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
