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exam 3 nur 365 > module 9 > Flashcards

module 9 Flashcards

1
Q

umbilical artery catheter

A
  • placed into umbilical stump and progressed through the ductus venosus and into the inferior vena cava
  • used to monitor ABG
  • rarely left in place for than 1 wk
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2
Q

umbilical venous catheter

A
  • placed into the umbilical stump and progressed through the ductus venous and into the inferior vena cava
  • 1 wk
  • fluid and medication administration and can be used for blood pressure monitoring
  • inserted right after delivery or else stump dries out
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3
Q

PICC

A
  • Peripherally inserted central like
  • used when intermediate-term IV access is required
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4
Q

CPAP

A

helps keep alveoli open so gas exchange is efficient

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5
Q

risk for prematurity

A
  • infection (mom has GI or GU infection)
  • fetal anomalies
  • preeclamspia/eclampsia (delivery only way to treat)
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6
Q

gestational age at birth: preterm/premature

A

before 37 wk of gestation

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7
Q

gestational age at birth: extremely preterm

A

before 38 wks of gestation

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8
Q

gestational age at birth: very preterm

A

birth from 28-31 6/7 wk of gestation

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9
Q

gestational age at birth : moderate-to-late preterm

A

birth 32-36 6/7 wk of gestation

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10
Q

gestational age at birth: late preterm

A

birth from 34-36 6/7 wk of gestation

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11
Q

gestational age at birth: early term

A

birth from 37 to 38 6/7 wk of gestation

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12
Q

gestational age at birth: full term

A

39 to 40 6/7 wk of gestation

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13
Q

gestational age at birth: late term

A

41 to 41 6/7 wk gestation

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14
Q

gestational age at birth: postterm (or postmature)

A

42wk of gestation or later

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15
Q

birth wt regardless of gestation age at birth: low

A

birth wt less than 2,500g (5.5 lb)

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16
Q

birth wt regardless of gestation age at birth: very low

A

less than 1,500 g (3.3 lb)

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17
Q

birth wt regardless of gestation age at birth: extremely low

A

less than 1,000g (2.2 lb)

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18
Q

size for gestational age: appropriate

A

wt from 10% to 90% on a growth chart

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19
Q

size for gestational age: small

A

wt less than 10% on a growth chart

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20
Q

size for gestational age: large

A

wt greater than 90% on a growth chart

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21
Q

respiratory distress

A
  • baby has very small and immature resp system w/ narrow passageways
  • alveoli are underdeveloped; little to no surfactant so gas exchange cannot occur well
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22
Q

retinopathy of prematurity (ROP)

A
  • immature/weak vessels
  • leading cause of blindness
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23
Q

factors that contribute to respiratory issues for preterm infants

A
  • surfactant (responsible for alveoli expansion and facilitating gas exchange) production is decreased
  • airway lumens small
  • lack gag reflex = risk for aspiration
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24
Q

apnea in preterm

A
  • breathing stops for more than 20 seconds or is associated w/ either a HR less than 70 to 80 bpm or O2 sat below 80-85%
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25
Q

s/s of respiratory distress syndrome (RDS)

A
  • low o2 sat
  • decreased lung sounds
  • nasal flaring
  • use of expiratory grunting
  • use of accessory muscles of breathing
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26
Q

clinical manifestations of respiratory distress syndrome

A
  • tachypnea
  • nasal flaring
  • intercostal, subcostal, and subxiphoid retractions w/ inspiration
  • grunting on expiration
  • cyanosis (later sign)
  • decreased breath sounds with auscultation
  • pallor
  • peripheral pulses diminished
  • oliguria
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27
Q

bronchopulmonary dysplasia (BPD)

A

treatment complication of artificial respiratory support
- when you give babies O2 it can cause BPD

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28
Q

symptoms of BPD

A
  • tachypnea
  • retractions
  • rales
  • wheezing
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29
Q

how is bpd related to prematurity?

