Genetics and Prematurity Flashcards
How many births are preterm?
1 in 8
What are 8 major influences that influence preterm birth?
genes,fetal growth, gestational clock, uterine activity, labor cascade, membrane strength, susceptibility to infection and twinning
In 3rd week, what is developed?
neural tube
In 4th week, what is developed?
heart beat
In 7th week what is developed?
a rudimentary skeleton
In 7th - 8th week, what is developed?
sexual development
______ is any agent that can harm an embryo or fetus
teratogen
True or False, one teratogen can cause different defects
TRUE
What are some rule-of-thumbs relatated to teratogens
longer exposire/higher dose = more harm, father’s exposure may affect embryo, lon-term effects depend on postnatal environemnt, some effect not apparent until later in life
What 2 things make each pregnancy unique?
genetic makeup and prenatal environment
3 things that affect perinatal environment
medications, delivery practices, and social environment
7 problems you might expect to see in premature infants
poor thermal regulation, immature CNS, immature immunity, IVH, immature cardiopulmonary system, immature GI system, an dGLucose instability
Nursing interventions for poor thermal regulation premies
prewarming the delivery room and placing infant in a plastic bag up to the neck during delivery room stabilization to prevent heat loss
What is apnea?
pause in breathing of longer than 10 to 15 seconds assoc. with bradycardia, cyanosis or both
Your are caring for a premie baby in the NICU. The alarm for desats goes off. What are your actions?
Assess baby for signs of breathing and skin color. If apneic, cyanotic or bradycardic, tactile stimulation needs to be given. If that doesn?t work, bag and mask w/ suctioning and airway positioning
What does IVH stand for?
Intraventricular Hemorrhage
What are risk factors for IVH?
extreme prematurity, presence of labor, birth asphyxia and need for vigorous resuscitation, mechanical ventilation, sudden change in BPs r/t hypetonic volume expansion
Describe common s/s for IVH
symptoms of increased intracranial presure- seizures, decreased or absent reflexes, hypotonia, bulging fontanels, enlarged head circumference, setting-sun eyes, shrill cry, hypothermia, apnea and bradycardia
________ is a hypoxic-ishemia injury to the mucosa of the intestinal tract which results in abdominal distention, sepsis, and nutritional impairment
Necrotizing enterocolitis
_____ ______ is causes vessel damage in the tiny periventricular capillaries, resulting in symptoms on increase ICP
Intraventricular Hemorrhage
NEC, is the disease of prematurity. What are the parameters for prematurity?
< 1000 grams, <28 weeks gestation
NEC is associated with what other interrelationships?
ishemia, immunity, infection, immaturity, nutrition
What is the grading system for IVH?
grade 1 = small bleed, grade 2= severe bleed
You are caring for a baby with NEC, how are you going to proceed with feeding?
constant 1-2 ml per hour flow, and mom’s milk b/c fortified with antibodies
Soft signs ( hard to identify) in NEC, include-
increased residual, lethargy, blood glucose instability, and temp instability
S/s of NEC include:
abdominal distention, visible bowel loops, bloody stool, feeding intolerance, bilious vomiting, apnea, bradycardia, desat
A baby was just admitted for NEC, what are your first actions?
stop all feedings and place IV for fluids. 100-120cc/kg/day
What are nursing management goals for NEC?
ventilation by trach, NG compression and TPN, broad spectrum antibiotics, pain control and minimal handling, serial exams and abd. Xrays, grequent labs, surgery
clef lip > in _____, palate > in _____
boys, girls
What ages are lip and palate correction surgeries performed?
lip - 2 week - 3 mon, palate 6-18 mon (minimize speech impairment)
What should be included in the nursing assessment of cleft lip and palate?
failure of fusion of lip, palate or bothl difficulty sukcing and swalloing and parent reaction
As a nurse caring for a baby with cleft lip and palate, what feeding education can you provide?
longer, softer nipple, squeezable bottle, feed upright position, feed slowly w/ bubbling
Common types of nipples for cleft lip and palate
lambs nipple, prosthetic palate, rubber tipped aspeto syringe
Baby Ellie just came from the OR for corrective lip and pallate surgery. What is number 1 priority?
