Maternal Infant Care and Anomalies Flashcards
Intimate Partner Violence
Level 1,2,3
Level 1 – Maltreatment is occasional; consists of slapping, punching, kicking, verbal maltreatment. Contusions occur.
Level II – Maltreatment is becoming more frequent; beatings are sustained and cause fractures, such as broken jaw or rib fractures.
Level III – Maltreatment is even more frequent, perhaps daily. A weapon, such as a gun, baseball bat, or broom handle may be used. Permanent disability or death from injuries, such as intracranial hemorrhage or concussion may occur.
Intimate Partner Violence
Cycle of Violence
Build up phase - increased tension
Stand over phase - control, fear
Explosion
Remorse phase - justification, minimilization, guilt
Pursuit phase – pursuit and promises, helplessness, threats
Honeymoon phase - enmeshment, denial of previous difficulties
Characteristics of the abuser and the abused
1 cause of death during pregnancy is homicide from intimate partner violence
Prevalence of IPV witnessed
Abused as a child
Alcohol may contribute -> poor impulse control
Learned helplessness
Partner Violence Screening tool
Advocacy – universal screening of all patients at every health care encounter
Have you been hit, kicked, punched, or otherwise hurt by someone in the past year?
Do you feel safe in your current relationship?
Is there a partner from a previous relationship who is making you feel unsafe now?
Transcultural Care
Health care values and beliefs
Health maintenance during pregnancy
Modesty, Fate
Childbirth, Childrearing
Health care practices
Rituals for preventing illness, restoring health
Care of anatomy & physiology of women
Assessing Families
Family centered care
Structure, parent style, communication, religion, culture, socioeconomic, morbidity, mortality
in delivery room – father, significant other, grandparents
cultural sensitivity
Cultural competence
Inspect for Obvious Anomalies
Eyes-Cataract, Retinablastoma
Nose-Choanal Atresia
Mouth-Cleft lip, cleft palate
Tracheoesophageal fistula
Abdominal wall defects
Omphalocele, Gastroschesis
Anal malformations
Biliary Atresia
Cardiac Anomalies
Neural tube defects
Anencephaly
Encephalocele
Meningocele
Musculoskeletal defects
Hip dysplasia
Talipes varus
Polydactyl
Osteogenesis imperfecta
Amniotic band injuries
GU
Bladder extrophy
Intersex
Hypospadias, Epispadias
Phimosis
Trisomy 21, 18, 13, Fragile X
Fetal Alcohol SyndromeRetinoblastoma
“Red reflex” Malignancy of retina Unilateral or bilateral (25%) Autosomal dominant gene in 40% of children
Chemotherapy, Radiation, Laser photo-coagulation
Surgery -> enucleation
Congenital Cataracts Maternal infections (11)
rubella (the most common cause) rubeola chicken pox cytomegalovirus herpes simplex herpes zoster poliomyelitis influenza Epstein-Barr virus syphilis toxoplasmosis
tetracycline antibiotics – correlation
EASILY TX
Choanal Atresia
Nasal passages are blocked by bone, soft tissue
70% are unilateral
Most are not dx at delivery
If bilateral = respiratory distress
Tx Stents are placed in nares
Cleft lip
Integrate nursing interventions (5)
Happens at about 6-8 weeks gestation
Respiratory status Feeding behaviors Parent/infant interactions - bonding Skin integrity, Oral hygiene Prevention of Infection
Breastfeed? YES
Hard? Yes
Cocaine increases incidence
Cleft lip
Treatment
Surgery, based on severity
Modified feeding techniques or devices
Feeding Difficulties
ESSR
ESSR E = Enlarge the nipple S = Stimulate the suck reflex S = Swallow fluid appropriately R = Rest when infant signals with facial expression
Lamb’s nipple with X
Haberman
Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF) Esophagus ends as...
Esophagus and trachea do not develop as parallel tracts
Esophagus ends as either…
Blind pouch (baby would need a G-tube since may not stretch down to reach stomach)
Connected to trachea by a fistula
TEF and EA Clinical Manifestations
5
“The Three C’s”: coughing, choking, cyanosis
Excessive salivation and drooling: frothy mucus
Apnea
Respiratory distress after eating
Abdominal distention
TEF and EA – Diagnostic testing and treatment plan
CXR -> radio-opaque or
Pediatric surgeon endoscopy or bronchoscopy
Surgery asap
TEF and EA – Nursing Interventions – Prioritize
Airway Management, Aspiration Precautions
Impaired Gas Exchange
Ensure NPO (nothing per os) preoperatively.