A
  • baby goes into respiratory failure, mechanically ventilated, has a lot of O2, lead to inflammatory response - has acute lung injury, leading to artery/vascular damage causes emphysema/atelectasis/edema/fibrosis
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30
Q

preterm infant : PDA patent ductus arteriosus

A
  • mostly all infants born at term have complete closure by 72 hrs after birth
  • preterm may have delayed course
  • higher risk for necrotizing enterocolitis (NEC) and intraventricular hemorrhage
  • mixing of blood from aorta into pulmonary arteries and back through
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31
Q

s/s of PDA depending on degree and include

A
  • systolic murmur
  • ventricular dilation
  • cyanosis
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32
Q

PDA treatment

A
  • cyclooxygenase inhibitors = ibuprofen (via IV treatment of choice) or indomethacin
  • if they do not respond to meds need surgery
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33
Q

intraventricular hemorrhage (IVH)

A
  • bleeding into lateral ventricles of the brain and is one of the most common and dangerous causes of brain injury
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34
Q

risk for developing IVH include

A
  • birth before 30 wks gestation
  • preeclampsia
  • chorioamnionitis
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35
Q

IVH diagnosis

A

routine ultrasound

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36
Q

saltatory manifestations, appearing over hour or days for IVH

A
  • reduced movement
  • disturbed respirations
  • altered LOC
  • hypotonia
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37
Q

catastrophic manifestations, appearing over minutes or hours for IVH

A
  • flaccidity
  • fixed pupils and other abnormalities of cranial nerves from pressure on cranial nerves
  • seizures
  • hypoventilation and/or apnea
  • coma
  • metabolic acidosis from poor oxygen profusion
  • decreased hematocrit levels due to bleeding
  • hypotension
  • bradycardia
  • bulging of the anterior fontanelle (increased ICP)
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38
Q

ROP caused by…

A

abnormal vascular growth of the blood vessels of the retina in infants born prematurely
- the abnormal vessels are permeable and leak, leading to edema and hemorrhage causing scarring that pulls on the retina leading to distortion and detachment

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39
Q

ROP linked to…

A

low birth wt, prematurity, and excess O2 after birth

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40
Q

s/s of ROP

A

edema, hemorrhage, scarring of the retina (able to see damage)

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41
Q

treatment of ROP

A
  • if doesn’t resolve spontaneously = laser photocoagulation and/or anti-vascular endothelial growth factor monoclonal antibodies
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42
Q

when is maternal IgG transferred to fetus and how

A
  • 32 wks through placenta
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43
Q

signs of sepsis

A
  • respiratory distress
  • lethargy
  • glucose instability (may give dextrose solution IV)
  • tachycardia
  • poor perfusion (cyanosis, pallor, poor cap refill)
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44
Q

temperature considerations preterm

A
  • do not have the brown fat
  • flex to stay warm, preterm babies dont have the muscle tone to flex
  • thin skin = vessels close to skin surface so they lose heat more readily
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45
Q

treatment of mild hypothermia

A

gradual rewarming
- radiant warmer and/or warming mattress
skin - to - skin

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46
Q

cold stress

A
  • low environment temp
  • low body temp
  • high HR and RR
  • high O2 consumption
  • depletion of glucose causing hypoglycemia
  • low surfactant
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47
Q

risk factors for cold stress

A
  • preterm
  • SGA (dont have a lot of brown fat)
  • hypoglycemia
  • prolonged resuscitation
  • sepsis
  • neurological, endocrine, or cardiorespiratory problems
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48
Q

s/s of cold stress

A
  • axillary temp below 36.5 C (97.7 F)
  • cool skin
  • lethargy
  • pallor
  • tachypnea
  • grunting
  • hypoglycemia
  • hypotonia
  • jitteriness
  • weak suck
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49
Q

necrotizing enterocolitis (NEC)

