Final Exam Flashcards
1
Q
Describe a febrile seizure
A
-occurs in children with no previous neurological condition
-fever >38
-resolves within 15 minutes
-for fevers not caused by meningitis, encephalitis or other illness infecting the brain
-most have stopped by the time the child reaches the hospital
-Tylenol for comfort but does not decrease the risk of having a febrile seizure
2
Q
What is the treatment for febrile seizures?
A
-no anticonvulsant therapy is indicated for children who have experiences 1 or more simple febrile seizures
-lab tests may be indicated by the nature of the underlying febrile illness
3
Q
What is a complex febrile seizure?
A
-Occur in children of any age usually with a neurological impairment consist of a prolonged seizure lasting more than 15 minutes and can reoccur within 24 hours and result in neurological deficits after the seizure
4
Q
What are the three types of onset for seizure classification?
A
focal onset, generalized onset, unknown onset
5
Q
What are the diagnostic evaluations for seizures?
A
-history and presentation of the seizures (rule out other factors, such as migraines, breath holding spells, TIAs, movement disorders)
-determine whether the events are epileptic or non-epileptic in nature
-define the underlying cause
EEG to help determine the type of seizure
6
Q
What are some ways of managing seizures?
A
-Monitoring and recording of symptoms
-Treatment of the underlying illness/condition
-Antipyretics
-Anticonvulsant medications
-Ketogenic Diet
-Vagus Nerve Stimuli
-Surgical Therapy
-Parental support & education
7
Q
What nursing care should be provided during a seizure?
A
-assess and document the seizure activity (NOTE the time)
-make sure that the child is safe (won’t fall or hit something)
-remain calm and support the child and family
-monitor vitals and O2 status
8
Q
What is status epilepticus?
A
-medical emergency
-defines as seizure activity for 5 minutes or longer or is 3 or more in a 15 min period
-treatment includes Lorazepam, Midazolam or Fosphenytoin
-ECG monitoring should be initiated
9
Q
What is Meningitis?
A
-acute inflammation of the meninges
-aseptic or bacterial
10
Q
Describe nonbacterial (aseptic) meningitis
A
Etiology is principally viral in nature
* Can occur at any age; more common in younger
children
* Similar presentation as bacterial meningitis
* CSF Clear with mononuclear leukocytes
* Onset is abrupt or gradual (vague in younger
children)
* Clinical findings like bacterial meningitis
11
Q
Describe bacterial meningitis
A
Focus of infection initially occurs elsewhere
*The infection spreads via vascular system to the
cerebral spinal fluid & extends to arachnoid space
*Brain becomes edematous & covered with purulent
exudate
* CSF Cloudy with high protein and decreased glucose
*Flow of cerebral spinal fluid may be obstructed
12
Q
What are the signs and symptoms of meningitis for children and adolescents?
A
-most children present with fever, headache and vomiting that may change depending on their level of consciousness
-some may only present with lethargy or irritability
-altered sensorium
-seizures
-agitation
13
Q
What are the clinical manifestations for meningitis in infants and young children
A
The clinical presentation found in older children and
adolescents are rarely found in younger children
* Fever
* Poor feeding
* Marked irritability
* Vomiting
* Frequent Seizures (with a high-pitched cry)
* Bulging fontanel
14
Q
What are the clinical findings of meningitis in new borns?
A
Extremely difficult to diagnose
Manifestation vague and nonspecific
Well at birth but within a few days began to look and behave poorly
* Refusal of feeding
* Poor sucking ability
* Vomiting or diarrhea
* Poor tone
* Lack of movement
* Weak cry
* Full, tense and bulging fontanel sometimes appear late in the course of the illness
15
Q
What is the diagnostic evaluation of meningitis?
A
-lumbar puncture (MOST IMPORTANT)
-CT scan
-blood culture
-nose and throat cultures
-urine cultures
16
Q
What are the complications of meningitis?
A
-seizures
-shock
-electrolyte and fluid abnormalities
-learning/hearing impairment
-developmental delay
17
Q
What is some nursing care that we can provide to a patient with meningitis?
A
*Vaccine administration
*Quiet Environment
*Pain assessments
*Assessment for fevers
*Fluid monitoring
*Neurological assessments
18
Q
Describe tonsilitis
A
- Tonsils are masses of lymph tissues in the
palatine/pharyngeal cavity - Filter and protect the respiratory tract
- Children have much larger tonsils than
teenagers or adults - May involve the tonsils and or the adenoids
19
Q
What is the therapeutic management for tonsilitis?
A
-Viral-symptomatic is self-limiting
-Bacterial throat cultures for GABHS are treated with antibiotics
Surgical:
* tonsillectomy &/or adenoidectomy
* For recurrent infections (6 episodes per year causing 20 days of missed school, and or airway obstruction that leads to sleep apnea
20
Q
What are the nursing considerations post-operatively for a tonsillectomy?
A
-rest
-minimize disturbance of surgical site
-check secretions
-ice collars
-po fluids (liquid to soft diet, no dairy products)
-medications for pain control
Assess for post-op hemorrhage:
-observe throat directly
-assess for s&sx of hypovolemic shock
-observe for continuous swallowing, vomiting of fresh blood, clearing throat, restlessness
-maintain npo, notify HCP and monitor VS
-bleeding risk after surgery, 7-10 days after surgery and up to 14 days post-operatively
21
Q
What is glomerulonephritis?
A
the immune process of fighting an infection injures the glomeruli resulting in altered glomerular structure and function of the kidney
22
Q
What are the signs and symptoms of glomerulonephritis?
A
Fever
Edema
Lethargy
Headache
Decreased urine output
Abdominal Pain
Vomiting
Anorexia
Tea colored Urine
23
Q
Describe acute post streptococcal glomerulonephritis?
