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Postnatal > Jaundice > Flashcards

Jaundice Flashcards

1
Q

Jaundice

A

Yellow discolouration of skin and sclera cause by raised levels of bilirubin in the blood

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2
Q

Causes of physiological jaundice

A

Normal breakdown of excessive RBC needed by newborn in extra uterine life. Fetus has greater need for RBC than newborn

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3
Q

Physiological jaundice

A

Normally never appears before first 24 hrs of age

Fades between 7-10days

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4
Q

Bilirubin levels rise to

A

200mmol/l term

250 premi

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5
Q

Pathological jaundice

A

Occurs before 24 hrs
Rapid increase in bilirubin levels
Persists beyond 10 days

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6
Q

Midwife role in jaundice

A

Educate symptoms
Who to contact
What to look for

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7
Q

Causes of pathological jaundice

A

Anything that increases the production of bilirubin or inhibits the transport, metabolism or excretion of it. Eg blood group incompatibility, sepsis, hypothermia, abs, dehydration

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8
Q

The normal breakdown of bilirubin process / conjugation

A

Into haem and gloving
Haem- is catabolised into bilirubin
It is lipid or fat soluble- unconjugated bilirubin
Body transports to liver to bind with albumin
If it’s not bound to albumin it can go to Brian or skin
Once at liver, conjugation occurs with aid of liver enzymes
Once conjugated, able to excrete
Moves via Villary system into small bowel excreted in faeces and some urine via kidneys

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9
Q

If conjugation occurs, why do they develop jaundice

A

Level of bilirubin they need to transport, convert and excrete exceeds ability to do so
Lower albumin conc- less transport
Liver immature
Lack bacteria in bowel

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10
Q

How does the lack of bacteria in bowel contribute to bilirubin

A

It ensures conjugated bilirubin is excreted properly, if not reconversion to unconjugated (lipid or fat soluble) which is reabsorbed by body

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11
Q

Supportive jaundice care

A

Early feeding

Freq feeing

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12
Q

How does early / freq feeding aid in jaundice care

A 
Hydration and Glucpse for energy 
Encourages bowel flora and morality
Glucose assists anymore process in liver
Motility- dec time billirubin in bowel, dec amount it is reabsorbed 
Maintains warmth
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13
Q

Jaundice ax

A 
Every 8-12 hrs
Is visible at 80-90mms/L
Alert/ drowsy
Feeding 
Output 
Kramer rule OR transcutaneous billirubinometer
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14
Q

Kramer rule

A

Blanching of skin with finger a different zones and observing colour

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15
Q

K1

A

Head and neck

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16
Q

K2

A

Chest an shoulders

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17
Q

K3

A

Umbi lower abdo and knees

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18
Q

K4

A

Lower arms and lower legs

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19
Q

K5

A

Whole of baby

Hands feet fingers and toes

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20
Q

Trancutaneous billirubinometer

A

Screens jaundice level to determine need for serum billirubin test (SBR)
Older than 24 hrs

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21
Q

Photo therapy

A

When level needs to be supported more than early and freq feeds
Blue lights to enhance billirubinn conjugation and therefore ability to excrete

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22
Q

Photo therapy rules

A 
Intermittent or continuous 
Exposure to entire skin 
Control temp
40-50cm from baby 
Eyes protected
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23
Q

Cons of phototherapy

A

Fluid loss increase, dehydration
Separation
Skin ax unreliable when exposed
When ceased - (rebound)

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24
Q

Importance of newborn ax

A 
Monitor health / wellbeing 
Responses to physiological changes
Check growth
Behaviour 
Affects I birth 
Detect congenital malformation 
Sick baby
Baseline
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25
Q

Principles of newborn ax

A 
Communicates 
Quiet and alert
Systematic approach 
Heart and lungs first 
Symmetry
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26
Q

Sequence of new born ax

A 
History 
Heart lungs 
Skin 
Head neck
Chest abdomen 
Spine 
Limbs and joints 
Neurological
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27
Q

History before nba

A 
Genetic factors 
Maternal blood group 
Apgar
Birth weight 
Mode of del
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28
Q