A
  • ischemic necrosis of the intestines and is a gastrointestinal emergency
  • high mortality rate
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50
Q

NEC first sign

A
  • feeding intolerance
  • had at least one oral feed and most have had formula - theory formula feeding relates to this
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51
Q

other signs of NEC

A
  • abdominal distention
  • vomiting, often bile
  • respiratory failure
  • hypotension
  • temp instability
  • baby is in pain - high pitch cry
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52
Q

NEC treatment

A
  • antibiotics, labs (CBC, electrolytes, BUN, creatinine, and acid base studies)
  • radiographic monitoring every 6-12 hrs (monitors progression)
  • bowel resection (may result in malabsorption)
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53
Q

symptoms of NEC: abdominal

A
  • gastric retention
  • vomiting
  • diarrhea
  • blood in stool
  • hypoactive bowel sounds
  • abdominal distention
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54
Q

symptoms of NEC: systemic

A
  • lethargy
  • apnea
  • respiratory failure
  • poor feeding
  • temp instability
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55
Q

nursing care for NEC

A

monitor for
- presence or absence of vomiting
- presence or absence of abdominal distention tenderness, and increased or diminished bowel sounds
- gastric residual fluid less than half the volume of previous feeding
- presecne of blood in stool
- abdominal mass

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56
Q

nutrition for preterm

A
  • breastmilk changes to meet needs of the baby and preterm babies need more colostrum type milk, so mother’s body will create this for a longer period of time to accommodate
  • formula has higher risk of NEC
  • should gain 20-30 g per day
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57
Q

bottle feeding

A
  • assess ability to coordinate suck and swallow
  • conserve energy
  • premature nipple = slower milk flow
  • should not take longer than 15-20 min
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58
Q

breastfeeding

A
  • should be initiated when baby can coordinate suck and swallow, is gaining wt, and can control temp outside of incubator
  • can pump and cup or gavage feed breastmilk
  • breastfeeding is the best nutrition for baby, but the act of sucking takes the most energy, so mom may pump and put it in a bottle to feed baby to conserve energy
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59
Q

gavage feeding

A
  • nasogastric or orogastric methods
  • usually a one time thing, if we want baby NPO we will leave NG or OG tube in place
  • continuous drip or intermittent
  • used when infant does not have coordinated suck and swallow, to decrease energy expenditure, or when there has been wt loss or no significant wt gain
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60
Q

NG tube measurement

A
  • tip of nose to earlobe to xyphoid process
  • mark the end and this is where you should insert tube to
  • after NG tube is placed, secure it, and check placement
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61
Q

NG tube placement check

A
  • x-ray
  • may insert a little bit of air and listen for gurgling over belly
  • aspirate abdominal contents
62
Q

TPN for premature neonate

A
  • may be administered through a central venous catheter or a peripheral venous catheter (central line preferred)
  • should include an inline filter
  • TPN is a vesicant that can cuase tissue damage w/ infiltration
  • may cause hyperglycemia (monitor glucose)
  • used in combination with oral feedings of breast milk
63
Q

late preterm at risk for

A
  • hypothermia (do not have brown fat)
  • hypoglycemia
  • respiratory distress
  • jaundice
  • feeding difficulties
  • unable to coordinate sucking, swallowing, and breathing
64
Q

post term at risk for

A
  • shoulder dystocia
  • cephalopelvic disproportion
  • bruising
  • brachial plexus injuries
  • fractured clavicles
65
Q

after 41 wks placenta declines resulting in….