A
-most common in children
-develops 5-21 days after an infection
Clinical manifestations:
-generalized body edema
-hypertension
-oliguria
-hematuria
-proteinuria
24
Q
What are the diagnostic tests for acute post-streptococcal glomerulonephritis?
A
-blood work (elevated urea and creatinine usually)
-urine dipstick (3-4+ hematuria)
-urinalysis
-ASO titres (test for strep infection)
-C3 levels (rising C3 levels indicates improvement)
-chest x-ray
-kidney biopsies are rarely indicated
25
What is the therapeutic management for acute post-streptococcal glomerulonephritis?
* Rest
* Restricting sodium
* Potassium restriction in food
* Fluid restriction
* Close monitoring of vital signs/weight/intake and output
* Antihypertensive drugs
* Diuretics
* Antibiotics only for children with evidence of persistent
strep infections
26
What is the first period of reactivity during the transition to extrauterine life?
-a period of reactivity that lasts up to 30 min after birth
-HR increases to 160-180 beats per min
-resps are irregular and frequent: 60-80 breaths per min
-fine crackles, audible grunting, nasal flaring, and retractions of the chest may be noted
-alert and may have spontaneous startles, tremors, crying, and move head from side to side
-bowel sounds are audible, and meconium may be passed
27
What is the period of decreased responsiveness in the transition to extrauterine life?
-Lasts 60 to 100 minutes
-Sleeps or has a marked decrease in motor activity
-Pink and respiration rapid but shallow
28
What is the second period of reactivity in the transition to extrauterine life?
-Occurs 2 to 8 hours after birth (lasts 10 minutes to several hrs)
-Brief period of tachycardia & tachypnea occur
-Meconium commonly passed
-Increased muscle tone, changes in skin colour, and mucus production
29
What are the chemical factors that occur during the initiation of breathing?
-transient decreases in PO2 and increase on PCO2 that have cumulative effects
-catecholamine surge which promotes fluid clearance
30
What are the mechanical factors that occur during the initiation of breathing?
-Changes in intrathoracic pressure from pressure of the chest during vaginal delivery to negative
intrathoracic pressure
-Crying increases distribution of air in the lungs and promotes expansion of the alveoli
31
What are the thermal factors that occur during the initiation of breathing?
-Environmental temperature changes stimulates receptors in the skin
-Cold stress may be important for initializing breathing
32
What are the sensory factors that occur during the initiation of breathing?
-Handling or drying the infant
-Pain associated with birth
-The lights, sounds, and smells of the new environment
33
Describe Transient Tachypnea of the Newborn (TTNB)
-Mild degree of respiratory distress
-Fluid retention or transient pulmonary edema
-Delayed clearance of fetal lung fluid producing “wet lung”
-Occurs in first few hours, resolving by 72hrs of age as fluid clears
34
What are the nursing assessments of Transient Tachypnea of the Newborn?
-perinatal history
Observe for signs of TTNB:
-tachypnea/expiratory grunting/retractions/labor breathing/nasal flaring/mild cyanosis
-barrel chest/hyperextension
-breath sounds-slightly diminished related to reduce air entry
35
What is the nursing management for TTNB?
-IV fluids and gavage feed until RR decreases
-Maintain a neutral environment (warm and limit
handling)
-O2 (NP or O2 hood)
-Monitor if resolving or persisting
-Assist parents to cope/reassurance as it resolves
36
What are the signs of respiratory distress in a newborn?
Nasal flaring
Intercostal or subcostal retractions or grunting
Suprasternal/subclavicular retractions with stridor or
gasping
Seesaw respirations
Respiratory rate less than 30 or greater than 60
breaths/min with the infant at rest
Apneic episodes
Colour can indicate respiratory distress
Acrocyanosis, the bluish discolouration of hands and
feet after 10 days
Transient periods of duskiness while crying are not
uncommon immediately after birth; however, central
cyanosis is abnormal and signifies hypoxemia
37
What are the signs of cardiovascular issues in a newborn?
-Persistent tachycardia (more than 160 bpm) can be associated with anemia, hypovolemia, hyperthermia, or sepsis
-Persistent bradycardia (less than 100 bpm) can be a sign of a congenital heart block, hypoxemia, or hypothermia
-Any central or prolonged cyanosis can indicate respiratory or cardiac problems and requires immediate investigation
38
What are the physiological adaptations of the cardiovascular system of a newborn?
-foraman ovale
-ductus artiosus
-ductus venosus
39
What are the physiological adaptations of the renal system in a newborn?
-Voiding increases with age of the infant
-Sometimes pink-tinged uric acid crystal(brick dust) stains appear on the diaper
-Dysfunction resulting from physiological abnormalities can range from the lack of a
steady stream of urine to anomalies such as hypospadias, enlarged or cystic kidneys
40
What are the physiological adaptations of the thermogenic system in a newborn?
-newborns are dependent on their environment for thermoregulation
-balance between heat loss and heat production
Predisposed to heat loss due to:
-radiation
-convection
-evaporation
-conduction
41
What are the results of cold stress on a newborn?
-increased anaerobic glycolysis
-metabolic acidosis
42
What are the physiological adaptations of the intestinal flora in a newborn?
-Intestinal flora, or gut microbiota are established within the first week after birth.
-Normal intestinal flora help synthesize vitamin K.
-Breastfeeding is important in establishing the intestinal microbiome of the newborn
43
When do most healthy term infants pass meconium?
most within 12-24 hours but must by 48 hours (in a healthy infant)
-black and sticky
-is a physiological adaptation
44
Describe transitional stools
-stools that usually appear by the third day after feeding
-greenish brown to yellowish brown, thin and may contain some milk curds
45
When does milk stool appear?
-usually by the fourth day
-in breastfed infants the stools are yellow to golden, pasty in consistency, resemble a mix of mustard and cottage cheese with an odor similar to sour milk
-in formula-fed infants the stools are pale yellow to light brown, have firmer consistency, with an odor more like normal stool
46
What are the signs of GI problems in newborns?