Average length

A

45- 50cm

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29
Q

Average weight

A

3500g -4500g

Normal to lose 10% normal physiological diuresis

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30
Q

Regain birth weight by day

A

10-14

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31
Q

Head circ average

A

34.5-35.5cm

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32
Q

Head circ measurement taken from

A

Occipitofrontal diameter

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33
Q

Normal auxilla temp

A

36.5-37.5

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34
Q

NBA heart lungs

A

RR effort rise and fall abdomen simultaneous
30-60 RR
HR 110-160 regular

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35
Q

When listening to heart in NBA

A

Reg
Diaphragm high pitch
Bell low pitch
S1 and s2

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36
Q

Skin NBA

A 
Lanugo 
Millia
Mottling 
Colour 
Pallor 
Acrocyanosis
Plethora
Jaundice 
Mongolian blue spot 
Vernix
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37
Q

Head and neck NBA

A 
Symmetry shape
Injury 
Sutures 
Fontanelles
Plagiocephally
Face
Hair
Moulding 
Caput succedaneum
Cephalhamltoma
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38
Q

Sutures

A

Frontal
Coronial
Sagital
Lanbdoidal

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39
Q

Fontanelles

A

Anterior- hard on palp

Posterior -flat not sunken or bulging

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40
Q

If post Frontanelle is bulging

A

Intracranial haemorrhage

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41
Q

If posterior Frontanelle is sunken

A

Dehydration

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42
Q

Cephalhaematoma

A

Bleeding eternal periostium and none of fetul skull

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43
Q

Most common site for Cephalhaematoma

A

Parietal bones

Can have more than one

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44
Q

How does Cephalhaematoma happen

A

Occurs from forceps, friction of fetal scull on pelvic bones
Because periostrium separating from skull bone and haemorrhaging between them

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45
Q

In Cephalhaematoma the swelling is confined to

A

One single bone per haematoma- won’t cross suture line

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46
Q

When does Cephalhaematoma occur

A

12-72hrs

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47
Q

Cephalhaematoma pit on pressure?

A

No

48
Q

True false Cephalhaematoma may be bilateral

A

True

49
Q

Cephalhaematoma enlarge or reduce after birth

A

Enlarges

50
Q

Cephalhaematoma can contribute to

A

Jaundice

Anaemia

51
Q

Caput succedaneum

A

Oedemous swelling of superficial tissues inside scalp

In unsupported part of head

52
Q

Causes of caput succedaneum

A

Pressure on fetal head during contractions

53
Q

Can caput succedaneum cross suture line

A

Yes

54
Q

Caput succ reduces or enlarges afterwards

A

Reduces

55
Q

Does caput succ pit on palp

A

Yes

Soft swelling

56
Q

Tx for caput vs Cephalhaematoma

A

Caput no tx

Cephalhaematoma gentle handling and vita k

57
Q

Face NBA

A

Eyes -discharge moving ocular organs gaze epicantal fold red reflex othalmascope
Nose- patent
Mouth- symmetrical, rooting reflex, asses lips gums palette complete, tongue tie, candida

58
Q

Chest and abdo NBA

A 
Round and soft 
Nipples symmetrical
Exclude hernia with palp of groins 
Genetalia 
Excited undescended testes
59
Q

Spine NBA

A 
Palp
Lumps
Swelling 
Dimpling
Butt creases 
Anus patent
60
Q

Limbs and joints

A 
Check auxilla for skin tags
Open hands
Webbing 
Equal ROM joints 
Flexion
Tone
61
Q