A

hypoxia, decreased circulation, and blood flow

66
Q

post term complications

A
  • hypoglycemia
  • meconium aspiration = fetal hypoxia
  • polycythemia = in response to hypoxia, produce more RBCs but they are immature
  • congenital anomalies
  • seizures = due to hypoxia
  • cold stress = loss of subcutaneous fat
67
Q

meconium aspiration

A

baby is in state of hypoxia and not getting as much O2 as they need, relaxes sphincter and passes meconium

68
Q

IUGR (Intrauterine growth restriction) symmetric

A
  • IUGR that is global = head, torso, extremities are symmetrically undersized
  • also called global growth restriction
  • indicates that growth has been slow throughout pregnancy
  • associated with a higher incidence of permanent neurologic problems
  • baby looks well proportioned, just small
69
Q

IUGR (Intrauterine growth restriction) asymmetric

A
  • IUGR in which the head grows normally but the body grows slowly
  • slowed growth of the body typically occurs in the third trimester, after normal growth in the first two
  • do not look proportionate, head is normal size, body grows slowly so torso and extremities look small
  • occurs in w/ slowed growth later in pregnancy, usually in 3rd trimester
70
Q

SGA

A
  • fall below 10th percentile on growth charts
  • may be normal based on ethnicity, ht and wt of parents, or could be due to environmental or pathologic genetic reasons
71
Q

SGA babies at risk for

A
  • hypoglycemia, polycythemia, (resulting from hypoxia in utero), or hypocalcemia (potentially caused by perinatal asphyxia, hypoparathyroidism , or maternal diabetes)
  • cold stress
72
Q

LGA

A
  • above 90th percentile for growth
  • high risk for birth injury, perinatal asphyxia, and hypoglycemia
  • not often at risk for cold stress
  • postterm babies can be AGA or LGA, postterm are at risk for hypoglycemia bc they have metabolized their brown fat
  • bigger more robust, have a lot of brown fat
73
Q

hyperbilirubinemia

A
  • bilirubin comes from breakdown of RBC
  • bilirubin binds to albumin and is transported to liver where it is detached from the bilirubin and conjugated
  • conjugated bilirubin is excreted in bile into digestive tract; because it is conjugated it cannot be reabsorbed by the intestine
  • because the intestinal system is initially sterile, conjugated bilirubin can be unconjugated and reabsorbed through the intestinal epithelium and deposited back into the circulatory system
  • known as physiologic jaundice in newborns
74
Q

physiologic jaundice

A
  • appears after 24 hrs of life
  • bilirubin levels peak around 96-120 hrs of life
  • diminish by day 14
  • normal transition from intra to extrauterine life
  • causes = increased destruction of RBCs, slow uptake of bilirubin by liver/impaired conjugation, lack of intestinal bacteria (increased reabsorption of bilirubin in the intestinal tract)
  • poorly established hydration
75
Q

pathologic jaundice diagnosis

A
  • exhibit jaundice in the first 24 hrs of life
  • total bilirubin increase of greater than 0.2 mg/dl/hour (rising too fast; acute)
  • surpass 95% percentile for age in hours (rising too high too fast)
  • persistent jaundice after 1 weeks of age for term babies and 2 weeks of age for preterm babies (also probably pathologic)
76
Q

pathologic processes of pathologic jaundice

A
  • hemolytic disease of the newborn = erythroblastosis fetalis
  • liver disorders
77
Q

high risk for development or severe hyperbilirubinemia in term and late preterm infants

A
  • high bilirubin levels prior to discharge
  • jaundice in first 24 h after birth
  • maternal/infant blood group incompatibility w/ positive coombs’ test
  • known hemolytic disease of the newborn
  • birth from 35-36 wk of gestation
  • treatment of a sibling for hyperbilirubinemia
  • cephalohematoma
  • extensive bruising
  • poor breastfeeding
  • mother of east asian ethnicity
78
Q

moderate risk for development or severe hyperbilirubinemia in term and late preterm infants

A
  • intermediate bilirubin levels prior to discharge
  • birth from 37-38 wk of gestation
  • jaundice prior to discharge
  • sibling w/ a discharge following suspected
  • macrosomic infant of a diabetic mother
  • maternal age of 25 y or more
  • male infant
79
Q

factors that reduce risk for development or severe hyperbilirubinemia in term and late preterm infants

