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OB High Risk Flashcards

High Risk NB

1
Q

What is AGA, SGA, LGA and LBW stand for?

A

AGA is Appropriate for Gestational Age
SGA is Small for Gestational Age
LGA is Large for Gestational Age
LBW is Low Birth Weight

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2
Q

What are SGA babies at risk for?

A

Asphyxia, hypoglycemia, hypothermia, hypocalcemia

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3
Q

What are LGA babies at risk for?

A

Hypoglycemia, hypothermia, hypocalcemia, polycythemia and trauma

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4
Q

Define premature

A

anything after 20 weeks but before 37th week COMPLETED regardless of weight

“red gummy bears” red sticky skin, floppy, no fat, poor suck, and a big head

At risk for RDS, anemia, neuro and cardiac problems

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5
Q

Define Post-mature

A

anything beyond completion of 42nd weeks of gestation

“panteen babie” Long and skinny, long finger nails, no vernix, wrinkly leathery skin.

At risk for trauma, hypoglycemia (check CBG immediately), maconium aspiration (suction, dry, warm, then stimulate after airway clear)

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6
Q

*Why do we give SGA and preterm babies gavage feedings?

A

So that the GI doesn’t die.

*Clarification.

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7
Q

list 4 factor that affect the growth of the baby

A 
Maternal:
smoking
alcohol 
Maternal age
Nutritional factors
Diabetes
Substance Abuse 
Hypertension
Poor utero-placental insufficiency 
Mulit para's
Fetal:
genetic anomalies
congenital anomalies
multiple gestation
IUGR
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8
Q

Define Asphyxia

A

Anything that prevents O2 delivery

Hypoxia, low O2, acidosis, hypercapnia (high CO2 levels)

can happen in utero or at birth; must get the baby breathing within 2 mins of being delivered

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9
Q

List three common risk factors for asphyxia

A

uteroplacental insufficiency-this could be previa, abprution
in utero maconium passage
maternal drugs during labor
congenital anomalies

Anything that can cause fetal distress to baby.

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10
Q

what is the difference between CPR and PALS

A

CPR- Cardio Pulmonary Resuscitation

PALS- Pediatric Advanced Life Support (AMBU Bag/ bag valve mask)

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11
Q

Describe respiratory distress syndrome and how it happens

A

leading cause of problem in premies

Deficiency in lung surfactant causing progressive atelectasis (alveoli collapse)

If C-Section think Squeeze
If Vag delivery think immature lungs

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12
Q

Name three symptoms of RDS

A 
Grunting
cynaosis on RA
tychpnea
pallor
retractions
nasal flaring
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13
Q

What are three GOALS for treating RDS

A

Improve oxygenation
Maintain lung volume
Minimize O2 consumption-by minimizing 02 consumption it helps with maintaining temp, maintaining B/P, maintaining blood sugar

If mother given Mag Sulfate to slow labor we want to give steroids to help the baby’s produce more lung surfactant

culture to rule out pneumonia

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14
Q

Describe maconium aspiration

A

Aspiration of maconium at birth in post mature, IUGR (intrauterine growth restriction), or stressed infants.

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15
Q

what three things can cause a NB to get pneumonia

A

Aspiration of infected amniotic or cervical fluids
Blood borne infections
Infections from poor hand hygiene
(GBS- Group Beta )

S/S: tachypnea, pallor, grunting, flaring of the nostrils, tachy/bradycardia, hypothermia

Culture everything, and broad spec antibiotics

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16
Q

Describe TTN (transient tachypnea of NB)

A

Delayed resorption of lung fluid d/t c-sections (no squeeze)

s/s: tychpnea, hypoxia

tx: may need ventilation or O2 support, keep baby crying to get fluid out

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17
Q

what is NEC (Necrotizing Enterocolitis)

A

Necrotizing Enterocrolitis
ischemia and necrosis of the GI tract leading to perforation of the intestine

s/s: similar to a bowel obstruction, big belly, no appetite, bloody stools

TX: NPO, rest gut, blood transfusion, TPN feeding, possible temporary colostomy

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18
Q

what are the three C’s to asses in a NB that has a TEF

A

Chocking
Coughing
Cyanosis

Use pacifier to promote gastric juices

montior respers, HOB up, NPO and suction

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19
Q

what is the difference between gastroschisis and omphalosele

A

gastroschisis usually occurs to the right of the umbilicus

omphalosele occurs through the umbilical cord (starts with an O- round like a belly button)

For both we are going to put in plastic bag above baby, and use moist sterile gauze around opening

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20
Q

which side would you place a NB who is post of for treatment of gastroschisis and omphalosele

A

Make sure the baby has a pacifier in mouth with NG tube feedings
Lay on right side to ensure digestion

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21
Q

what is an umbilical hernia

A

a protrusion of part of an organ through ABD opening

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22
Q

how does retinopathy of prematurity happen

A

this happens when there is a high o2 concentration for a long period of time causing vasoconstriction and causing retinopathy (blindness)

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23
Q

what is the difference between cyanotic and acyanotic defects of the heart

A

cyanotic: Transportation of great vessels, tetrology of fallot and Tricpsid atresia. (tacypnea and tachycardia. count HR for one full minute- no half stepping)
acyanotic: left ventricle doesn’t develop. give prostaglandin E to help close

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24
Q

describe why the RH factor of a mother is so important

A

If mom is Rh- it can cause the moms antibodies to attack the fetal cells. Therefor, if mom is RH- Rogham must be give at 28 weeks, 72 hours after birth and anytime any trama has happened during pregnancy.