Patent airway and proper positioning
Positioning for cleft lip post op
side or upright in infant seat. NOT prone
positioning for cleft palate
on side or abdomen
How can the nurse portect the surgical site for lip and palate surgery?
elbow restraints, minimize crying to prevent strain, and maintain Logan bow to lip if applied
How do you care for a restrained child?
remove one restraint at a time, preform ROM exercises and age-appropriate stimulation
Why do you clean suture site with sterile water after feeding?
formula remaining on suture line may impede healing and lead to infection
____ _____ is a nonprogressive disorder of the developing brain causing neuromuscular disorders of spasticity or dyskinesia (involuntary movement)
cerebral palsy
True or False, CP may be present only at childbirth
False, can be present at birth or evident in infancy/early childhood
What are common problems associated with CP?
mental retardation, epilepsy, and visual and hearing disturbances
Risk factors for CP include:
birth asphyxia, intrauterine infection, preterm infant, very low birth weight (MAJOR)
How might CP be diagnosed?
neuro exam, history, posture/tone, persistence of primitive reflexes
Which reflexes might remain after 6 mon, which indicate CP?
moro, tonic neck
What disease the following assessment indicate?
CP
What are common CP management ideals the nurse should use?
Team approach ( PT, OT, ST, nutrionist, ortho, neuro, maximize motor fxn/ADLs, AFOs, enhance communication, bracing/casting/surgery, meds which decrease spasticity, nutrition assistance, fam support
What are 2 common meds used for CP?
Dilantin (anticonvulsant) and Valium (muscle spasms)
One goal for CP patients is preventing aspiration during feeding. As a nurse how would you educate you patient on this?
position child upright and support lower jaw
____ _____ is defined as a deformity, a defect of the spine that includes several injuries with different severity and prognosis
Spina Bifida
What is the most common location of SB?
lumbosacral (85%)
What may Spina Bifida lead to?
paralysis, neurogenic bowel/bladder, hydrocephalus, ortho abnormalities
Spina bifida occulta
vertebrae only. No sac present, usually benign. Bowel and bladder problem may occur
Meningocele spina bifida
only meninges and spinal fluid, has less neurologic involvement than a myelomeningocele. Has a sac somewhere along the spine
Myelomeningocele
more severe than meningocele because the sac contains spinal fluid, meninges and nerves
Dimple with or without hair tuft at base of spine can indicate
spina bifida occulta
Presence of sac at lumbar or lumbosacral area may indicate?
myelomeningocele
Flaccid paralysis, limited or no feeling below the defect, head circumference at variance with noms on growth grids are s/s of what?
spina bifida
What are immediate nursing interventions for spina bifida?
cover sac with moist clean dressing (prevent rupture of defect/infection), no pressure on affected area, antibiotics, IV fluid, latex precaution, pre-op care
What is preop care for spina bifida?
keep sace clean, cover with moist sterile dressing, elevate foot of bed w/ child on abd legs abducted, measure head cir. Q 8 hr w/ fontanel check, assess neuro, monitor for s/s of infection, empty bladder w/ crede method or foley
What is post op care for spina bifida?
prone for first 7 d. and then sides (NOT SUPINE), foley then intermittent cath, keep incision clean, observe for leaks, antibiotics, head circ. , urecholine to decrease retention, colace to soften stool
Long term care for spina bifida
teach straight cath & bowel program, splints, ROM, PT, assess skin, Chari malformation
What is a common bowel program for spina bifida?
high-fiber diet, increased fluids, reg. fluids, and suppositores prn
_______ a mismatch between the production and absorption of CSF.
Hydrocephalus
True or False, Cause of hydrocephalus can be flow obstruction or absorption impairment
TRUE
True or False, hydrocephalus is most often associated with IVH and a possible complication of meningitis
FALSE, spina bifida and meningitis
HESI hint for ICP vs shock
Shock= increase in HR and decrease in BP. ICP= decrease pulse and increase in HR
Irritability, increase head circ., bulging fontanels, widening suture lines, sunset eyes and high pitched cry are all s/s of what?
ICP in infants
What would explain to a parent about the placement of a shunt for hydrocephalus?
shunt is being inserted into ventricle, tubing is tunneled through skin to peritoneum where it drains excess CSF
What can cause hydrocephalus?
infection, IVH, tumor, structural abnormality, prematurity
What is post op care for hydrocephalus VP shunt insertion?
HOB flat to decrease rapid and excess drainage of CSF, don?t pump shunt unless prescribed because it can change pressure in ventricle
What is primary apnea and how would you intervene?
premie forget to breathe, O2 drop, RN can intervent by tactile stimulation
What is Secondary apnea and how do you intervene?
baby continues to desat and deteriorate. This apnea will lead to a bradycardic state. The nurse will need to give O2, possibly bag and mask.
What is the feeding order when bottle feeding a child with cleft palate?
child suck, then squeeze, child suck, then squeeze
If bottle doesn’t work when feeding a cleft lip/palate baby, what do you expect to intervene with?
NG/G Tube.
Why wouldn’t you want to send a baby home with a a NG tube?
because It can get displaced
What are your 2 biggest concerns when caring for a child post-op cleft lip/palate surgery?
Feeding and aspiration