Assess Emma’s respiratory status for rate, depth, and ease, and breath sounds q 2-4 hrs and before and after suctioning
Assess Emma’s oxygen saturation level continuously
Elevate Emma’s head of bed (HOB) 30
Administer supplemental oxygen as indicated.
Perform oropharyngeal suctioning as appropriate.
Analyze Emma’s ABG, confer with provider
Abdominal Wall Defects
Two Variations of abdominal hernias
Omphalacele
Omphalacele
Intra-abdominal contents herniate through umbilical cord
Covered with peritoneal membrane
Abdominal Wall Defects
Two Variations of abdominal hernias
Gastroschisis
Abdominal organs herniate through abdominal wall
Not covered with peritoneal membrane
Stress on respiratory system and may have compromise
Anorectal Malformations
Types
Common congenital defects
Minor to complex
Occur in isolation or with other defects
Types
Anal stenosis - narrowing
Anal atresia - absent -> blind pouch or fistulas
Imperforate anus - blind pouch or membrane
Fistula – recto-urethra, recto-vaginal, recto…
Biliary Atresia
Absence or constriction of common bile duct
Bile cannot flow from liver into duodenum
Results in
Cholestasis
Fibrosis
Cirrhosis
Death
Clinical Manifestations of biliary atresia
Bile backup in liver Inflammation, edema, hepatic degeneration Malabsorption of fats and vitamins Jaundice Dark urine Acholic stools = WHITE STOOLS Weight loss Irritability Enlarged liver and abdomen
CF: Impermeable Epithelial Cells
Excessive mucous production in bronchioles and in pancreas, bile ducts, and small intestine
Cystic fibrosis is a hereditary disorder characterized by lung congestion and infection and malabsorption of nutrients
Instead of producing thin mucous, they produce thick mucous that leads to lung congestion
CFTR gene: autosomal recessive
Important Facts:
Both parents contribute the altered gene
Each pregnancy has 25% chance of developing altered gene
Higher incidence in Caucasians and Ashkenazi Jews
Prenatal tests moms are getting blood drawn to test for CF gene 00
CF Initial Symptom
meconium ileus – may be first sign of CF
No stool in 24 hours – obstruction because of thick mucous in intestine gets impacted
Steatorrhea – bulky, frothy, foul-smelling stool
Fetal circulation
Ductus arteriosus
Foramen ovale
Ductus venosus
ALL CLOSE
Factors associated with CHD
Prenatal
Genetic
Prenatal Maternal insulin-dependent diabetes Maternal rubella Maternal alcoholism Maternal age > 40 yrs
Genetic Chromosomal – 50% risk Down Syndrome Sibling with heart defect Parent with CHD Other non-cardiac congenital anomalies
Sx. Poor oxygenation, Murmur
Diagnosing Heart Anomalies
Echocardiogram
Cardiac catheterization
CHD
Acyanotic
Increased pulmonary blood flow
Obstructed blood flow
Cyanotic
Decreased pulmonary blood flow
Mixed blood flow
Acyanotic
Increased pulmonary blood flow –> VSD, ASD, PDA, AVC
Ventricular septal defect, atrial septal defect, patent ductus arteriosus, atrioventricular canal
Obstructed blood flow –> COA, AS
Coarctation of aorta, aortic stenosis
Cyanotic
Decreased pulmonary blood flow –> TOF, PS, T/PA
Mixed blood flow –> TGA, HLHS, TAPVR, TA
Transposition of great arteries, hypoplastic left heart syndrome,
Ventricular Septal Defect
Small or large opening in septum between left and right ventricles
Left to right shunting
VSD Assessment
Tachypnea, dyspnea
Poor growth, reduced fluid intake
Frequent respiratory infections
Onset of Heart Failure
Atrial Septal Defect
Small or large opening in septum between the left and right atria
Foramen ovale doesn’t close
Patent Ductus Arteriosus
Connection between the aorta and the pulmonary artery
Blood flows from the aorta (left side) to the pulmonary artery (right side) increasing blood flow to the lungs
Coarctation of the Aorta
Aorta narrows, usually near the ductus arteriosus, obstructing blood flow
Ejection click
Systolic murmur
Persistent hypertension is common – restenosis can occur
Transposition of the Great Arteries
Parallel circulation
Aorta originates from the right ventricle
Pulmonary artery originates from the left ventricle
Prostaglandin to maintain PDA
Genetics and environment +
Folic acid deficiency can lead to…
Anencephaly
Encephalocele
Spina Bifida Occulta
Spina bifida cystica
Head deformities
Microcephaly – small skull
Anencephaly – skull does not form over brain
Neural tube defects
Encephalocele
Nasoencephalocele