Neurological NBA

A

Alert
Reflexes
Grasp

62
Q

Babinski reflex

A

Stimulus sole of foot

Response big toe bends back toward top of foot and other toes fan

63
Q

Startle (mono) reflex

A

Stim- loud sound or movement

Red- head thrown back, extends arms and legs, pulls them back in

64
Q

Root reflex

A

Stim- corner of mouth stroked

Re- head turns to touch

65
Q

Suck reflex

A

Roof of mouth touched

Res sucking

66
Q

Truncal incuration / galant reflex

A

Tap side of spine

Red- twitch hips towards touch

67
Q

Tonic neck reflex

A

Stim - head turned to one side

Res- extremities on same side straighten Opp side flexed

68
Q

Grasp reflex

A

Touch palms or fingers

Res- close fingers in grasp

69
Q

Meconium stained liquor risk

A

Aspirate- infection

70
Q

Common disorders of neonate

A 
Oral thrush 
Sucking blister
Septic spots 
Breast engorgement 
Vom mucous
71
Q

True false urates normal in nappy first 24 hrs

A

Yes

72
Q

Stool changes

A

Meconium- black green tenacious
Transitional- 3-5 brownish yellow
Feeding established- loose yellow offensive

73
Q

Newborn physiological adaptations

A 
Resp
Haematological
Thermal
GIT
Metabolic
74
Q

Primary functional change of lungs

A

Lungs change from fluid excretion function to gas exchange
Fluid needs to be removed for this
Expelled- through oral an nasal pharynx
Reabsorbed- remainder with inflation

75
Q

The first few breaths encourage

A

Remaining intra alveolar fluid to move peri bronchial and peri vascular spaces to be absorbed into local vascular system

76
Q

Establish resp

A

RR is irreg
Apnoea 5-15 secs norm
Effort is diaphormatic

77
Q

Resp adaptations

A

Primary functional change of lungs
Establish resp
Increase expansion of terminal sacs

78
Q

Expansion of terminal sacs

A

Complet inflation - complete inflation I terminal alveolar sacs- efficient gas exchange

79
Q

Lung vol per kg

A

25ml

80
Q

Haematological adap

A

Fetal haemoglobin - at birth 17g per decilitre of blood
Fetal type has high affinity of oxygen to compensate for prev hypoxic uterine enviro
After, hb no longer req, hemolysis will occur = jaundice

81
Q

Why vita K

A

Newborn doesn’t have adequate supply of vita k to be able to synthesis thrombin and other Clotting factors

82
Q

What stimulates synthesis of vita k

A

Feeding,’colonisations of bowel

End of First week

83
Q

Thermal adaptation

A 
Need to adapt to cooler enviro
Uterine temp 37.7 
Dry and wrap
Thermoregulation
Risk of heat loss
84
Q

Why are babies at risk of heat loss

A

Less subcutaneous fat
Large surface area to mass ratio
Thin epidermal layer
Blood vessels superficial decrease ability to shiver

85
Q

Loss of heat from baby

A

Convection to moving air
Conduction to cold surface
Evaporation to air through wet skin
Radiation to cold structures

86
Q

How do babies gain heat

A

Brown adipose tissue- provided heat through chemic thermogenesis
Withdrawal of prostaglandin and adenosine which prevents shivering

Decrease ability to sweat 
Flexed posture 
Chemical thermogenesis- metabolic activity 
Limb movement 
Sucking
87
Q

To use brown fat

A

SNS stimulates release of adrenaline, TSH, & catecholamines which increase metabolism of brown fat, enhance production of bfat and make extra glucose to fuel this conversion
Rapidly metabolised and produces heat- transfers through vascular system by strategic placement around bodies with high circulation (kidneys adrenal glands head and neck)

88
Q

GIT adaptations

A

Sucking and swallowing- reflexes present at birth
Stomach capacity- 6mL/kg meaning 3.5kg=21 ml normal increases rapidly
Cardiac sphincter immature at birth- causes positing so this plus size of stomach and competition of ingested air in stomach = regurgitation of milk

89
Q

Digestion adaptations

A

Milk feeding stimulates production of enzymes within the git tract and stimulates rapid proliferation of cells lining the tract
At term has the ability to digest simple carbs, protein and fat

90
Q

Glucose adaptations

A

Maternal glucose withdrawn
In 3rd try feotus lays down stores of glycogen to ensure enough in first few days
More efficient in synthesis rather than using it- need for ketones and ffa as immediate source of energy - gluconeogenesis
Decrease in serum insulin- NB ability for fat metabolism (lipolysis) increases- supports while gluconeogenesis occurs
The release of ffa and ketones relies on lipolysis