-failure to pass meconium
-active rectal "wink" reflex shows good sphincter tone so no wink is bad
-amount and frequency of regurgitation (spit up) after feedings should be documented
47
When does vernix appear?
-starts at about 22-24 weeks and is most abundant at 33-35 weeks
-should be non-existent at term
-babies become dry post-dates
48
Define lanugo
fine hair noted over the face, shoulders and back
49
Define milia
distended, small, white sebaceous glands
50
Define Mongolian spots
Congenital Dermal Melanocytes
-appears over any part of the exterior surface of the body, including the extremities
-looks similar to a bruise
51
Define Telangiectatic nevi
-stork bite or angel kisses
-flat, pink capillary hemangiomas that are easily blanched
52
Define erythema toxicuma
-transient rash
-also called newborn rash
53
Define Nevus Vasculosus
Strawberry Hemangioma
-common type of capillary hemangioma
-raised and rough
-develops in the first year of life and then fades
54
What is a pilonidal dimple?
-sacral dimple
-requires further inspection to determine whether a sinus is present
55
What is Caput Succedaneum?
-edematous area between the skin and the scalp, most commonly found on the occiput
-extends across the suture lines of the skull and disappears spontaneously within 3-4 days
56
What is cephlahematoma?
-collection of blood between a skull bone and its periosteum
-does not cross a cranial suture line
-largest on the second and third day
-resolves in 3-6 weeks
57
What is a subgaleal hemorrhage?
-bleeding into the subgaleal compartment
-difficult operative delivery
-blood loss can be severe
58
What are the usual signs of a small for gestational age infant?
-less than 2500g at term or below 10%ile at any gestational age
-poor muscle tone over buttock
-sunken appearance
-decrease amount of breast tissue
-head is disproportionately large
-loose skin that appears oversized
-reduced subcutaneous fat stores
59
What are the usual signs of a large for gestational age infant?
-greater than 4000g or above the 90%ile at any gestational age
-large body and full face
-more difficult to arouse
-plump appearance
-difficulty regulating behavioural states
-prone to birth injury
-poor motor skills
60
Describe physiological jaundice
-occurs after 24 hours of age
-high risk infants: exclusive breastfeeding not well established, visible bruising, cephalohematoma, hemolytic disease, asphyxia, sepsis, poor feeding, LGA and SGA
61
What are the treatments for jaundice?
-prevention is key-- early and frequent feeding stimulates the passage of meconium
-phototherapy
-exchange blood transfusions
62
What are the signs and symptoms of hypoglycemia in newborns?
-jittery
-poor feeding
-seizures
-eye rolling
-weak or high pitch cry
-apnea
-cyanosis
-lethargy
63
What are the biggest signs of newborn sepsis?
-tachypnea
-tachycardia
-temperature instability
-hypotonia
-feeding intolerance (increasing residuals)
-pallor
64
What is the treatment for newborn sepsis?
-fluids and vasopressors
-O2 and mechanical ventilation
-obtaining cultures
-antibiotic administration as ordered, observing for side effects
-promoting newborn comfort
-assessing the family's educational needs and providing instructions as necessary
65
What are some signs of withdrawal in neonates?
-irritability
-seizures
-hyperactivity
-tremors
-high-pitched call
-hypertonicity
-diaphoresis
-fever
-mottled skin
-nasal stuffiness
-poor feeding
-diarrhea
-dehydration
-vomiting
-disrupted sleep
-tachypnea
-temp instability
66
What nursing management should be done for newborns of substance abusing mothers?
-decrease stimuli (lights and noise)
-providing adequate nutrition and hydration
-appropriate individualized developmental care should be implemented to facilitate the infant's self-consoling and self-regulating behaviours
-irritable and hyperactive infants have been found to respond to physical comforting, movement, and close contact (promote skin to skin)
-cluster care to reduce stimulation
-pacifier
-intake and output, watch electrolytes, additional caloric supplementation, and daily weight
-SIDS is high
67
Define preterm infant
any infant born before 37 weeks gestation
68
What is the difference between a later preterm, moderate preterm, very preterm and extremely preterm?
late-- 34-36+6 weeks
moderate-- 32-34 weeks
very-- 28-32 weeks
extremely-- less than 28 weeks
69
What is the minimum gestational viability age in Canada?
24 weeks
70
Why is thermoregulation so important in low-birth-weight infants?
rapid changes in body temp may cause changes in cerebral blood flow which may contribute to intraventricular hemorrhage
71
What is respiratory distress syndrome (RDS)?
-complication related to prematurity
-caused by a surfactant deficiency
-diagnosed based on clinical manifestations
-tachypnea >/=60
-dyspnea
-pronounced intercostal or substernal retractions
-fine inspiratory grunt
-flaring of the external nares
-cyanosis or pallor
-apnea
72
What is a periventricular-intraventricular hemorrhage?
-hemorrhage around the ventricles in the brain
-one of the more common neurological injuries of the newborn with severe short and long-term outcomes
-most common in the first 72 horus post birth
-classified according to severity
73
What are the nursing actions that can be done for periventricular-intraventricular hemorrhage?
-decreasing the risks
-supportive care to the infants that have a bleed
74
What are the early clinical signs of necrotizing enterocolitis?
-decreased activity
-hypotonia
-pallor
-recurrent apnea
-bradycardia
-respiratory distress
75
What are the clinical manifestations of necrotizing enterocolitis?
-metabolic acidosis
-oliguria
-hypotension
-decreased perfusion
-temp instability
-cyanosis
-abdominal distension
-bilious vomiting
-bloody stools
-abdominal tenderness
-erythema of the abdominal wall
76
What are the diagnostic tests for necrotizing enterocolitis?
-abdominal CT
-CBC/lytes/blood culture/blood gas analysis
77
What is the treatment for necrotizing enterocolitis?