Pathophysiology of Neural Tube Defects
Prenatal Dx
In first few weeks:
Neural Tube fails to close, or
Neural Tube splits after closing
Prenatal Dx
Ultrasound
Elevated AFP
Spina Bifida (3)
Usually cannot identify which lesion from viewing exterior
spinda biffida occulta
- Can be fistula or fissure
Meningocele
Sac contains meninges (membranes) and CSF
No spinal cord abnormalities
Myelomeningocele
Usually in lumbar area but can occur anywhere on spinal column
Impact depends on location
Infection, lots of compromise
Last two Spina Bifida Cystica
Impact of neural tube defects
L2
S3
Below L2
Partial paralysis of lower extremities
Incontinence
Below S3
No motor impairment
May be incontinent or have some control
Nursing Interventions
Pre-op (5) for neural tube defects
Pre-Op Cover sac with warm NS sterile dsg Monitor for CSF leakage Prone with knees slightly flexed Assess bowel, bladder function Monitor for signs of infection
Family Centered Care
Involve parents in care
Hold the baby
Developmental Dysplasia of Hip
Ortolani’s maneuver – physical exam test for hip dysplasia
Instability
Dislocation
Subluxation
Acetabular dysplasia
Pavlik harness –dynamic splint that allows movement
Talipes Varus
aka club foot
Polydactyly
extra digits
Osteogenesis Imperfecta
Genetic disorder - “brittle bone disease”
Autosomal dominant - affecting production of collagen, the major protein of the body’s connective tissue
Less than normal or poor collagen leads to weak bones that fracture easy
4 types of OI, mildest may not be dx all until a routine xray discloses multiple fractures
Hypospadias and Epispadias
Epispadias
“top” of the penis
(dorsal)
Ends in an opening at the upper aspect of the penis
Hypospadias
“under” the penis
(ventral)
A condition in which the opening of the penis is on the underside rather than the tip.
Phimosis
Bladder Exstrophy
Foreskin doesn’t retract Anomaly vs Develop. Delay Tx with cortisone cream Surgical intervention: Circumcision for adults
Bladder exstrophy – protrusion of the urinary bladder through a defect in the abdominal wall
Intersex
ambiguous genitalia and/or gender chromosomes
Down Syndrome
Phenotype - observable
Trisomy 21
Advanced maternal age
Advanced paternal age
Ultrasound, amniocentesis
Nuchal fold translucency Epicanthal eye folds Simian crease on palm Flat nose Wide, short neck Hypotonia
Edwards Syndrome
Ultrasound
Trisomy 18 90% stillbirth Rare to live beyond first 1 yr Advanced maternal age Advanced paternal age
Ultrasound:
Microcephaly, small jaw
Low set ears
Rocker feet
Other anomalies: cleft lip/palate, cardiac, meningocele, kidney,
Patau Syndrome
Trisomy 13
90% stillbirth
Rare to live beyond first 1 yr
Multiple anomalies
Ultrasound:
Microcephaly, sloping forehead
Low set ears
Rocker feet
Fragile X
X chromosome disorder
Neural development impaired due to a malfunctioning protein in the gene
Female carriers
Phenotype - Facial Characteristics Long face Prominent jaw Large ears Strabismus
Fetal Alcohol Syndrome
Most common cause
of intellectual disability
Phenotype Small eye opening Flat nasal bridge Short upturned nose Smooth philtrum Thin vermilion
Infant Behavior
Dysphagia
Prenatal Core Measures
Elective delivery
Induced deliveries less than 39 weeks gestation
Why? There is a higher rate of c/s and neonatal morbidity and mortality when patients are induced when they are less than 39 weeks.
Cesarean section
Deliveries by c/s
Why? C/S are a riskier delivery procedure with a higher rate of maternal and neonatal morbidity and mortality.
Antenatal steroids
Preterm laboring patients that received antenatal steroids
Why? Antenatal steroids reduce the risk and incidence of premature neonatal morbidity and mortality from respiratory distress syndrome.
Health-care associated bloodstream infections in newborns
Newborns with HCA bloodstream infections
Why? High neonatal morbidity and mortality from preventable infections (handwashing, sterile technique).
Exclusive breast milk feeding
Newborns fed breast milk only from delivery
Why? The benefits to newborns from breast milk feeding are significant
Amniotic Band Syndrome
Amniotic Band Syndrome occurs when the unborn baby (fetus) becomes entangled in fibrous string-like amniotic bands in the womb, restricting blood flow and affecting the baby’s development.
Lose fingers, toes, cleft lip, club feet
