Exam 4 Flashcards
What is the definition of small for gestational age (SGA)?
- Less than 2,500 grams at birth (5 lb 8 oz) at term
- birth weight below 10th percentile for gestational age
What is the definition of large for gestational age (LGA)?
- Greater than 4,000 grams at birth (8 lb 13 oz)
- Birth weight above the 90th percentile for gestational age
What is the definition of low birth weight?
Less than 2500 g (5 lb 8 oz)
What is the definition of very low birth weight?
Less than 1500 g (3 lb 5 oz)
What are features of small for gestational age (SGA) babies ?
loose, dry skin, little fat/ muscle, scaphoid (sunken) abdomen, thin cord, wide skull sutures, weak cry
What are small for gestational age babies at risk for?
Hypoglycemia, developmental delay
What is large for gestational age often related to?
maternal diabetes, postdates, large parents
What are large for gestational age babies at risk for?
hypoglycemia, respiratory distress, birth trauma
What is the definition of a preterm baby?
Born before 37 weeks
What are common causes of premature delivery?
infection, ATOD, trauma, preeclampsia, malnutrition, diabetes, multiple pregnancy
What are issues premature babies face?
- Lack of subcutaneous fat and surfactant.
- Weak lungs, suck, and gag
- Fragile capillaries
What is the definition of a post-term baby?
Born after 42 weeks (note: may be SGA, LGA, or AGA)
What are common features of a post-term baby?
- Lack of vernix, lanugo, and subcutaneous fat.
- Dry and cracked skin
What are post-term babies at risk for?
asphyxia, hypoglycemia, meconium aspiration, birth trauma
What are important parts of preterm infant care?
- flexed in a quiet, dark, warm nest
- avoid overstimulation
- facilitate self stimulation
- prevent skin dryness/ breakdown
What are feeding methods for preterm infants?
TPN, gavage, nipple supplemental nursing system breastmilk fortifier
What are important things to assess for with premature infants?
Cerebral bleed, necrotizing enterocolitis (NEC), hypothermia, hypoglycemia, retinopathy of prematurity, respiratory distress syndrome (RDS), cerebral palsy, developmental delay
What does the ideal implementation of Kangaroo Care involve?
- A warm, quiet environment
- Infant upright on parent chest, ear over heart, skin to skin
- Encourage to rock/ stroke infant
- Decrease activity if overstimulated
What are the benefits of Kangaroo Care?
- increased sleep time
- HR regularity
- Fewer apneic and bradycardic spells
- decreased O2 levels
What are the outcomes/ benefits of Kangaroo care?
- thermal synchrony
- effective breastfeeding
- more rapid weight gain
- increased attachment
-shorter hospital stays
Explain the pathophysiology of Transient Tachypnea of the Newborn (TTN)
TTN occurs when the liquid in the lungs is removed incompletely or slowly during delivery and shortly after
(Fetal lungs filled with fluid –> and the fluid is removed and replaced with air during usual delivery)
What is the management of Transient Tachypnea of the Newborn (TTN)?
Oxygen or CPAP as needed
Supportive care
IV fluids or gavage feedings
(Normally not an emergency, so only supportive care needed, e.g., suction with bulb or deeper suction)
What are the risk factors for Transient Tachypnea of the Newborn?
Low gestational age
Cesarean birth
Precipitous delivery
Perinatal hypoxia
Male sex
What is Neonatal Respiratory Distress syndrome?
Insufficient surfactant, inadequate/ collapsed alveoli, weak skeletal muscles
What should be assessed when NRDS is suspected?
S/sx develop in first 1-2 hours of life
Decreased O2 sat; duskiness, pallor, central cyanosis; tachypnea, retractions, nasal flaring, grunting, crackles, diminished breath sounds, tachycardia
What is the management of Neonatal Respiratory Distress Syndrome (NRDS)?
Inta-tracheal surfactant replacement therapy
Ventilatory and oxygenations support (CPAP, NC)
Monitor O2 sats and arterial blood gases (ABGs)
No oral feeding if respiratory rate is greater than 60
What are the risk factors of NRDS?
PREMATURITY, maternal diabetes
How is NRDS prevented?
antenatal maternal steroids (Betamethasone)
How is chlamydia (Chlamydia trachomatis) transmitted?
Vaginal, anal, oral sex (also transmitted to neonate during birth)
What are the S/sx of chlamydia?
often asymptomatic. but if there are symptoms women present with - mucopurulent discharge, cervicitis, urethritis, vaginal bleeding. Men with urethritis with clear or mucoid urethral discharge.
What can happen if chlamydia is left untreated?
Mom: PID, ectopic pregnancy, infertility
Newborn: ophthalmia neonatorum/ blindness; pneumonia
What is the treatment for chlamydia?
Doxycycline 100 mg orally BID x 7 days or azithromycin 1 gm single dose (doxycycline recommended; slightly more effective)
Treat partners/ abstain until cured
Prevention counseling/ education
Reportable STI
How is Gonorrhea (Neisseria gonorrhea) transmitted?