A
  • predischarge bilirubin level in the low-risk zone
  • birth at or after 41 wk if gestation
  • bottle feeding exclusively
  • African ethnicity
  • discharge from hospital at or after 72 h postpartum
80
Q

ABO incompatibility

A
  • mother is blood type I and baby is blood type A or B
  • may result in mild jaundice
  • mom has anti-A and anti_B antibodies naturally occurring in maternal blood
  • once pregnant these antibodies cross the placenta and produce hemolysis of fetal RBCs (attack baby’s blood)
  • one of the causes of pathologic jaundice
81
Q

erythroblastosis fetalis

A
  • Rh-negative mother pregnant with an Rh-positive fetus and maternal antibodies cross the placenta (mother is sensitized)
  • maternal antibodies enter fetal circulation and destroy fetal RBCs
  • fetal response is to increase RBC production (immature RBCs0
  • jauncdice and anemia result
  • marked increase in immature RBC
  • can be avoided with use of RhoGAM
82
Q

hydrops fetalis

A
  • most severe form of erythroblastosis fetalis
  • maternal antibodies attach to Rh site on the fetal RBCs
    severe anemia and multiple organ failure can result
  • frequent cause of death due to Rh disease in utero
83
Q

give Rhogam

A
  • Rh- mom pregnancy with Rh+ fetus is when they develop antibodies that cross placenta, give Rhogam to prevent sensitization during pregnancy
  • if for some reason mom never had Rhogam during pregnancy she could be sensitized so that for the next time she gets pregnant, if she has an Rh+ fetus it can attack them and hemolyze their RBCs
84
Q

kernicterus

A
  • most severe form of hyperbilirubin
  • accumulation of unconjugated bilirubin in brain
  • result of untreated hyperbilirubinemia
  • irreversible bilirubin encephalopathy
  • seizures, hearing loss, brain damage, death
85
Q

jaundice assessment

A
  • assess for jaundice every 8-12 hrs (visual)
  • jaundice prior to 24 hrs, higher risk for severe hyperbilirubinemia
  • many institutions now universally screen infants by transcutaneous bilirubin (TcB) measurements.
86
Q

phototherapy

A
  • used in hospital or at home, exposes the infants skin to a particular wave length of light
  • converts bilirubin into a more soluble form that does not need to be conjugated in the liver and can be excreted directly into the bile
  • monitor temp, serum bilirubin, hydration status, I&Os, and exposure time during phototherapy
  • baby is naked except cover genitalia and eyes
  • blankets that provide light, overhead lights
87
Q

exchange fusion for jaundice

A
  • effectively removes bilirubin from circulation
  • expensive
  • requires clinical expertise, rarely used
  • involves the systematic removal and replacement of blood volume
88
Q

persistent pulmonary hypertension of the neonate (PPHN)

A
  • caused by vascular resistance that causes left to right shunting and hypoxia, underdeveloped or abnormal pulmonary vascular, or lung disease
89
Q

symptoms of PPHN

A
  • respiratory distress within 24 hrs of birth
  • cyanosis (later sign)
  • prominent apical impulse
  • split S2 heart sound
  • systolic murmur
90
Q

treatment for PPHN

A
  • supportive care, nitric oxide, ECMO, and treatment of the underlying respiratory disease
91
Q

transient tachypnea of the newborn (TTN)

A
  • caused by failure to clear fluid from lungs and is most common in late preterm or postterm infants
  • typically resolves within 72 hours
  • fluid is squeezed out through mechanical stimulation on delivery & baby loses that fluid
  • as alveoli get filled w/ air it pushes fluid out
  • with these babies, the air does not clear out right away so they have wet lungs for a day or two
92
Q