-broad spectrum antibiotics
-NG decompression
-TPN therapy
-surgical intervention
78
What treatment for syphilis occurs during pregnancy?
* Long acting benzathine penicillin G delivered via IM route
* Maternal neurosyphilis is Pen G IV for 10 days
* 3 doses for latent syphilis or uncertain stage of disease
* Course needs to be successfully be completed greater than
4 week before delivery and show a drop in titer levels
79
What is seen during the infant physical examination of an infant born from a mom with syphilis?
* Growth-Low birth weight, failure to thrive
* General- Fever, pallor, jaundice,
nonimmune hydrops, generalize lymphadenopathy, severe
sepsis syndrome
* Head and Neck- Rhinitis, Chorioretinitis, cataracts, uveitis, keratitis
* Skin maculopapular, desquamating or vesiculobullous lesions
* Cardiorespiratory- myocarditis, congestive heart failure, respiratory
distress, pneumonia
Central Nervous System--cranial neuropathies, meningitis, seizures, hearing loss
Musculoskeletal-- dactylitis, periostea, leading to pseudo paralysis
Renal--Proteinuria. Hematuria, or nephrotic syndrome
Other-- may mimic other infectious diseases syndromes or congenital infections and non-infectious conditions (e.g., juvenile myelomonocytic leukemia
80
What is the treatment of an infant born from a mom with syphilis?
* IV dose of Penicillin G for 10
days
* LFT
* CSF
* Long bone X-ray
* Screening audiology
* Ophthalmologic assessment
81
What is cerebral palsy?
* Several disorders related to the development of movement and
posture
* Can occur prenatally, and in the natal and postnatal period
* Cerebral Palsy is the most common movement disorder of
childhood, a lifelong condition, most common physical disability.
* Anoxia plays the most significant role in the pathological state
of brain damage
82
What are the possible maternal origins of cerebral palsy in an infant?
* Exposure to radiation
* Infection
* Prematurity, low birth weight, intrauterine growth restriction
* Pre-eclampsia
* Malformation of brain structures, abnormal blood flow to brain
* Assistive reproductive technology
83
What are the possible perinatal causes of cerebral palsy in infants?
* Prematurity <32 weeks
* Asphyxia/hypoxia
* Breech position
* Sepsis/infection/electrolyte complications
* Cerebral hemorrhage
84
What are the possible postnatal causes of cerebral palsy in infants?
* Head trauma
* Seizures
* Toxins
* Viral or bacterial infections
85
What are the clinical classifications of cerebral palsy?
-motor abnormalities
-associated impairments
-anatomical and neurological findings
-causation and timing
86
What are the classifications/types of cerebral palsy?
-spastic
-athetoid
-ataxic
-mixed
87
What risk factors should be further evaluated in children that could be early signs of cerebral palsy?
* Early handedness in children under 12 months
* Stiffness or tightness in the legs between 6 and 12 months
* Persistent fisting of the hands in a child over 4 months
* Persistent head lag in a child over 4 months
* Inability to sit without support in a child over 9 months
* Any asymmetry in posture or movement
88
What management techniques are used to help children with cerebral palsy?
* Optimizing Function
* Maximize Independence
* Promoting Community Participation
* Reducing Secondary Muscular Skeletal Issues
* Managing comorbid conditions
* Rehabilitation
* Pharmacological
* Neurosurgical
* Orthopedic
89
What is cystic fibrosis?
-inherited respiratory condition
-autosomal recessive disease with a mutated gene
-causes difficulty breathing because of increased viscosity of mucus gland secretion
90
What are the diagnostic tests that are done to check for cystic fibrosis?
-intrauterine diagnosis
-newborn screen
-DNA test for CFTR gene
-sweat chloride >/= 60mmol/L
-normal less than 40 with an average of 18
-chest x-ray
91
What is the presentation of cystic fibrosis?
INCREASED VISCOSITY OF MUCUS GLAND SECRETION ELEVATED SWEAT CHLORIDE DIFFERENT SALIVA ENZYMES ABNORMALITIES OF THE AUTONOMIC NERVOUS SYSTEM FUNCTION EARLIEST PRESENTATION IS OFTEN MECONIUM ILEUS OF THE NEWBORN CAUSES THE OBSTRUCTION OF MULTIPLE DUCTS IN THE BODY
* BRONCHI
* SMALL INTESTINES
* PANCREATIC DUCTS
* BILE DUCTS
92
What are the clinical manifestations of cystic fibrosis?
-meconium ileus
-gastrointestinal manifestations
-pulmonary manifestations
93
What is a meconium ileus?
-abdominal distention
-vomiting
-failure to pass stools
-rapid development of dehydration
94
What are the pulmonary manifestations of cystic fibrosis?
INITIAL:
WHEEZING RESPIRATIONS
DRY NONPRODUCTIVE COUGH
SECONDARY:
INCREASED DYSPNEA
PAROXYSMAL COUGH
EVIDENCE OF OBSTRUCTIVE EMPHYSEMA AND PATCHY AREAS OF ATELECTASIS
PROGRESSIVE INVOLVEMENT:
OVERINFLATED BARREL SHAPED CHEST
CYANOSIS
CLUBBING OF FINGERS AND TOES
REPEATED EPISODES OF BRONCHITIS AND BRONCHOPNEUMONIA
95
What are the gastrointestinal manifestations of cystic fibrosis?
* Large loose bulky frothy foul-smelling stools
* Voracious appetite (early disease) Loss of appetite (late disease)
* Weight loss
* Marked tissue wasting
* Failure to grow
* Distended abdomen
* Thin extremities
* Sallow skin
* Evidence of deficient of fat-soluble vitamins (A,D, E,K)
* Anemia
96
What are the airway clearance therapies for cystic fibrosis?
