Maternal/Child Exam 2 Flashcards
1
Q
When is it appropriate to give a fluid bolus to a child?
A
Never
2
Q
What is the main risk associated with overly high uterine tone?
A
It restricts blood flow to the uterus which decreases the fetal oxygen supply
3
Q
What is Cushing’s Triad and what does it indicate?
A
Increased temp, decreased HR, and widening pulse pressures (along with irregular RR). It indicates imminent intracranial herniation
4
Q
What are the s/s of adenoiditis? Select all that apply.
A. Bad breath
B. Mouth breathing
C. Sleep apnea
D. Nasal-sounding speech
E. Difficulty hearing
F. All of the above
A
F. All of the above
5
Q
What are some S/S of ICP/hydrocephalus in infants?
A
Bulging fontanels, shrill crying, lethargy, vomiting/poor feeding, crying, “setting-sun” sign, separation of cranial sutures, increased head circumference, sluggish/uneven pupils
6
Q
What is Kernig’s sign and what does it indicate?
A
The inability to straighten the knee when the hip is flexed while lying down. It indicates meningitis
7
Q
What is a major cause of bacterial meningitis and what can prevent it?
A
Hib/Influenza B vaccine
8
Q
What age group of children are most at risk for accidental poisoning?
A
2-3 years
9
Q
What important development happens between weeks 3 and 8 during the embryonic period?
A
Neural tube development
10
Q
Does extensive vomiting cause metabolic acidosis or alkalosis?
A
Alkalosis (because of the loss of stomach acid)
11
Q
What is a late sign of infection in children?
A
Hypotension
12
Q
What is the earliest sign of infection in children?
A
Tachycardia
13
Q
What are the 4 P’s of labor?
A
Power, passage, passenger, and psyche
14
Q
What sensation is sometimes an indicator that the baby is coming in someone who has had an epidural?
A
The need to poop
15
Q
Is the size of a child’s tonsils an accurate indication of infection?
A
No. Tonsil size varies from child to child.
16
Q
What neurological condition does the MMR vaccine protect against?
A
Aqueductal stenosis (enlargement of the third ventricle)
17
Q
What is relaxin and what role does it play?
A
It is a hormone that softens the cartilage in the pelvic bones to make the passage of the baby’s head easier
18
Q
What is the function of ECF?
A
To transport nutrients and waste products to and from the cells
19
Q
What is the maximum acceptable level of lead a child should have in their body?
A
<3.5mcg/dL
20
Q
Besides hearing loss, what are the most serious secondary health risks for long-term otitis media?
A
Meningitis and and mastoiditis
21
Q
What are the three layers of the meninges?
A
Dura mater, arachnoid mater, and pia mater
22
Q
When do the posterior fontanelles close?
A
Around 2 months
23
Q
What two meds would you expect to administer for a bacterial meningitis emergency?
A
Mannitol and high-dose barbiturates
24
Q
What is precipitate labor?
A
Birth that occurs within 3 hours of the onset of labor
25
What are the characteristics of hypertonic labor?
Uncoordinated and irregular contractions, painful but ineffective contractions, overly high uterine tone
26
What are some S/S of ICP in children?
Slurred speech, headache, papilledema, altered LOC, N/V, mood swings, sluggish/uneven pupils
27
What does a gray/pink tympanic membrane indicate?
Gray/pink is the color of a healthy tympanic membrane
28
What are five physical assessment findings for esophageal fistula?
1. Apnea
2. 3 C's: cyanosis, coughing, choking
3. Respiratory distress
4. Abdominal distension
5. Excessive salivation/drooling
29
What is the purpose of prostaglandins?
To help ripen the cervix
30
What are Braxton Hicks contractions?
"Practice" or false contractions
31
What are the two classifications of seizures and what is the difference?
Generalized and partial. Generalized seizures affect both hemispheres and will always cause loss of consciousness. Partial seizures affect one hemisphere and may or may not cause loss of consciousness
32
What is the major physiologic difference between the eustachian tubes of children under 3 and adults?
The tubes are horizontal in children under 3
33
Why does metabolic acidosis need to be corrected as fast as possible?
Metabolic acidosis increases the respiratory rate (because the body is trying to rid itself of excess bicarbonate), which contributes to insensible fluid loss aka more dehydration
34
What type of croup is always a medical emergency?