TTN symptoms

A
  • tachypnea
  • nasal flaring
    expiratory grunting
  • retractions
  • cyanosis (late sign)
93
Q

treatment for TTN

A
  • supportive care, O2 supplementation (usually oxyhood) as needed to keep O2 sat above 90% (titrate)
  • do not feed PO
94
Q

meconium aspiration syndrome (MAS)

A
  • caused by aspiration of meconium in the fetal lungs resulting in airway obstruction, inflammation and chemical irritation, infection, and inactivation of surfactant
  • baby passed meconium into amniotic fluid in utero and then there is aspiration during first breath when baby is born
  • can result in pneumonia infection
95
Q

symptoms of MAS

A
  • meconium-stained amniotic fluid
  • respiratory or neurologic depression at birth = may need resuscitation
  • prematurity or small for gestational age infant
  • respiratory distress
  • cyanosis
  • rales and rhonchi on lung assessment from blocked passages
  • pneumothorax
  • PPHN
96
Q

MAS treatment

A

supportive care, antibiotics, surfactant, nitric oxide, and ECMO

97
Q

meconium stained fluid

A
  • can be as little as green-tinged fluid, or as bad that is think and looks like pea soup
98
Q

neonatal abstinence syndrome (NAS)

A
  • withdrawal symptoms that occur as a result of in utero to opioids
  • other substances (such as, alcohol, nicotine, benzodiazepines, and antipsychotics) may cause symptoms that mimic NAS symptoms
99
Q

treatment for NAS

A
  • infants are given opioids for symptoms and then weaned from them after they are stable for 24 hrs
100
Q

general signs of NAS

A
  • irritability
  • high-pitched cry
  • sleep/wake disturbances
  • failure to thrive
101
Q

alterations in movement in NAS

A
  • hypertonia
  • hyperactive reflexes
  • tremors
  • skin excoriation
102
Q

GI signs for NAS

A
  • disorganized feeding
  • vomiting
  • frequent loose stools
  • uncoordinated suck and swallow, look like they are hungry and want to eat but will be losing fluid outside their mouth, not swallowing, vomiting
103
Q

autonomic dysfunction signs in NAS

A
  • sweating (babies usually dont sweat so this is a sign)
  • sneezing
  • mottled skin
  • fever
  • nasal stuffiness
  • yawning
104
Q

nursing care for NAS

A
  • identify in prenatal period
  • drug screening following birth
  • assess for congenital anomalies
  • assess for signs of withdrawal
  • reduce withdrawal symptoms, sometimes with comfort measures or opioids in small amounts to wean the,
  • promote adequate nutrition (small, frequent feedings)
  • reduce stimuli- quiet, dim room, limit visitors
  • swaddle
  • provide pacifier
105
Q

neonatal abstinence scale

A
  • scoring begins within 2 hours of birth if known in advance or as soon as symptoms are noticed if did not know
  • then at least every 4 hours
  • may do more or less often depending on rating
    highest score = 44
106
Q

early onset sepsis

A

first 7 days after birth

107
Q

late onset sepsis

A

after first week after birth

108
Q

risk factors for sepsis

A
  • chorioamnionitis, maternal temp greater than 100.4 F, delivery prior to 37 wk, or an apgar of 6 or less
109
Q

blood culture for suspected sepsis

A
  • from venipuncture, arterial puncture, or newly inserted venous or arterial catheter
  • one or two samples
  • min volume of 1 mL per sample
  • results in 24-36 h
110
Q

lumbar puncture for suspected sepsis

A
  • infants often asymptomatic with meningitis
  • performed prior to antibiotic start
  • gram stain, culture, cell count w/ differential, protein, glucose
  • over 1/3 on infants w/ meningitis have a negative blood culture
111
Q

CBC w/ differential and platelet count for suspected sepsis

A
  • obtain 6-12 h after birth
  • more useful for ruling out sepsis than ruling it in
  • normal immature-to-total neutrophil ratio can help rule out sepsis
  • a low neutrophil count is ore indicative of sepsis than high
112
Q