* PERCUSSION AND POSTURAL DRAINAGE
* POSITIVE EXPIRATORY PRESSURE (PEP)
* ACTIVE CYCLE OF BREATHING TECHNIQUE
* HIGH FREQUENCY CHEST COMPRESSION VEST
* POSITIVE END EXPIRATORY PRESSURE MASK
* FLUTTER MASK
97
What are some ways of managing GI complications of cystic fibrosis?
-TREATMENT OF PANCREATIC INSUFFICIENCIES WITH PANCREATIC
ENZYMES WITH MEALS AND SNACKS
-HIGH PROTEIN HIGH CALORIE DIET
* May need NG or GT tube
-INCREASED FAT-SOLUBLE VITAMINS (A D E K)
98
What is an endocrine complication due to cystic fibrosis?
Cystic fibrosis related diabetes
-insulin resistance and insulin deficiency
99
Describe spina bifida occulta
-defect of the vertebral bodies without protrusion of the spinal cord or meninges
-this defect is not visible externally and, in most cases, has no adverse effects-- commonly anomaly
100
What is a meningocele?
-assessment will reveal a visible external sac protruding from the spinal area
Monitor:
-evidence of leaking of CSF fluid
-prevent rupture of sac
-prevent infection
-monitor head circumference
-monitor intake and output
101
What are the complications of a myelomeningocele?
* Most common severe form of neural tube defects
* Complications due to a neurogenic bladder
* At risk for hydrocephalus
* Increased risk of latex allergy
* Difficulties with ambulation
102
What nursing actions should be done for patients with neural tube defects? (spina bifida, etc)
* Prevent Infection
* Promoting Urinary/Bowel Elimination
* Promoting Adequate Nutrition
* Preventing Latex Allergy Reaction
* Maintaining Skin Integrity
* Educating and Supporting the family
103
How is sickle cell anemia diagnosed?
-newborn screen
-sickle-turbidity test
-Hgb electrophoresis test
-can be diagnosed during their first crisis
104
What are the complications associated with sickle cell anemia?
Pain
Abdominal pain
Hematuria
Hemorrhage
Retinopathy
Heart Failure
Paralysis
Avascular necrosis (shoulder and hip)
Hepatomegaly
Gallstones
Splenomegaly
Dactylitis
105
What are the clinical manifestations of sickle cell?
* Possible Growth Restriction
* Chronic Anemia (Hgb levels of 60-90 g/L
* Possible delayed sexual maturation
* Marked susceptibility to sepsis
106
What is the medical treatment for sickle cell?
Rest and minimize energy expenditure
Hydration through oral and IV fluids
Electrolyte replacement
Analgesia for pain
Blood replacement
Antibiotics
107
What education should be done for the family of a child with sickle cell?
Early intervention for fever
Give penicillin as ordered
Vaccine administration (pneumococcal, flu shot, Hep A and
B)
Recognize the signs of crisis
Oxygen support during a crisis
Hydration
Blood transfusions
Hydroxyurea
Provide normal growth and development activities
108
What is the curative treatment for sickle cell?
hematopoietic stem cell transplant offers the only cure
109
What is Human Chorionic Gonadotropin (HCG)
-earliest biochemical marker
-trophoblast cell secrete HCG early in the pregnancy
-HCG stimulate estrogen and progesterone production
-helps to maintain the pregnancy until the placenta can assume this function
110
What is Nagele's rule?
-a formula for calculating estimated date of birth
-add 7 days to last normal menstrual period and count forward 9 months
-most women give birth from 7 days before to 7 days after EDB
111
What are presumptive signs of pregnancy?
-changes felt by the women
-primarily felt in the first trimester
-ex. amenorrhea
-can be attributed to pregnancy or something else
112
What are probable signs of pregnancy?
-changes observed or felt by the examiner
-usually, physiological changes of the pelvic organs or hormonal changes
-ex. Goodell sign
113
What are positive signs of pregnancy?
-attributed ONLY to the presence of the fetus
-ex. ultrasound verification of the fetus, auscultation of FH tones
114
What are the cardiovascular system adaptations to pregnancy?
-slight cardiac hypertrophy
-elevated upward and rotated forward to the left
-heart rate increases
-blood pressure decreases (starts at the end of first trimester... continues 24-32 weeks)
-supine hypotension syndrome-- second trimester
-fainting can be an issue in the second trimester
-increase in blood volume and change in composition
-cardiac output increases
-increase in clotting factors
115
When does a pregnant woman start feeling kicks?
26-32 weeks-- should feel 6 movements in 2 hours
116
What happens to the cervix during pregnancy?
-cervix begins to soften (Goodell sign) and takes on a blue/blush colour (Chadwick sign) by 6-8 weeks
-mucous plug forms as a barrier against bacteria, this is different from the leukorrhea
-cervix ripens 4 weeks before labour
117
What is the Goodell sign?
-cervix softening during pregnancy
118
What is the Chadwick sign?
cervix changing to a blue/blush colour during pregnancy
119
What adaptations occur to the vagina during pregnancy?
-vaginal vault lengthening because connective tissue loosens and smoot muscle becomes hypertrophic in the first trimester
-PH becomes acidic
120
What adaptations occur to the breasts during pregnancy?
-fullness, heaviness
-heightened sensitivity from tingling to sharp pain
-areolae become more pigmented
-montgomery's tubercles
-colostrum
121
What respiratory system adaptations occur during pregnancy?
-respiratory system (thoracic cage increases)
-vasocongestion (response to elevated estrogen-- nasal stuffiness)
-increase in basal metabolism rate (greater demand for O2)
-acid-base balance (tidal volume increases and PCO2 decreases)
122
What are the renal system adaptations during pregnancy?
