows blood to bypass lungs, if closes prematurely can cause abnormal pressure in lungs & heart
What anticoagulant is safer for pregnant women
Heparin
What is a significant modifiable cause of poor pregnancy outcomes
Smoking
HCG prevents what
Prevents menstrual Sloughing
Increase endometrium growth
Amnion
Protects embryo thin membrane
Chorion
Outer membrane has villi