GBS (group B streptococcus)

A
  • a significant cause of neonatal sepsis but the transmission from mother to infant at the time of birth has decreased since routine screening and antibiotic administration during labor becoming a standard of care
113
Q

early onset GBS disease may manifest as…

A
  • sepsis, pneumonia, or meningitis w/ most displaying symptoms within 24 hrs after birth
  • may not have symptoms for a few days
114
Q

risk factors for early-onset GBS disease include

A
  • delivery less than 37 wks
  • premature rupture of membranes 18 or more hrs prior to delivery
  • chorioamnioitis
  • GBS in urine in current pregnancy
115
Q

late-onset GBS symptoms

A
  • less likely to exhibit signs of shock than early-onset GBS
  • fever
  • cellulitis
  • irritability
  • lethargic w/ poor feeding
  • grunting
  • tachypnea
  • apnea
  • nuchal rigidity
  • seizure
116
Q

GBS + mom going into labor

A
  • they get prophylaxis antibiotics, but sometimes mom is not treated or labor goes very quickly it can put baby at risk
117
Q

congenital syphilis

A
  • transmitted vertically from mother to fetus and can result in stillbirth, prematurity, or hydrops fetalis
118
Q

congenital syphilis treatment

A
  • penicillin G
119
Q

gonorrhea neonatorum

A
  • newborn conjunctivitis
    once leading cause of blindness
  • routinely treated with an antibiotic eye ointment at time of birth
120
Q

chlamydia how it affects neonates

A
  • can cause conjunctivitis or pneumonia
  • transmitted through vaginal birth but may pass membranes or the placenta
121
Q

treatment for chlamydia

A

oral antibiotics

122
Q

herpes

A
  • most common when vaginally delivered by mother experiencing a herpes outbreak
  • may cause sepsis
123
Q

herpes treatment

A

antiviral medication therapy for 14-21 days
- given acyclovir for the course of their pregnancy to reduce risk of outbreak close to delivery

124
Q

moms tested for …. prepregnancy and before delivery

A

syphilis, chlamydia, gonorrhea

125
Q

eye ointment

A

erythromycin at delivery bc risk for newborn conjunctivitis

126
Q

toxoplasmosis

A
  • caused by a common protozoan parasite found in cat feces, contaminated soil, and undercooked meat
  • may cause anemia, seizure activity, calcifications in the brain, thrombocytopenia, or jaundice
  • diagnosed w/ blood test or CSF evaluation
127
Q

infants born to hep B positive mothers

A
  • treated with HBsAG after birth and receive first doses of hep B vaccine within 12 hours to reduce transmission by 95%
  • hep B mothers treated with hepB antigen after birth
128
Q

mother-to-child transmission of HIV

A
  • occurs during the intrapartum period
  • women taking ART are at low risk for transmitting the virus during delivery
  • prophylactic treatment of infants w/ ART is begun 6-12 hrs after delivery
  • breast feeding is contraindicated for HIV-positive mothers
  • mother on ART has a very low risk of transmitting virus during delivery so they can have vaginal delivery because it is much more controlled now
  • baby is treated 6-12 hrs after delivery
  • no breastfeeding
129
Q

congenital heart anomalies risk factors

A
  • family history
  • certain genetic syndromes
  • prematurity
  • certain in utero infections
  • use of assisted reproductive technology
130
Q

symptoms of heart disease/defects

A
  • cyanosis
  • tachypnea
  • pulmonary edema
  • cardiogenic shock
  • some infants will appear normal at birth and begin to decompensate at the ductus arteriosus closes
131
Q

signs of cardiogenic shock

A
  • inadequate perfusion of tissue (cool extremities, acrocyanosis, pallor, delayed cap refill)
  • abnormal HR (tachycardia common, bradycardia (late), bradycardia (early, typically in preterm infants)
  • metabolic acidosis
  • lethargy, irritability, coma, hypotonia, diminished or absent reflexes
  • oliguria
  • apnea
  • hypotension (late finding)
132
Q