-hormonal activity causes enlarging uterus and blood volumes
-renal pelvis and the ureters dilate
-Hegar's sign and urinary frequency
-bladder tone may decrease, which increases the bladder capacity to 1500mL
-glomerular filtration rate and renal plasma flow increase early in pregnancy
-selective renal tubular resorption maintains sodium and water balance
-kidneys to excrete water is more efficient
-kidney reabsorbs almost all the glucose and other nutrients from the plasma filtrate, but tubular reabsorption of glucose in pregnancy is impaired
-proteinuria does not usually occur in normal pregnancy
123
What is Chloasma?
-mask of pregnancy
-darkening of face during pregnancy
124
What is linea nigra?
a dark line that develops on your stomach during pregnancy
125
What is striae gravidarum?
-stretch marks
126
What are palmar erythema?
itchy, diffuse and blotchy red patches on their palms
127
What are the musculoskeletal adaptations during pregnancy?
-Centre of gravity shifts forward
-Aching, numbness, and weakness of the upper
extremities
-Slight relaxation and increased mobility of the pelvic
joints- waddling gait
-Muscles of the abdominal wall stretch and the rectus
abdominis muscles may separate
-Leg cramps
128
What are the neurological adaptations during pregnancy?
-compression of pelvic nerves
-dorsolumbar lordosis can cause traction on nerves
-carpal tunnel syndrome
-tension headache
-hypocalcemia can cause neuromuscular issues
129
What are the GI adaptations during pregnancy?
-nausea and vomiting
-change in appetite
-mouth and teeth
-gum hypertrophy
-esophageal regurgitation (heartburn)
-increased emptying time and thickening of bile in the gallbladder
-pelvic heaviness or pressure, round ligament tension, flatulence
130
What are the steps of maternal adaptation to pregnancy?
-accepting pregnancy
-relationships undergo change
-establishing relationship with fetus
-preparing for childbirth
131
What are the steps of paternal adaptation?
-accepting pregnancy
-identifying with father role
-reordering personal relationships
-establishing relationship with fetus
-preparing for childbirth
132
What are the calorie requirements during pregnancy?
2nd trimester-- 340Kcal more than maintenance
3rd trimester-- 452Kcal more than maintenance
133
What is pre-eclampsia?
hypertension in pregnancy
134
What are the risk factors for pre-eclampsia?
-greater than age 40 with their first pregnancy
-family history
-chronic conditions, such as obesity, diabetes, lupus, kidney disease or past history
135
What are some prevention methods for pre-eclampsia in women at low risk of developing pre-eclampsia?
-abstention from alcohol
-smoking cessation
-multivitamins containing folate (also to prevent neural tube defects)
-calcium supplementation (at least 1g/day orally) for women with low dietary intake of calcium
-regular exercise
136
What are the qualifications of non-severe pre-eclampsia?
-BP >/= 140/90 mmHg but not exceeding 160/110 mmHg
-mean arterial pressure MAP >105 mmHg
-proteinuria <0.3g in 24 hour specimen or
137
What are the qualifications for severe pre-eclampsia?
-BP >/= 160/110 mmHg
-mean arterial pressure >105 mmHg
-proteinuria of >0.3g in 24 hours specimen or >/=30mg/mmol urinary creatinine in a random urine sample
-presence of one or more severe complications
138
What is eclampsia?
seizure activity or coma in women diagnosed with pre-eclampsia
-occurs before, during or after birth
-fetus is at increased risk for placental abruption, preterm birth, IUGR, and acute hypoxia
139
What is HELLP syndrome?
-lab diagnostic variant of severe pre-eclampsia that involves hepatic dysfunction
Hemolysis (H)
Elevated Liver enzymes (EL)
Low Platelets (LP)
140
What are the associated risks with HELLP syndrome?
-placental abruption
-renal failure
-pulmonary edema
-ruptured liver hematoma
-disseminated intravascular coagulation (DIC)
141
What treatment is used for BP control in mild to severe pre-eclampsia?
-Initiation of antihypertensive therapy
-Consider uteroplacental perfusion (Consider MAP)
-Labetalol administered intravenously
-Nifedipine; methyldopa; other beta blockers such as
metoprolol, and propranolol; and hydralazine are also used
-Choice of medication - woman's response and physician preference
142
What is magnesium sulfate used for?
-prevent or control convulsions (eclamptic seizures)
143
What are the adverse effects of magnesium sulfate?
-lethargy
-feeling warmth
-headache
-nausea
144
What are the early signs of magnesium sulfate toxicity?
-vomiting
-respiratory distress
-hypotension
-flushing
-muscle weakness
-decreased reflexes
-slurred speech
145
What are the signs of magnesium toxicity?
-loss of patellar reflexes
-respiratory and muscular depression
-oliguria
-decreased level of consciousness
146
What is the antidote for magnesium sulfate?
calcium gluconate
147
What is the postpartum care for pre-eclampsia?
-Report symptoms, such as headaches and blurred
vision.
-Assess affect, level of consciousness, BP, pulse, and
respiratory status before analgesic
-Antihypertensive medication, if her dBP exceeds
100 mm Hg at discharge.
-Ambulates after birth - assess for weakness,
dizziness, shortness of breath, and muscle soreness
148
What are the antepartum interventions of Gestational Diabetes Mellitus?
-monitoring blood glucose levels (at 1 hour after meals it should be 5.5-7.7 mmol/L and 2 hours after it should be 5.0-6.6 mmol/L)
-diet
-exercise
-insulin therapy (NO oral hypoglycemics)
-fetal surveillance (performed weekly from 32 weeks and onward)
149
What are the intrapartum interventions for gestational diabetes?
-monitored at least every hour to maintain levels ideally at less than 8 mmol/L
-insulin, if controlled in antepartum
150
What are the postpartum interventions for gestational diabetes?
-return to normal glucose levels after childbirth
-carbohydrate intolerance can be initiated 6 weeks to 6 months postpartum
-offspring of women with GDM are at risk of developing obesity and diabetes in childhood
151
What is hyperemesis gravidarum?