Acute epiglotitis
35
What is the main concern for newborns whose birth parent has diabetes?
Hypoglycemia (due to large amount of circulating insulin in response to the parent having high blood sugar)
36
What is meconium ileus a sign of?
Cystic fibrosis
37
What is the purpose of oxytocin?
It induces contractions
38
What makes a child eligible for a tonsilectomy and/or adenoidectomy?
They must be older than 3 years and have had tonsilitis every year for more than 3 years
39
What is the result of oxytocin oversaturation during induced labor?
Oxytocin receptors become flooded and all the receptor spots get "taken up" which prevents the uterus from being able to relax so that it can contract again properly
40
What is Brudzinski's sign and what does it indicate?
The neck automatically flexes when legs are bent while lying down. It indicates meningitis
41
What are some benefits of skin to skin contact during "Golden Hour" (or Golden Time)?
It helps regulate the baby's temperature, HR, breathing, and blood glucose and helps birth parent stop bleeding due to oxytocin release
42
Fractured clavicals and damage to the brachial plexus (of the fetus) are two major risks of what birthing complication?
Shoulder dystocia
43
What is usually the cause of acute epiglotitis?
Hib (Influenza B)
44
How long should you wait before giving the newborn baby a bath and why?
12-24 hours. If given too soon it can cause a dangerous spike in blood sugar.
45
How many breaths of water does it take for someone to start drowning?
Three
46
What is the ideal fetal position for birth?
Occiput Anterior = fetus is facing the parent's back and the top of the head reaches the cervix first)
47
What are the most common causes of hyponatremic dehydration?
Renal dysfunction, severe burns, and severe vomiting/diarrhea
48
What medical emergency has "currant jelly stool" as a symptom?
Intusussception
49
Patients requiring more than ___% oxygen will be automatically moved to the ICU?
50%
50
When do the anterior fontanelles close?
Between 12 and 18 months
51
What defines the 1st phase of labor and what happens during this time?
The first phase of labor occurs from the onset of labor until complete dilation. Involuntary uterine contractions push the fetus down through the pelvis
52
Why are children more at susceptible to laryngeal spasms (multiple coughs)?
The larynx is narrower and more flexible than an adult larynx
53
What are the ways the fetus adapts to reduced blood flow in the umbilical cord during contractions?
More RBCs are produced, and there is a baseline "reserve" of blood in the uterine circulation to compensate
54
In what type of tonsil infection would you expect to see redness, swelling, and white spots in the back of the throat?
Bacterial
55
How can you differentiate purpura from bruises?
Purpura do not blanch when pressed
56
Where are labor contractions felt in the uterus (as opposed to false contractions)?
In the back of the uterus
57
What does sorbitol and activated charcoal do?
Binds to toxins and causes diarrhea, which helps eliminate the poison from the body fast.
58
What parasite causes nocturnal anal itching and how do you test for it?
Helminths, and you can test with a piece of tape over the anus overnight
59
Is stridor heard on inspiration or expiration?
Inspiration
60
What are the signs and symptoms of pyloric stenosis?
Visible peristaltic wave, projectile nonbilious vomiting, palpable mass in RUQ (stenosed pyloric valve), signs of dehydration, hunger, weight loss
61
What is the purpose of the peanut ball?
It helps open the pelvic floor
62
What vital development would you want to see happen by around week 4 of the embryonic period?
The neural tube closes
63
Would administering oxytocin be be indicated for hypotonic labor or hypertonic labor?
Hypotonic
64
What is the purpose of making sure the pregnant patient is voiding regularly?
To reduce bladder trauma during birth. A full bladder can also obstruct the path of the fetus.
65
When does the 2nd phase of labor begin and end, and what happens during this phase?
Occurs from complete dilation until birth. The birth parent takes over with voluntary pushing.
66
What does purpura indicate?
Bacterial meningitis
67
Are children under 3 years more susceptible to viral or bacterial tonsil infections?
Viral
68
Fetal heart rate of >160 BPM for more than 10 minutes can be an indication of what?
Intrauterine infection
69
What is sensible fluid loss?
Fluid loss that is measurable, such as from vomiting, urination, diarrhea, bleeding, or large burns
70
What is the ICF primarily responsible for?
Organ cellular function
71
True or false: NG and OG tubes always need an MD order.
True
72
What are four methods of airway management in order from least to most emergent?