Vaginal, anal, oral sex (transmitted to neonate during births)
What are the s/sx of gonorrhea?
Women: often asymptomatic; may have cervicitis/ urethritis
Men: typically present with dysuria & purulent penile discharge
What can happen is gonorrhea is left untreated during pregnancy?
Mom: PID, ectopic, infertility, preterm labor
Newborn: ophthalmia neonatorum/ blindness
What is the treatment for gonorrhea?
Ceftriaxone 500 mg IM x 1 & PO doxycycline x 10 days
Treat partners/ abstain until cured
Prevention counseling/ education
Reportable STI
How is syphilis transmitted?
Sexual contact; crosses placentaW
What are the s/sx of syphilis?
vary depending on infection stage:
Primary: painless chancre
Secondary: fever, lymphadenopathy, HA, anorexia, rash
Latent: asymptomatic
Tertiary: irreversible multi-organ damage & death
What screening tests are used to detect syphilis?
VDLR (Venereal Disease Research Laboratory) and RPR (Rapid Plasma Reagin)
What can happen if syphilis is left untreated during pregnancy?
Mom: SAB (spontaneous abortion), stillbirth
Newborn: congenital syphilis (deformities; mental delay)
What is the treatment for syphilis?
Penicillin IM x 1 dose (2.4 million units)
Treat partners/ abstain until cured
Prevention counseling/ education
Reportable STI
How is Human Papillomavirus (HPV) transmitted?
Sexual contact or during delivery
Is HPV curable?
No; it is incurable
What can HPV cause?
Genital warts & cervical cancers
What are the s/sx of HPV?
fleshy painless growths on vagina, labia, cervix, or anus
How is HPV diagnosed?
Pap smear or visual exam
What can happen if HPV is untreated during pregnancy?
may obstruct birth canal & newborn may develop laryngeal papilloma
What is the management for HPV?
may disappear without treatment
Removal via cryotherapy, surgery, podophyllin, or acid
Prevention counseling/ education
Sexual partner examination is not necessary
What are the risk factors bacterial vaginosis (Gardnerella vaginalis)?
multiple partners, new partner, douching
What are the s/sx of bacterial vaginosis?
thin, gray-white vaginal discharge; fishy odor
How is bacterial vaginosis diagnosed?
Microscopic identification of clue cells; whiff test; vaginal pH greater than or equal to 4.5
What may happen if bacterial vaginosis is left untreated during pregnancy?
PROM, chorioamnionitis, PTL, PID
What is the proper treatment and management of bacterial vaginosis?
Metronidazole (Flagyl) PO bid x 7 days
Abstain or use condom until antibiotics completed
Treating male partner not beneficial
What is PID?
An acute infection of uterus & fallopian tubes (usually caused by untreated STIs)
What are the s/sx of PID?
dysuria, pelvic pain, fever, chills, anorexia, abnormal vaginal discharge or bleeding
How is PID diagnosed?
Abdominal tenderness, greater in lower quadrants
Pain in uterus & cervix when moved during exam
Nonspecific lab findings
What are the risk factors for HPV?
history of STIs, young, multiple partners, recent IUD insertion, douching
(increases risk of ectopic pregnancy & infertility)
What is the proper treatment/ management of PID?
Ceftriaxone 500 mg IM single dose, PO Doxy 100 mg bid x 14 days with metronidazole 500 mg bid x 14 days
Treat partners/ abstain until cured
Prevention counseling/ education
How is Herpes Simplex Virus (HSV) transmitted?
skin or sexual contact & to neonate in vaginal birth (viral shedding can occur in absence of visible sores)
Highly contagious; incurable
What are the s/sx of HSV?
painful blisters on the vulva, perineum, & anus
What is the treatment/ management of HSV during pregnancy?
Acyclovir & healthy lifestyle reduces symptoms
C/S if active genital infection at time of birth
What are the s/sx of Trichomoniasis (trichomonas vaginalis)?
May be asymptomatic. If symptoms are present:
Women: profuse yellow-green or frothy gray vaginal discharge with foul odor. Vulvar puritis/ edema, dysuria, cervicitis (strawberry cervix)
Men: dysuria, thin, white penile discharge
What are complications if Trichomoniasis is left untreated during pregnancy?
PPPROM, PTL, stillbirth
What is the treatment for Trichomoniasis?
Metronidazole (Flagyl) 500 mg PO bid x 7 days for women
Metronidazole 2 g orally once for men
treat partners/ abstain until cured
Prevention counseling/ education
What are the s/sx of Vaginal Candidiasis (candida albicans)?
vaginal/ vulval itching, burning, vulva/ vagina very red & swollen; cottage cheese-like discharge
What can happen is vaginal candidiasis is left untreated during pregnancy>
can infect newborn at birth: thrush, diaper rash, meningitis, endocarditis, UTI, sepsis