-nausea and vomiting in its extreme form occurs between 4-9 weeks of pregnancy
-cause is not well understood
-associated with nulliparous, diabetes, increase BMI, hx of migraines and twins
-protracted vomiting, retching, severe dehydration, weight loss, poor skin turgor, decrease BP, tachycardia, electrolyte imbalance that requires hospitalization
152
What is the initial care for hyperemesis gravidarum?
-Clear liquid diet - slowly introducing small,
frequent meals
-Multivitamin
-Avoid triggers
-Diclectin first-line treatment or ondansetron
(Zofran)if not effective
-Alternative therapies such as ginger, acupuncture,
and acupressure
-IV therapy for correction of fluid and electrolyte
imbalances
153
What care needs to be done for severe hyperemesis gravidarum?
-consult GI medicine
-TPN may be needed
-sings of complications (metabolic acidosis, hemorrhage)
-accurate measurement of intake and output
-oral hygiene
-diet is progressed slowly
154
What is placenta previa?
-placenta implanted in lower uterine segment near or over internal cervix
-late pregnancy bleeding
155
What are the clinical manifestations of placenta previa?
-painless, bright red bleeding, soft uterine tone, often fetal heart is normal, slow progression usually
-may have increase fundal heights
156
What are the maternal and fetal outcomes of placenta previa?
-complications such as hemorrhage and creta's
-fetal risks include malpresentation, stillbirth, fetal anemia, IUGR
-preterm birth
157
What diagnostic criteria need to be met to diagnose placenta previa?
-standard diagnosis is transabdominal ultrasound examination, or transvaginal ultrasound
158
What is the expectant management of placental previa?
-for less than 36 weeks, mild/no bleeding/not in labour
-ultrasound examinations every 2 weeks
-fetal surveillance once or twice a week
-serial lab values
-venous access with an IV infusion or heparin lock
-antepartum steroids
-no vaginal or rectal examinations are performed (NOTHING IN THE VAGINA!! EVER!!)
159
What is the active management of placenta previa?
-beyond 36 weeks, excessive bleeding, in labour, obs reason to end the pregnancy
-c-section for complete placenta previa
-attempt vaginal birth for partial or marginal placenta previa
160
What is placental abruption?
-premature separation of placenta
161
What are the clinical manifestations of a placental abruption?
-Often sudden
-Abdominal or low back pain, uterine tenderness(contractions) and firm; can be
localized or broad-like pain
-Dark red bleeding(port wine)
-Abnormal fetal heart patterns
-Often has increase fundal heights
162
What antepartum care is needed for women with diabetes?
-Routine prenatal care
-Diet and exercise
-Monitoring blood glucose levels (3.4-6.7 mmol; 2hr
postprandial –less than 6.7mmol))
-Insulin therapy
-Determination of EDC and mode of delivery
-Routine prenatal laboratory tests (A1C,24hr urine-
renal function)
-Fetal surveillance (Fetal echo @ 20 wks, BPP,NSTs)
163
What intrapartum care is needed for women with diabetes?
Close monitoring of blood glucose levels and
dehydration.
-Blood glucose levels are assessed every hour in active
labour (4-7 mmol).
-Insulin is administered by intermittent subcutaneous
injection or continuous insulin infusion may be required.
-Continuous FHM is required
164
What postpartum care is needed for women with diabetes?
-blood glucose levels are monitored in the postpartum period-- sliding scale method
-breastfeeding has an anti-diabetogenic effect
-may have early breastfeeding difficulties
165
When would a c-section be needed for a woman with HIV/AIDS?
-if she's not receiving antiretrovirals
-plasma load greater than 1000
-an unknown plasma level
-antepartum bleeding
166
What nursing care should be done for a pregnant woman with HIV and AIDS?
-tested for other sexually transmitted infections, including hepatitis
-IV zidovudine administered during the intrapartum period
-every effort should be made to decrease the newborn's exposure to blood and secretions
167
What are the health risks associated with substance use during pregnancy?
-bleeding complications (placenta abruption)
-miscarriage
-stillbirth
-prematurity
-low birth weight
-sudden infant death syndrome
168
What is the presentation of anemia?
-tachycardia
-headache
-fatigue
-shortness of breath
-muscle weakness
-heart murmur
-PICA
169
What are the main causes of anemia in children?
-rapid rate of growth
-blood loss
-insufficient nutritional intake
170
What are the risk factors for children to have cancer?
-familial and genetic predisposition
-down's syndrome
-previous history of cancer
-immunodeficiency (congenital, acquired, treatment related)
171
What is the presentation of Acute Lymphocyte Leukemia?
-pale
-listless
-irritable
-febrile
-anorexic
-weight loss
-petechia
-bruising without cause
-bone and joint pain
172
What factors influence a child's cancer prognosis?
-initial WBC count
-age of child at diagnosis
-type of cell involvement
-sex of the child
-karyotype analysis
-presence of leukemia cells in the CNS at diagnosis
173
What is the goal of induction treatment for cancer?
-to achieve normal blood counts, bone marrow function and absence of leukemic cells in the bone marrow
-very intense and lasts for about 4-5 weeks
174
What is consolidation/ intensification treatment for cancer?
-intensive therapy that lasts for 6 months
-has the goal of reducing disease cells left in the body
-drugs and doses used during consolidation therapy depend on the patient's risk factors
175
What is maintenance therapy for cancer treatment?
-a less intense round of treatment (compared to induction and consolidation)
-weekly or monthly CBC are taken to evaluate marrow response
-begins when the child achieves remission after the induction and consolidation therapy
-goal is to destroy any disease cells that remain so that the leukemic cells are absent
-treatment length is greater for boys than for girls and lasts between 2-3 years
176
What is central nervous system prophylactic therapy?