Positioning, corticosteroids, racemic epinephrine (inhalation via mask), and intubation
73
When inducing labor, prostaglandin E should be used cautiously in people who have which conditions?
Glaucoma, asthma, ischemic heart disease, renal disease, pulmonary disease, or hepatic disease
74
What is the most common cause of adenoiditis?
Strep
75
What is the baseline safe volume for a pediatric fluid bolus?
10-20mL/kg
76
Which type of croup would you expect to see treated at home?
Spasmodic croup aka acute spasmodic laryngitis
77
What are the three phases of Stage 1 of labor?
Latent phase, active phase, and transition phase
78
What must be confirmed prior to restarting feeding for a post-op patient?
Bowel sounds
79
What is late deceleration of the FHR and what does it indicate?
Late deceleration is the slowing of the FHR following a contraction, and it indicates uteroplacental insufficiency
80
What 4 signs/symptoms would you expect to see in acute epiglotitis
The 4 D's: dysphagia, drooling, dysphonia, distress
81
What are two early signs of hypovolemic shock in children?
Cold extremities and tachycardia
82
What type of dehydration would you expect to cause seizures?
Hyponatremic dehydration
83
Do asthma and bronchiolitis generally produce wheezing or stridor?
Wheezing
84
What are some signs that a contraction is false?
They're usually felt in the front of the uterus, they go away after sitting or movement, they do not get stronger or closer together
85
What is early deceleration of the FHR and what does it indicate?
Early deceleration is the slowing of the FHR due to the head being compressed by contractions, and it is a normal sign
86
When should maternal vital signs be taken during labor and why?
Between contractions, because BP will be higher and HR will be lower during a contraction due to blood flow to the placenta being slowed. Pain will also be greater during a contraction.
87
What are three important functions of CSF?
It removes waste/toxic substances, it acts as a shock absorber, and it supplies vital nutrients to the brain
88
Which of the following are a risk for containing lead? Select all that apply.
A. Certain foods
B. Old paint chips
C. Homemade canned goods
D. Home-glazed pottery
A, B and D
89
Where do dystocias and dysfunctional labor occur?
Anywhere within the 4 P's (powers, passenger, passage, psyche)
90
What postpartum complication involves signs of blood loss (tachycardia, drop in BP), a firm fundus, and lochia within normal limits?
Hematoma
91
How does the cervical ripening balloon work?
It puts pressure above and below the cervix to help mechanically induce dilation
92
What does administering racemic epinephrine do?
It relaxes the larynx and pharynx to help reopen the airway
93
How long does a patient need to be symptom-free before a tonsilectomy/adenoidectomy can be done?
7 days
94
Does extensive diarrhea cause metabolic acidosis or alkalosis?
Acidosis (because bicarbonate gets flushed out with the feces)
95
What is a NST and what does it measure and indicate?
Non-stress test. It detects acceleration in the fetal heart rate, which indicates healthy neural pathways and adequate oxygenation
96
What is the formula for pediatric daily fluid maintenance?
100mL/kg for first 10kg +
50mL/kg for second 10kg +
20 mL/kg for remainder of weight
Divide total by 24 to figure out mL/hr
97
What type of dehydration needs slow fluid replacement and why?
Hypernatremic dehydration, because you don't want to drop the sodium levels too much too fast
98
When would oxytocin be administered and why?
During the third stage of labor to help prevent postpartum hemorrhage
99
What is the most important thing to make sure is happening before administering potassium?
Make sure the child has had at least one void before administering.
100
What is the significance of children under 3 having horizontal eustachian tubes and why?
It makes them more susceptible to ear infections because fluid doesn't drain as easily
101
What is a BPP and what does it indicate?
Biophysical profile. It's an NST with added ultrasound and measures fetal breathing patterns, amniotic fluid index, FHR reactivity, fetal tone, and gross body movements
102
What is insensible fluid loss?
Fluid loss that isn't measurable, such as from sweating or high respiratory rate
103
What neurologic response is triggered when the face is immersed in cold water and what does it include?
The Mammalian Diving Reflex, and it includes apnea and bradycardia. The purpose is to shunt blood from the periphery to vital organs
104
What are the characteristics of hypotonic labor?
Coordinated but weak contractions, over-distension of the uterus (thinner muscle), low uterine resting tone, easily indented abdomen