congenital anomalies: heart disease screening

A
  • all infants should be screened for congenital heart disease after 24 hrs of age by pulse ox
  • blood o2 sat from right hand and either foot to test difference between circulation before ductus arteriosus
133
Q

diagnostic criteria for a positive screen of congenital heart disease

A
  • SpO2 below 90% in either location
  • SpO2 below 95% in both locations in three different readings, each separated by 1 h
  • a difference in SpO2 of more than 3% between extremities in three different readings, each separated by 1 h
134
Q

anencephaly

A

open defect of the cranial neural tube caused by the anterior neural tube failing to close at day 25 post conception
- parts of brain are missing
- pregnancy ends early

135
Q

encephalocele

A

brain or meninges protrude through a skull defect called a cranium bifidum
- often picked up on in utero

136
Q

spina bifida

A

incomplete closure of the vertebra surrounding the spinal cord. results from the spinal neural tube failing to close by 28 days after fertilization
- parts of spinal column protrude from neural tube

137
Q

risk factors for neurologic anomalies and what to do to try to prevent

A
  • family history
  • obesity
  • elevated temperature in first trimester (sauna, fever, hot tube)
  • inadequate folic acid
    prevent by = adequate levels of folic acid (400 mcg daily)
138
Q

TEF

A
  • tracheoesophageal fistula
  • abnormal passage joining the trachea and the esophagus
  • at risk for aspiration, usually symptomatic shortly after birth. lots of secretions, choking, drooling, resp distress esp after eating
  • almost always occurs with esophageal atresia (EA)
  • treatment = surgery, can sometimes be done in utero
139
Q

Hirschsprung disease

A
  • enervation of the colon causing functional obstruction
  • occurs between gestational wks 4 and 7
  • telescoping colon happens pretty early on
140
Q

Hirschsprung s/s

A
  • abdominal distention
  • vomiting of bile, failure to pass meconium within first 48 hrs of life
  • newborn vomiting can be common but green substance (bile) is never a good thing
141
Q

Hirschsprung diagnosis

A

biopsy, barium enema, imaging

142
Q

Hirschsprung treatment

A

surgical removal of the abnormal section of bow

143
Q

omphalocele

A
  • opening of the abdominal wall at the level of the umbilical cord that contains abdominal contents contained in a membrane
  • occurs during the 11th and 12th wk of pregnancy
  • will see umbilical content protruding into umbilical cord
  • ultrasound likley to pick this up
144
Q

risk for omphalocele

A
  • younger than 20 or older than 40
145
Q

omphalocele method of delivery

A

spontaneous vaginal delivery
- wrapped in a sterile dressing to prevent head and fluid loss

146
Q

gastroschisis

A
  • abdominal wall defect associated with bowl herniation with no containing membrane
  • associated w/ poor maternal nutrition, smoking, maternal immune response, exposure to agricultural chemicals
  • warp contents with sterile wet dressing
147
Q

congenital diaphragmatic hernia

A
  • abdominal contents herniate through the diaphragm into the chest
148
Q

congenital diaphragmatic hernia s/s

A
  • development of persistent pulmonary hypertension in the neonate
  • breath sounds may be diminished or absent
  • classic clue = listen to lungs and there isnt a lot of air being exchanged bc not a lot of room for lungs to expand
  • heart sounds may be displaced
  • abdomen is flat bc there is nothing in it
149
Q

hydrospadias

A
  • misplacement of the urethera on the ventral aspect of the penis (underneath)
150
Q

epispadias

A

abnormal placement of urethra on dorsal aspect of the penis (on top)

151
Q

risk factors for congenital anomalies

A
  • maternal diabetes
  • advanced maternal age
  • placental insufficiency

exam 3 nur 365 (3 decks)

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