-chemo injected right into the spinal fluid using a lumbar puncture
-done to prevent or treat leukemia cells that could or have entered the CNS
-reserved for children that are high risk or with resistant CNS disease
177
What is reinduction? (cancer treatment modification)
-patients who relapse after chemo may be treated with different chemo drugs and/or more intense doses
-each reinduction creates a poor prognosis
178
What is a hematopoietic stem cell transplant?
stem cells transplanted from a donor
-antigen from matched donors or mismatched donors
-used in children who have relapsed more than once in ALL or after first remission in AML
-bone marrow of the child is destroyed prior to receiving the transplant
-risk factors include GVHD (graft versus host disease), overwhelming infection or severe organ damage
179
What are some complications of chemotherapy?
-nausea and vomiting
-anorexia
-mucosal ulcerations
-pain
180
What are some side effects of chemotherapy?
-neuropathy
-hemorrhagic cystitis
-alopecia
-steroid effects
-mood changes
181
What could neuropathy due to chemotherapy look like?
-decreased bowel motility
-changes in body alignment and foot drop
-difficulties in balance and fine motor movements
-jaw pain
182
What are the signs and symptoms of an air emboli?
-sudden difficulty in breathing
-sharp pain in chest
-apprehension
183
What are the signs and symptoms of electrolyte disturbances?
-nausea/diarrhea
-muscle weakness
-flaccid paralysis
-paresthesia of extremities
-bradycardia
-apprehension
-cardiac arrest
184
What are the delayed reactions that can be triggered by a blood transfusion?
Alloimmunization: an immune response to an introduced foreign antigen
-increased risk of hemolytic, febrile and allergic reactions
Delayed hemolytic reactions: destruction of RBCs and fever 5-10 days after transfusion
185
What are the early symptoms of preterm labour that we should provide education about?
-uterine activity (contractions)
-discomfort (back pain)
-vaginal discharge (mucus plug)
186
What are tocolytics used for?
-stop labour after uterine contractions and cervical change have occurred
-no medications have been approved for use as tocolytics in Canada (off label)
-the rationale for giving these medications is to delay birth long enough to allow time for maternal transport and for corticosteroids to reach maximum benefit
187
What are some medications that are tocolytics?
-nifedipine
-indomethacin
-nitroglycerin
188
What are the clinical manifestations of post-term pregnancy?
-maternal weight loss
-decreased uterine size
-meconium in the amniotic fluid
-advanced bone maturation of the fetal skeleton
189
What are the maternal risk factors of a post-term pregnancy?
-perineal injury
-hemorrhage
-infection
190
What are the fetal risks for post-term pregnancy?
-shoulder dystocia
-birth trauma
-asphyxia from macrosomia
-compromising effects on fetus of an "aging" placenta
191
Define dystocia
abnormally slow progress of labour
-greater than 4 hours of less than 0.5cm per hour of cervical dilation in active labour or greater than 1 hour of active pushing with no descent
192
What is hypertonic uterine dysfunction?
-painful and frequent contractions
-uncoordinated contractions usually occur in the latent stage
-force of the contraction is midsection, rather than the fundus
-the uterus may not relax completely between contractions
-usually exhausted and express concern over loss of control
-therapeutic rest.. awaken in active labour
193
What is hypotonic uterine dysfunction?
-secondary uterine inertia
-makes normal progress into the active stage of labour, then teh contractions become weak and inefficient or stop altogether
-CPD and malposition are common causes of this type of uterine dysfunction
-may become exhausted and be at increased risk for infection
-management usually consists of rule out CPD, assess FH, ROM and maternal well-being
-if findings are normal, measures such as ambulation, augmentation, stripping membranes and nipple stimulation
194
What is pelvic dystocia?
-contractures of pelvic diameter that reduce capacity of bony pelvis, inlet, midpelvis or outlet
-fractures
-congenital
-immature pelvis
195
What is soft dystocia?
-results from obstruction of birth passage by an anatomical abnormality other than bony pelvis
-uterine fibroids
-full bladder or rectum
-HPV
-cervical swelling
196
What are some fetal causes of dystocia?
-anomalies, such as ascites, neural tube defect, etc
-CPD (cephalopelvic disproportion)-- disproportion between the size of the fetus and the maternal pelvis
-malposition
-malpresentation (breech)
197
What nursing care should be done during dystocia?
-electronic fetal monitoring (EFM)
-ultrasonography
-risk assessment is a continuous process
-prevention
-health care team approach
198
What is precipitous labour?
-labour that lasts less than 3 hours from onset of contractions to birth
199
What are some of the complications of precipitous labour?
-lacerations
-hypertonic uterine contractions
-should dystocia
-amniotic fluid embolism
-hemorrhage
200
What is the most important predictor of successful induction?
cervical ripeness
201
What is an amniotomy?
-artificial rupture of membranes
-risk of prolonging labour and infection
-usually labour begins within 12 hours
-most effective when combined with oxytocin
202
What is oxytocin/syntocin?
-hormone normally produced by posterior pituitary gland that stimulates uterine contractions
-used to induce labour or augment a labour progressing slowly because of inadequate uterine contractions
203
What is augmentation of labour?
-stimulation of uterine contractions after labour has started spontaneously but progress is unsatisfactory
-implemented for management of hypotonic uterine dysfunction
-common augmentation methods include: oxytocin infusion, amniotomy, noninvasive methods (nipple stimulation)
204
What risks does a vacuum-assisted birth pose to the newborn?
-cephalhematoma
-scalp lacerations
-subdural hematoma
205
What are the complications and risks of a caesarean birth?
-hemorrhage
-infection
-dehiscence
-endometritis
206
What is a prolapsed cord?
-when the cord lies below the presenting part of fetus
-contributing factors include: a long cord, malpresentation (breech), unengaged presenting part
207
What should be done for a prolapsed cord?
-modified SIMS, Trendelenburg or knees to chest
-call for help
-place fingers in vagina to displace the presenting part (do not put cord back into vagina)
Second nurse:
-O2, wrap cord in 4x4s with sterile water
-monitor FH
-prep for delivery