91
Q

Metabolic adaptations

A

Fat metabolism

Protein metabolism

92
Q

Protein metabolism

A

Learns to digest milk proteins to provide source of amino acids to so in remodelling urging rapid cell differentiation to Feed rapid cell growth

93
Q

Adult hb

A

180

94
Q

Fetal hb

A

220

95
Q

Fetal circulation

A

Structures of fetal circ enable efficient transport of gases to and from placenta
Aimed at quick transport of O2 and nutrients to vital organs

96
Q

Why is there a greater need for 02 to be transported quickly in fetal

A

Gas exchange not as effective in placenta than lungs

97
Q

Why do fetid have different hb

A

Fetal hb allows 20-30% greater 02 carrying capacity than adult and O2 disengages easily from this - supplies tissues more effectively

98
Q

Why is fetal circ a temporary thing

A

Minimises circ to I rgans that are less improtant in fetal life like lungs and git- must be temporary to allow for rapid transition

99
Q

When does cvs develop

A

En of 3rd week (5wks gestation)
Fetal placental villi forming along with fetal placental vessels. A rudimentary umbi cord can be seen.
Fetal vessels are made of mesoderm- one of the basic layers of the tri laminae embryo

100
Q

At week four (6wks gest) CVS

A

Rudimentary two chambered heart begins to beat

101
Q

Critical time for cardiac Dev is

A

20-50 days after fertilisation

102
Q

6wks (8g)

A

Umbi cord developed
Carries 02 rich blood to embryo
2 umbi arteries carry deox to placenta

103
Q

8 was (10g)

A

Structures making up fetal circ in place

Whartons jelly protects vessels in cord

104
Q

Feto-placental circ

A

Deox to placenta via 2 umbi arteries away from fetal heart.
Umbi arteries divide and subdivide entering into villi of placenta for gas exchange
Return circ through umbi vein 02 blood fetus toward fetal heart

105
Q

Temporary structures of fetal circ

A 
Umbilical vein 
Ductus venosus
Foramen ovale 
Ductus arteriosus
Umbilical arteries
106
Q

Umbilical vein

A

From the umbi cord to underside of the liver. Has branch that joins portal vein. Half the blood supplies from
Vein enters this branch- other half shunted through temp structure ductus venosus

107
Q

Ductus venosus

A

Connects umbilical win to inferior vena cava high in 02 directed toward the heart

108
Q

Foramen ovale

A

Opening between r and L atria of heart
Allows blood entering heart to bypass pulmonary circ
Has flap which can open or close with changing pressures of heart

109
Q

Ductus arteriosus

A

Connection between pulmonary artery and the aorta

Allows like entering pulmonary circ to be diverted before entering lungs

110
Q

Umbilical arteries

A

From hypo gastric arteries to the umbilical cord
Carries 02 rich blood back to placenta via hypo gastric artery which are branches of the internal illiacs
Pic

111
Q

Foramen ovale at birth

A

Functional closure 1-2 hrs after permanent within 6 months know as fossa ovalis

112
Q

Ductus arteriosus changes a birth

A

Functional closure in 15 hrs- fibroses takes within 3 weeks becoming known as ligamentum arteriosum

113
Q

Ductus venosus changes a birth

A

Functional closure soon after birth

Fibroses takes within 2 months belong known as ligamentum venosum

114
Q

Umbilical vein & arteries (intra abdominal) changes

A

Constricts and fibrose to become the ligamentum teres and the medial umbilical ligaments and superior vesicular artery (supplying the bladder)

115
Q

Signs functional structures changing

A 
Take a breath 
Crying 
Peaks up 
Umbi cord apps pulsating 
Pink 
Warm
116
Q

What physiological factors can interfere with adaptations

A

Hypothermia- lowers bsl

Will revert back to fetal circ

117
Q

Apgar score

A 
1 activity (tone)
2 pulse (hr)
3 grimace (reflexes)
4 appearance (colour)
5 resps (rate and effort)

Postnatal (3 decks)

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