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25
without treatment of RH inccompatibility what can happen to the baby and why
Erthroblastocytosis- the abnormal presence of erthroblast in the blood. This causes anemia and CHF in baby; will be edematis when born, and occurs within 24 hours after birth. moms RNA will now remember this reaction of making antibodies and respond similarly and stronger if similar proteins are again encountered if Rhogam is not given.
26
what is the only treatment for RH incompatibilities
the only treatment is prevention To prevent we give Rogham If mom is Rh- it can cause the moms antibodies to attack the fetal cells. Therefor, if mom is RH- Rogham must be give at 28 weeks, 72 hours after birth and anytime any trama has happened during pregnancy.
27
describe ABO incompatibility
this has to do with blood type incompatibilities when people have one blood type receive blood from someone one with a different blood type it may cause their immune system to react.
28
sweating, yawning, mottling, sneezing, temperature irregularities, tachypnea, and GI problems are symptoms of....
Drug exposed infants If mom is given drugs during the transition stage we would give "baby narcan". dilute; give through cord; narcotic last longer than narcan does; dont give rapidly If it is a substance abuse mom (meaning she has done drugs during pregnancy) we would give methadone
29
what are some fetal alcohol effects?
``` Attention deficit disorder Mild to moderate congnitive difficulty fine/gross motor difficulty increased activity poor locomotion poor suck feeding difficulty irritable personality ```
30
*what will a baby with fetal alcohol syndrome look like
mental retardation Thing long upper lip facial anomolies *clarification
31
what number do we want NB glucose to be at
above 40mg/dl If below 40 we feed baby; recheck 20 mins later and if if it still hasn't gone up we notify physician
32
why do we warm babys SLOWLY
because if we warm them too fast it can cause apnea
33
what does TORCH stand for
Toxoplasmosis: uncooked red meat and kitty litter Other: GBS and other STD's Rubella- Deafness, blindness, heart issues, and cleft Cytomeglo Virus- blood borne; infected breast milk Herpes and HIV- if mom has active herpes c-section must be done
34
How can a mother come into contact with taxoplasmosis
Uncooked red meat and kitty liter
35
when do want to give the hep b immunoglobulin
Within 12 hours of delivery
36
how is messals / rubella spread?
Its spread through respiratory secretions causes hearing problems, cataracts, glaucoma, neuro, encephalitis, growth retardation, patent ductus and bleeding problems
37
how is cytomegalovirus spread
spread through blood borne and infected breast milk
38
what do we do for a mother with active herpes during labor
C-Section Isolation Comfort measures
39
which babies are at more risk for developing sepsis
``` premi's PROM maternal infections early asphyxia invasive procedures ``` Sepsis = LOW temp
40
A NB with an infection will have a high temperature
False- they will have LOW temp;
41
What are epispadias and hypospadias
Epispadias is opening of the urethra at the upper aspect of the penis Hypospadias is opening of th eurethra at the bottom aspect of the penis
42
what is the drug Ditropan used for
Used for bladder spasms; overactive bladder;
43
what is cryptorchidism
Testes not palpable (one or both testes fail to descend)
44
describe hydrocoele
Painless scrotal swelling, fluid filled mass no treatment, goes away by itself
45
what is the common name for talipes equinovarus
Club Foot Feet in spanish is Peis like pes in talipes
46
describe how serial casting helps club foot
manipulation and plaster casting of club foot, the ligaments and tendons of foot are gently stretched and manipulated
47
describe developmental hip dysplasia
Malformation of the hip with various degrees of deformity; creases in thighs
48
How would a baby with hip dysplasia present
asymmetric thigh and gluteal folds Dislocation Subluxation Dysplasia of acetabulum
49
what is one treatment for hip dysplasia
Pavlik Harness 0-6 months Surgical reduction Hip spica cast (will do this if harness doesnt work)
50
when do the posterior fontanel close
8 weeks 18 months for anterior
51
name one neuro tube defect
spina bifida meningomyeolcele myelocele meningocele
52
what allergy are spina bifida more likely to have
latex
53
describe occulta spina bifida
a malformed vertebrae only, no sac present and benign
54
describe meningocele spina bifida
contains only meninges and spinal fluid | less neuro involvement than mylomeningocele
55
describe mylomeningocele
contains meninges, fluid, and nerves
56
what is the most important thing to do for an infant with myelomengiocele
lay them on their belly | cant lay on back because they'll pop it
57
*define anencephaly/encephaliocele / micocephaly
anencephaly- a baby born with an underdeveloped brain and incomplete skull "sunken in" Encephaliocele- sac like protrusions of the brain and the membranes that cover it through openings in the skull "two heads" Micocephaly- baby's head is significantly smaller than expected; d/t abnormal brain development
58
When is the only time a baby will sweat and have an increased temp
Pain
59
how long can a baby go without breathing before it is considered apnea?
pause longer than 20 seconds
60
What is the difference between esophageal atresia and trachoesophalgeal fistula?
Atresia: esophagus stops before it reaches the stomach. anything they swallow comes back up. LUNGS NOT COMPROMISED. Fistula: upper segment of esophagus stops and the lower segment connects with the trachea. whatever they eat goes to lungs. whatever they breath goes to the stomach. frothy at mouth is an emergency situation; call dr and suction.

OB (9 decks)

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